Combination Chemotherapy Superior to Single-Agent Chemotherapy in Advanced NSCLC
According to results recently published at the 38th Annual Meeting of the American Society of Clinical Oncology, combination chemotherapy appears superior to single-agent chemotherapy in the treatment of advanced non-small cell lung cancer.
Lung cancer is the leading cause of cancer death in the United States and non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Stage IIIB and stage IV NSCLC are considered advanced NSCLC and refer to cancer that has spread from its site of origin to other sites in the body. Standard treatment for advanced NSCLC typically includes some type of chemotherapy regimen.
Researchers recently conducted a clinical trial to directly compare a single-agent chemotherapy regimen, paclitaxel (Taxol®), to a chemotherapy regimen containing two chemotherapy agents, paclitaxel and Paraplatin® (carboplatin), as initial therapy for advanced NSCLC. Patients were allowed to receive a different chemotherapy regimen once their cancer progressed on the initial regimen. In this trial, 277 patients were treated with paclitaxel only and 284 patients were treated with Paraplatin®/paclitaxel. The overall anti-cancer response rate was 29% for patients treated with paclitaxel/Paraplatin®, compared to only 17% of patients treated with paclitaxel alone. The average duration of survival was 6.7 months for patients treated with paclitaxel/Paraplatin®, compared to only 6.7 months for patients treated with paclitaxel alone. Survival at one year following therapy was 37% for patients treated with paclitaxel/Paraplatin® and 33% for patients treated with paclitaxel alone. There were no significant differences in quality of life or utilization of resources such as in-hospital stays due to side effects for either treatment group. Of the patients treated with paclitaxel/Paraplatin®, 32% were treated with a second chemotherapy regimen due to cancer progression, compared to 39% of patients treated with paclitaxel alone.
The researchers also evaluated these two regimens separately in patients over 70 years of age. In this group of patients, the anti-cancer response rates were 36% for patients treated with paclitaxel/Paraplatin® versus only 21% for patients treated with paclitaxel alone. The average survival was 8.0 months for patients treated with paclitaxel/Paraplatin® and 5.8 months for patients treated with paclitaxel alone. Survival at one year following treatment was 35% for patients treated with paclitaxel/Paraplatin® and 31% for patients treated with paclitaxel alone.
These researchers concluded that combination chemotherapy is superior to single-agent chemotherapy for the treatment of advanced NSCLC. They also commented that newer chemotherapy agents may produce different results than demonstrated by this clinical trial.
Results from a separate clinical trial reported in The New England Journal of Medicine evaluated four different chemotherapy combinations in over 1,000 patients with advanced NSCLC. In this trial, patients were divided into four groups and received one of the following treatment regimens: Gemzar® and Platinol®; paclitaxel and Platinol®; Taxotere® and Platinol®; or paclitaxel and Paraplatin®. All of these chemotherapy combinations demonstrated similar anti-cancer responses and one-year survival rates1. These chemotherapy combinations are representative of different treatment options for patients with advanced NSCLC.
Patients with advanced NSCLC may wish to speak with their physician about the risks and benefits of participating in a clinical trial evaluating different chemotherapy agents and/or chemotherapy combinations. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.CancerConsultants.com . CancerConsultants.com also provides personalized clinical trial searches on behalf of patients.
Reference: Lilenbaum R, Herndon J, List M, et al. Single-agent (SA) versus combination chemotherapy (CC) in advanced non-small cell lung cancer (NSCLC): a CALGB randomized trial of efficacy, quality of life (QOL), and cost-effectiveness. Proceedings from the 38th Annual Meeting of the American Society of Clinical Oncology. 2002;21: Abstract 2.
1 Schiller J, Harrington D, Belani C, et al. Comparison of Four Chemotherapy Regimens for Advanced Non-Small-Cell Lung Cancer.
The New England Journal of Medicine. 2002;346:92-98.
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