ECOG randomized patients with advanced NSCLC to 1 of 4 new 3 of the 4 regimens used in ECOG docetaxel/cisplatin, paclitaxel/cisplatin. In the ECOG trial, the only direct comparison of similar regimens, response rates and survival times were similar between patients treated with cisplatin. ECOG was chosen as a plenary session presentation because it is an important trial that reflects the state of care in of metastatic NSCLC—the.
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Patients were allowed to have clinically stable central nervous system metastases.
Taxane-Platinum Combinations in Advanced Non-Small Cell Lung Cancer: A Review
Dexamethasone exog administered to patients receiving docetaxel as prophylaxis against fluid retention and hypersensitivity reactions. Elderly patients have peculiar characteristics related to physiological ageing with progressive reduction of organ functions and are at risk of unexpected and unpredictable toxicity.
Notwithstanding the presence of the limitations described above, the panellists aimed for a consensus and to identify priorities for future research because of the clinical relevance of the issue. These are important studies to compare because they were conducted at nearly the same time and in very similar though not identical patient populations.
Population-based study of 20 cases. As our use of these taxane-platinum combinations expands, these differences in survival, response rate, adverse events, and QOL will permit us to better balance our treatment goals for all patients with all stages of NSCLC. Triplet combinations will be pursued, as they should, but they too are unlikely to produce clinically meaningful advances for patients with 15944 cancer. Chemotherapeutic management of stage IV non-small cell lung cancer.
Enrollment required a PS score of 0 or 1. Despite the disappointing results of ECOGthere were notable trials describing new agents with novel mechanisms of action reported at this year’s ASCO meeting. Docetaxel is also commonly used as part of a combined modality regimen in locally or regionally advanced disease, with notable results as consolidation therapy. There was an imbalance by sex with more men being in the CP-alone arm.
Most of the studies show some advantage of chemotherapy in terms of overall survival also in the sub-group of PS2 patients, although formal statistical comparisons are precluded by the low absolute number of patients.
Have we made any progress in the treatment of advanced non-small cell lung cancer NSCLC over the past 15 years? Previous Section Next Section. N Engl J Med. Consensus on clinical research.
The panellists are aware that sub-group analysis from randomised clinical trials must be interpreted with caution [ 18 ], but currently there are no published prospective trials specifically dedicated to PS2 patients, and retrospective information based on sub-group analysis remains the best level of information on this topic available from the literature to date.
Because of its low aqueous solubility, the vehicle for paclitaxel is a purified polyoxyethylated castor oil, which has been implicated in paclitaxel toxicity [ 89 ] and in the nonlinear pharmacokinetics of paclitaxel [ 10 — 12 1954. Pharmacokinetics and pharmacodynamics of the taxanes. In recent years, several trials comparing fcog combinations containing new cytotoxic agents versus platinum-based treatment, enrolling patients with PS between 0 and 2, have been performed Table 3 [ 38 — ecof ].
Topotecan is one of most active new agents for SCLC.
Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer.
In the ECOG study, four cycles of topotecan added toxicity but did not enhance overall survival. The discouraging survival, the lower compliance to eecog and the fear of a higher risk of toxicity put a question mark behind chemotherapy administration in this category of patients. For NSCLC, novel agents Iressa anti-epidermal growth factor receptor tyrosine kinase and anti-vascular endothelial growth factor monoclonal antibody appear promising.
Of the taxane-platinum combinations tested, docetaxel-cisplatin was the only platinum combination to yield survival and response rates superior to another platinum combination. Grade 3 or 4 toxicities were fairly evenly distributed among treatments. PS2 may be due to tumour-related symptoms e.
Taxotere docetaxel injection concentrate. The role of adding platinum to third generation single agents in PS2 patients. Time to progression was chosen wcog an endpoint because this was a randomized phase II eocg and patients on the chemo-alone arm were allowed to cross over to anti-VEGF upon progression. For patients with extensive stage SCLC, there has been little progress over the past 20 years since the establishment of etoposide and cisplatin as the standard of care.
In conclusion, docetaxel has markedly impacted the treatment of advanced NSCLC and continued evaluation in earlier-stage disease is warranted. Disclosure — in the Blink of an Eye. The use of G-CSF was allowed for recovery of counts.