The study found that treatment with paclitaxel, etoposide, and carboplatin yielded better rates of survival and fewer side effects than treatment with carboplatin, etoposide, and vincristine--one standard chemotherapy regimen. Paclitaxel, both alone and in combination with other chemotherapy drugs, has been associated with high response rates in smaller studies of patients with SCLC, the most aggressive form of lung cancer.
Martin Reck, M.D., and Ulrich Gatzemeier, M.D., of the Hospital Grosshansdorf in Hamburg, Germany, and their colleagues conducted a randomized, phase III trial of the two regimens in 614 patients with SCLC. Patients were evaluated for response rate, survival, and toxicities.
Tumor response rates of the two groups were similar. However, patients who received the experimental treatment had a longer median survival time (12.7 months versus 11.7 months) than patients who received standard chemotherapy. The 3-year survival rate of patients in the experimental group was nearly twice that of patients in the standard treatment group (17% versus 9%, respectively). Notably, the improvements in survival were limited to patients with early-stage disease.
Patients in the experimental group also experienced a longer median progression-free survival time (8.1 months versus 7.5 months) than patients in the standard treatment group. For each completed chemotherapy cycle, rates of side effects, such as severe anemia and thrombocytopenia, were lower for patients in the experimental group than patients in the standard treatment group.
"Our results are the first from a randomized trial to demonstrate a statistically significant increase in median and long-term survival, progression-free survival, and a decrease in drug-related toxicities for patients with SCLC on a paclitaxel-containing regimen compared with standard chemotherapy," the authors write. "The three-drug combination of paclitaxel, etoposide, and carboplatin was effective, safe, and well-tolerated, and therefore we conclude that its use is a reasonable treatment choice for at least some patients with SCLC."
In an accompanying editorial, Janessa Laskin, M.D., of the British Columbia Cancer Research Centre in Vancouver, Canada, and Alan Sandler, M.D., and David H. Johnson, M.D., of the Vanderbilt-Ingram Comprehensive Cancer Center in Nashville, Tenn., point out that despite these encouraging results, the addition of a third drug to etoposide and carboplatin has not been shown in a randomized trial to be better than etoposide and carboplatin alone in the treatment of patients with lung cancer.
They say that the future of SCLC treatment lies in targeted therapies, such as drugs that target protein kinases or angiogenesis (the formation of new blood vessels). "Strategies that take advantage of our admittedly limited knowledge of tumor biology are in progress," they say. "It is hoped that one or several of these approaches will prove successful and further enhance our ability to treat this still-too-common and deadly disease."
Contact: Alice Fietz or Sabine Brands, Hospital Grosshansdorf, 49-4102-601-261, onko.doku2@net.de or pneumo.onko@t-online.de.
Editorial: Cynthia Manley, Vanderbilt-Ingram Comprehensive Cancer Center, 615-936-5711; fax: 615-936-5879, Cynthia.manley@mcmail.vanderbilt.edu.
Reck M, von Pawel J, Macha H, Kaukel E, Deppermann KM, Bonnet R, et al. Randomized phase III trial of paclitaxel, etoposide, and carboplatin versus carboplatin, etoposide, and vincristine in patients with small-cell lung cancer. J Natl Cancer Inst 2003;95:1118–27.
Laskin J, Sandler A, Johnson DH. An advance in small-cell lung cancer treatment--more or less. J Natl Cancer Inst 2003;95:1099–1101.
Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage.
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