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Carboplatin/Docetaxel Combination May Be Safe, Effective in Patients with Advanced Non-Small-Cell Lung Cancer

Carboplatin plus docetaxel is well tolerated and achieves a partial response in some non-small-cell lung cancer (NSCLC) patients with previously untreated advanced or metastatic disease, according to a phase II multicentre study.

Systemic chemotherapy is the standard treatment approach used in patients with advanced or recurrent lung cancer.

Greater quality of life and survival rate improvement is seen with platinum-based chemotherapy than with cisplatin-based chemotherapy. Furthermore, carboplatin has become the preferred platinum compound to treat advanced NSCLC in clinical practice in the US.

Docetaxel is an active agent used in NSCLC, and the combination of docetaxel and cisplatin has been recently approved for first-line treatment of advanced NSCLC. Its use in combination with carboplatin, however, is still under investigation.

Sakkaraiappan Ramalingam, MD, at the University of Pittsburgh School of Medicine, Pennsylvania, United States, and American colleagues evaluated the efficacy of docetaxel in combination with carboplatin in the treatment of patients with previously untreated advanced NSCLC.

The study included 45 patients, mean age 62, who had inoperable stage IIIB or stage IV NSCLC, primarily adenocarcinoma. All patients had an ECOG performance status of either 0 or 1 and had no prior chemotherapy. Patients were given a combination of carboplatin AUC (5 mg/mL min) and docetaxel (80 mg/m²) once every 3 weeks and received a median of 4 cycles.

Overall, 29% of patients responded to the carboplatin-docetaxel regimen, with 26% showing a partial response and 3% showing a complete response. Maximal response was achieved after 5 cycles and the median duration of response was 29 weeks.

The median survival of this cohort was 11.9 months, and 47% were estimated to survive 1 year. Moreover, the median time to progression was 6.4 weeks.

The combination of docetaxel and carboplatin was generally well tolerated. The most common adverse event was grade 4 neutropenia, which occurred in 71% of patients. Furthermore, febrile neutropaenia occurred in 17.8%. Half of the patients experienced grade 3 leukopaenia and 16% experienced grade 4 leukopaenia.

Grade 3 fatigue was the worst nonhaematological toxicity reported and occurred in only 4% of patients. Other toxicities that were less than grade 3 in severity included neurosensory toxicity (22%), alopecia (53%), nausea (44%), vomiting (18%), stomatitis (18%) and fever (22%).

The authors conclude that "our study, along with data presented from similar studies, established the efficacy of the combination of carboplatin and docetaxel in the first-line treatment of patients with advanced NSCLC."



Cancer Chemother Pharmacol 2004 Jan 27;[Epub ahead of print]. "Carboplatin and docetaxel in advanced non-small-cell lung cancer: results of a multicenter phase II study"

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