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Chemotherapy for Lung Cancer

Many American patients with advanced lung cancer undergo chemotherapy, even though average gains in survival are modest at best. In these 2 multicenter, randomized, clinical trials, investigators examined several contemporary chemotherapy regimens.

U.S. researchers compared 4 regimens in 1155 patients with advanced non-small-cell lung cancer: cisplatin plus paclitaxel, cisplatin plus gemcitabine, cisplatin plus docetaxel, and carboplatin plus paclitaxel. Overall, median survival was 8 months, and 1- and 2-year survival rates were about 33% and 11%, respectively, with no significant differences between the 4 groups. Carboplatin plus paclitaxel was slightly less toxic than were the other regimens.

Japanese researchers compared etoposide plus cisplatin (standard treatment) and irinotecan plus cisplatin (a newer treatment) in 154 patients with metastatic small-cell lung cancer. Median survival was significantly longer in the irinotecan group than in the etoposide group (12.8 vs. 9.4 months), as was 2-year survival (20% vs. 5%). Hematologic toxicity was more frequent with etoposide, and severe diarrhea was more common with irinotecan.

Comment: These results suggest that (1) none of the standard regimens for non-small-cell lung cancer is significantly better than any other, and (2) irinotecan (a topoisomerase I inhibitor) plus a platinum compound may represent an advance in treatment of small-cell lung cancer. But the overall message, echoed by an editorialist, is rather pessimistic: He notes that "chemotherapy in advanced lung cancer has reached a plateau" and that newer biologic agents (e.g., inhibitors of epidermal growth-factor receptors) may be more promising.

— Allan S. Brett, MD

Published in Journal Watch General Medicine January 29, 2002

Citation(s):

Schiller JH et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med 2002 Jan 10; 346:92-8.

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Noda K et al. Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med 2002 Jan 10; 346:85-91.

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Carney DN. Lung cancer -- Time to move on from chemotherapy. N Engl J Med 2002 Jan 10; 346:126-8.

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