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A recent article in the British Journal of Cancer reports that the combination of docetaxel and irinotecan does not improve the response rate for patients being treated for non-small cell lung cancer (NSCLC).

Lung cancer is the leading cause of cancer related deaths in the United States and Europe. NSCLC is the most common type of lung cancer and is a malignancy that arises from the tissues of the lung. Under most circumstances, NSCLC is not curable. Current treatments include, surgery, chemotherapy and radiation in an attempt to destroy tumor cells or prevent further tumor growth. Researchers are now focused on determining how to best treat patients if they do not respond to first-line treatment with chemotherapy. Whether or not single-drug regimens are superior to combination chemotherapy drug regimens for patients as second-line treatment remains unclear.

In this recent trial, 108 patients diagnosed with stage IIIB or IV NSCLC who had failed first-line treatment were randomized to receive either docetaxel 75mg/m2 on day 1 or a combination of docetaxel 60mg/m2 and irinotecan 200mg/m2 on day 1. These treatments were repeated every 3 weeks, although the group receiving combination chemotherapy was also treated with daily injections of lenogastrim (days 2-12) to prevent a drop in their white blood cell count. A maximum of 5 cycles were administered to each patient.

When the study was completed, 99 patients were eligible for evaluation. Results of the study indicated that the overall response rate for the patients who received single-agent chemotherapy was 16%, compared to 10% for the group who received combination chemotherapy. The average progression-free survival was not significantly different between the 2 groups (18 weeks vs. 15 weeks). The 1-year survival rate was 26% for the group that received docetaxel alone, compared to 30% for the patients who received docetaxel and irinotecan. Side effect profiles revealed that the patients who received docetaxel alone experienced lower blood counts than the patients who received both docetaxel and irinotecan, although the patients who received irinotecan experienced frequent diarrhea, which in 6 cases required hospitalization.

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Researchers concluded that the addition of irinotecan to docetaxel in this trial demonstrated no clear benefit, and resulted in increased side effects for the patient. However, the question remains if other combinations of chemotherapy may benefit patients who have failed first-line chemotherapy. Patients are encouraged to speak to their physician regarding treatment options.

Reference: Wachters FM, Groen H, Biesma B, et al. A Randomized Phase II Trial of Docetaxel versus Docetaxel and Irinotecan in Patients With Stage IIIb-IV Non-Small Cell Lung Cancer Who Failed First Line Treatment. British Journal of Cancer. 2005; 92: 15-20.

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