Newer Chemotherapy Regimens Boost Survival in NSCLC

ASCO—Treatment with chemotherapy extends the lives of patients with advanced lung cancer and should become a standard treatment option offered to these patients, according to two papers presented at the 36^th Annual Meeting of the American Society of Clinical Oncology (New Orleans).

At the plenary session, Joan H. Schiller, MD, University of Wisconsin Medical School, reported results of a randomized phase III trial examining the relative benefits of four platinum-based chemotherapy regimens.

All offered similar survival benefits: Median survival for all arms was 8 months, 1-year survival 33.5%, and 2-year survival 12%. These results are superior to those achieved with drugs offered just 5 years ago. “Patients now have a 35% to 40% chance of 1-year survival, up from 20% to 25% with the older regimens,” Dr. Schiller said.

The study, conducted by the Eastern Cooperative Oncology Group, compared three platinum-based regimens containing third-generation drugs to a control regimen of cisplatin (Platinol) and paclitaxel (Taxol) in 1,207 patients with stage IIIB or IV, previously untreated non-small-cell lung cancer (NSCLC).

The experimental regimens were paclitaxel plus carboplatin (Paraplatin), gemcitabine (Gemzar) plus cisplatin, and docetaxel (Taxotere) plus cisplatin.

“While all of the regimens used today are effective, only the paclitaxel plus carboplatin arm was shown to have statistically fewer life-threatening side effects,” Dr. Schiller said. Other important toxicities such as nausea and vomiting were also reduced in the paclitaxel/carboplatin arm. Gemcitabine/cisplatin had the longest time to recurrence (4.5 months vs 3.5 months for the other treatments).

Dr. Schiller concluded that the decision to use one regimen over another should be based on weighing different parameters, such as side effects, cost, dosing schedules, and response rate.

Consolidation Docetaxel

In a poster session, David R. Gandara, MD, professor of medicine, University of California, Davis, presented phase II results showing improved survival with “consolidation” docetaxel.

Dr. Gandara and investigators from the Southwest Oncology Group added docetaxel to traditional chemotherapy with cisplatin/etoposide given concurrently with radiation therapy in 83 patients with stage IIIb lung cancer.

Median survival with the addition of docetaxel was 22 months, and 2-year survival is 50%. This is substantially better than results reported in an earlier study using concurrent cisplatin/etoposide and radiation therapy followed by two more courses of cisplatin/etoposide. That trial achieved a median survival of 15 months and 2-year survival of 34%.

“We can’t say that results from this latest trial are definitive because it’s a phase II study, and the only trial we can compare it to is our own,” Dr. Gandara told ONI. “But the results were markedly superior with docetaxel, and I believe this regimen can be considered an acceptable alternative therapy for these patients.” Further study is warranted, he added.