Ronald B. Natale, MD

Standard first-line chemotherapy regimens in advanced non-smallcelllung cancer (NSCLC) include carboplatin (Paraplatin)/paclitaxel,cisplatin/docetaxel (Taxotere), cisplatin/gemcitabine (Gemzar), andcisplatin/vinorelbine (Navelbine). An informal meta-analysis of 13 randomizedtrials of these regimens in NSCLC indicates no marked differencesin terms of response rates or survival, but toxicity advantageswith cisplatin/gemcitabine and cisplatin/vinorelbine regimens. An informalmeta-analysis to assess the feasibility of substituting carboplatinfor cisplatin in combination with gemcitabine or docetaxel shows nomarked differences in efficacy between cisplatin- and carboplatincontainingregimens, although a slight trend favoring carboplatin/gemcitabine treatment may be observed; comparison of toxicity profilesamong carboplatin-based regimens suggests advantages forcarboplatin/gemcitabine treatment. A formal meta-analysis of 13 trialscomparing gemcitabine/platinum combinations with other platinumbasedregimens in NSCLC indicates significant improvements inprogression-free survival and overall survival with gemcitabine/platinum treatment. On balance, available data suggest that carboplatin/gemcitabine may be the first-line option with the best therapeutic index.

Gemcitabine (Gemzar), paclitaxel (Taxol), docetaxel (Taxotere), and vinorelbine (Navelbine) are among the most active agents for the treatment of non-small-cell lung cancer and are generally more active than platinum

This multicenter study enrolled 73 patients with locally advanced or metastatic non–small-cell lung cancer (NSCLC). The study design was based on the hypothesis that the non-overlapping toxicities of a 3-drug