Docetaxel - A review of its use in non-small cell lung cancer

Docetaxel, a semisynthetic member of the taxoid class of antineoplastic age nts, is effective in the treatment of patients with locally advanced and me tastatic non-small cell lung cancer (NSCLC). In noncomparative trials in pa tients with NSCLC, docetaxel 75 or 100 mg/m(2) produced objective response rates of 20 to 38% and 14 to 25% as a first-line or second-line monotherapy , respectively. In Japan, docetaxel 60 mg/m(2) produced objective response rates of 19 to 25% in previously untreated patients. Docetaxel 100 or 75 mg/m(2) produced significantly higher response rates th an either vinorelbine or ifosfamide in previously treated patients; patient s treated with docetaxel 75 mg/m(2) had an improved 1-year survival rate co mpared with those who received vinorelbine or ifosfamide. Docetaxel monothe rapy in chemotherapy-naive patients produced survival rates that are simila r to those reported for most platinum-containing standard combinations such as cisplatin plus vinorelbine. Combination of docetaxel with one other antineoplastic resulted in objectiv e response rates of 20 to 54% in chemotherapy-naive patients; triple chemot herapy combinations produced responses in 51 and 60% of patients. Promising results from a few small studies and one large phase II study have also in dicated a potential role for docetaxel as neoadjuvant therapy. The main dose-limiting adverse event associated with docetaxel is neutropen ia, and fluid retention is common in many patients. The tolerability profil e is generally acceptable in the majority of patients, although extra care has to be taken in patients with impaired liver function to minimise the ri sk of severe or febrile neutropenia. Conclusions. Docetaxel is generally well tolerated by patients receiving tr eatment for locally advanced and metastatic NSCLC, and produces response an d survival rates equivalent to many current standard treatment options. Com parative studies have shown that docetaxel monotherapy provides significant survival benefits over best supportive care or treatment with vinorelbine or ifosfamide. Response and 1-year survival rates with docetaxel monotherap y are particularly encouraging in patients refractory or resistant to cispl atin or carboplatin, for whom treatment options are few. Neoadjuvant doceta xel has produced improved survival compared with local treatment alone. Com binations of docetaxel with other antineoplastic agents have produced relat ively high response and 1-year survival rates; however, further comparative studies are required to confirm these benefits. In the meantime, docetaxel is a welcome addition to the options available for patients with advanced NSCLC. axel.