PACLITAXEL AND CARBOPLATIN IN COMBINATION IN THE TREATMENT OF ADVANCED NON-SMALL-CELL LUNG-CANCER - A PHASE-II TOXICITY, RESPONSE, AND SURVIVAL ANALYSIS
Cj. Langer et al., PACLITAXEL AND CARBOPLATIN IN COMBINATION IN THE TREATMENT OF ADVANCED NON-SMALL-CELL LUNG-CANCER - A PHASE-II TOXICITY, RESPONSE, AND SURVIVAL ANALYSIS, Journal of clinical oncology, 13(8), 1995, pp. 1860-1870
Purpose: To determine the activity and toxicity of combination paclita
xel (24 hours) and carboplatin in advanced non-small-cell lung cancer
(NSCLC). Patients and Methods: Eligibility required measurable disease
(stage IV or stage IIB with malignant pleural effusion), Eastern Coop
erative Oncology Group (ECOG) performance status 0 or 1, absolute neut
rophil count greater than or equal to 2,000/mu L, platelet count great
er than or equal to 100,000/mu L serum creatinine concentration less t
han or equal to 1.5 mg/dL, and bilirubin level less than or equal to 2
mg/dL. Paclitaxel was initially administered at a dose of 135 mg/m(2)
/d, followed by carboplatin on day 2 at a targeted area under the conc
entration-time curve (AUG) of 7.5 using the Calvert formula. Granulocy
te colony-stimulating factor (G-CSF) 5 mu g/kg subcutaneously (SC) on
days 3 to 17 was introduced during the second and subsequent cycles. I
n patients who sustained less than grade 4 myelosuppression, the pacli
taxel dose was sequentially escalated 40 mg/m(2) per cycle to a maximu
m of 215 mg/m(2). Treatment was repeated at 3-week intervals for six c
ycles. Results: From June 1993 through February 1994, 54 patients were
enrolled; 53 are assessable for toxicity and response. The median age
was 62 years (range, 34 to 84). Sixty-nine percent were male, 65% had
adenocarcinoma, and 93% had stage IV disease. Two hundred sixty-eight
cycles were administered; 32 patients (59%) completed all six cycles.
Twenty-five unanticipated hospitalizations occurred during treatment
(9.3% of cycles) in 20 patients (37%). Myelosuppression was the princi
pal toxicity; grade 3 or 4 granulocytopenia occurred in 57% of patient
s after the first cycle, but decreased to 35% during the second cycle
after introduction of G-CSP and consistently remained less than or equ
al to 22% during subsequent cycles. Seven episodes of neutropenic feve
r occurred, all during the first cycle. Grade 3 or 4 thrombocytopenia
and anemia occurred in 47% and 33% of patients, respectively. Eight pa
tients (15%) required platelet transfusions and 16(30%) required packe
d RBC support. Neuropathy, my algias/arthralgias, and thrombocytopenia
, although generally mild, were cumulative. The paclitaxel dose wets b
oosted to 215 mg/m(2) in greater than or equal to 70% of patients who
received three or more cycles. Ar an AUC of 7.5, the median first-cycl
e carboplatin dose was 424 mg/m(2) (range, 273 to 709 mg/m(2)). The ob
jective response rate was 62%, with five (9%) complete responses and 2
8 (53%) partial responses. The median progression-free survival time w
as 28 weeks and the median survival time 53 weeks. The 1-year survival
rate is 54%. Conclusion: The paclitaxel-carboplatin combination is ac
tive in advanced NSCLC and may enhance survival; it merits further inv
estigation in phase III trials. J Clin Oncol 13:1860-1870. (C) 1995 by
American Society of Clinical Oncology.