Source: Gastroenterology  |  Posted 9 years ago

By Peggy Peck

ORLANDO, FL -- May 21, 2002 -- A chemotherapy doublet should be the standard treatment in advanced non-small cell lung cancer, according to results of a Cancer and Leukemia Group B (CALGB) study comparing single agent therapy to combination chemotherapy.

Patients with non-small cell lung cancer (NSCLC) who received carboplatin plus paclitaxel had a median survival of 8.5 months, compared to 6.5 months for paclitaxel alone. But the one-year survival rates of 36 percent for doublet versus 31 percent for single agent did not reach statistical significance.

Rogerio C. Lilenbaum, MD, of Mount Sinai Comprehensive Cancer Center, Miami Beach, Florida, United States, presented the findings during the plenary session here on May 20 at the 38th Annual Meeting of the American Society of Clinical Oncology (ASCO).

Dr. Lilenbaum said the chemotherapy doublet produced better survival and this benefit extended to elderly patients. But he added that combination chemotherapy is "associated with increased toxicity," although this was not associated with measurable differences in quality of life. As discussant for Dr. Lilenbaum?s study, ASCO president-elect Paul A. Bunn Jr., MD, said the study "clearly illustrates that two drugs are better than one drug."

Dr. Bunn, who is Grohne/Stapp Chair in Cancer Research at the University of Colorado Cancer Center, in Denver, Colorado, also admonished the packed hall at the plenary session that "it is still the case in this country and elsewhere in the world that most patients with NSCLC are offered no chemotherapy even though we know treatment is effective."

The study compared the efficacy of carboplatin and paclitaxel to paclitaxel alone in patients with stage IIIB (malignant effusion) and stage IV NSCLC. End points included survival, quality of life and cost-effectiveness.

Researchers enrolled 399 men and 185 women, median age 63.5 years, from October 1997 to January 2001; 158 patients (27 percent) were older than 70 years.

Group 1 received intravenous paclitaxel 225 mg/m? over three hours; group 2 received paclitaxel 225 mg/m? in combination with intravenous carboplatin at an area under the curve (AUC) of 6, both intravenously. Treatment for both groups was administered on day 1 every three weeks for up to six cycles.

The response rate was 16 percent for paclitaxel monotherapy and was 30 percent for paclitaxel/carboplatin, Dr. Lilenbaum said.