Paclitaxel plus carboplatin in advanced non-small-cell lung cancer

Despite a response rate of only 9%, single-agent carboplatin (Paraplatin) produced the best 1-year survival rate with the lowest toxicity in a five-arm Eastern Cooperative Oncology Group study of cisplatin (Platinol) combinations and analogs. Single-agent paclitaxel (Taxol) has also proven to be active in non-small-cell lung cancer, with objective responses of over 20% when administered as a 24-hour infusion and a similar response rate when administered by short 3-hour infusion. For instance, in a Spanish Lung Cancer Group study, 17 out of 58 patients (29%) achieved an objective response when treated with paclitaxel at 210 mg/m(2) by 3-hour infusion in 21-day cycles. Several European studies have focused on the paclitaxel/ carboplatin combination administered by short (3-hour) infusion. These studies have confirmed that myelosuppression is generally mild and thrombocytopenia is rare with this regimen. In total, eight European studies, including 260 evaluable patients with an overall 28% objective response rate, have been reported so far. Among these studies, the two Greek studies confirmed the tolerability of the paclitaxel/carboplatin regimen and reported higher response rates for higher paclitaxel doses, 175 mg/m(2) vs 225 mg/m(2). The Dutch and Italian studies, on the other hand, observed a possible dose-response relationship. It can be inferred from these studies that a paclitaxel dose of at least 200 mg/m(2) by 3-hour infusion is needed to induce objective response in advanced non-small-cell lung cancer. Moreover, the paclitaxel/carboplatin regimen in a 21-day cycle does not require special ancillary measures (ie, blood transfusions, antiemetic therapy, or hospitalization). And finally, neither the paclilaxel/carboplatin nor the carboplatin/paclitaxel combination produces a sequence-dependent cytotoxic effect. The paclitaxel/carboplatin regimen has recently been examined in a large-scale Pan-European clinical trial in which patients were randomized to receive either 200 mg/m(2) of paclitaxel (3 h) plus carboplatin at an area under the concentration-time curve of 6 (AUC in mg/ mt min) or 200 mg/m2 of paclitaxel (3 h) plus 80 mg/m(2) of cisplatin (1 h) in a 21-day cycle. A total of 618 patients have been included and interim results of the first 289 patients were reported at the 1998 meeting of the American Society of Clinical Oncology.