Seminars in oncology
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Seminars in oncology · Feb 1999
ReviewReview of paclitaxel/carboplatin in advanced non-small cell lung cancer.
The management of non-small cell lung cancer (NSCLC) has advanced in the last two decades. The greatest benefit has been achieved with the development of newer chemotherapeutic agents with single-agent response rates > or =20%. Recent research has focused on adding these newer agents to established drugs for NSCLC, like cisplatin and carboplatin, yielding notable improvement in response and survival rates. ⋯ Phase III trials are under way to establish the specific role of this regimen in NSCLC. The success of this combination also is being expanded through studies investigating its combination in triplets with newer agents, with follow-up therapy via sequential regimens, and by the addition of biologically based treatments. The results of these trials will determine the preferred treatment approach to NSCLC for the next decade.
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Seminars in oncology · Feb 1999
ReviewPaclitaxel plus carboplatin in the treatment of ovarian cancer.
Two large, prospective randomized trials by the Gynecologic Oncology Group and the European Organization for Research and Treatment of Cancer have demonstrated the superiority of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ)/cisplatin compared with cisplatin/cyclophosphamide in previously untreated patients with advanced ovarian cancer. Patients receiving the paclitaxel combination had a higher overall response rate, a longer time to disease progression, and prolonged median survival. In an effort to reduce toxicity, investigators developed combinations of carboplatin/paclitaxel that were found by phase I/II trials to have activity comparable to cisplatin/paclitaxel but with less toxicity. ⋯ The Gynecologic Oncology Group has completed a randomized comparison of three versus six cycles of paclitaxel/carboplatin in early stage disease. This study will be followed by a trial in which all patients with poor-prognosis, early stage ovarian cancer receive three cycles of paclitaxel/carboplatin followed by randomization to no further treatment or to weekly paclitaxel. The combination of paclitaxel/carboplatin is currently the preferred regimen for the treatment of ovarian cancer.
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Seminars in oncology · Feb 1999
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialIrinotecan versus infusional 5-fluorouracil: a phase III study in metastatic colorectal cancer following failure on first-line 5-fluorouracil. V302 Study Group.
In a multicenter phase III trial, 267 patients with nonbulky metastatic colorectal cancer who had failed first-line 5-fluorouracil (5-FU) therapy were randomized to receive second-line treatment with either the new topoisomerase agent, irinotecan (Rhône-Poulenc Rorer, Antony, France), or a high-dose infusional 5-FU regimen. Patients treated with irinotecan survived significantly longer than those treated with infusional 5-FU. The 1-year survival rate was 45% for patients receiving irinotecan compared with 32% for patients receiving 5-FU. ⋯ Overall, mean global quality of life scores were similar in the two arms of the study throughout the period of treatment and follow-up, demonstrating that the more effective disease control achieved by irinotecan at least maintains quality of life. Indeed, deterioration in quality of life (defined as >50% decrease from baseline score) occurred significantly later in irinotecan-treated patients. In light of these data, irinotecan should be considered the reference treatment for patients with 5-FU-refractory advanced colorectal cancer.
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Seminars in oncology · Feb 1999
ReviewConcurrent paclitaxel, carboplatin, and radiation therapy for locally advanced non-small cell lung cancer.
Combination chemotherapy plus radiation therapy for non-small cell lung cancer has several theoretical advantages: the potential of chemotherapy to radiosensitize tumors, the possibility of improved local control due to combined treatment, and the opportunity for spatial cooperation, attacking disease both locally and systemically and thus potentially increasing response and, ultimately, survival. The combination of radiotherapy plus standard chemotherapy (etoposide plus cisplatin) has yielded limited success; therefore, new and novel chemotherapies have been sought. ⋯ Concurrent paclitaxel/carboplatin/radiotherapy appears to offer a relatively safe and more active regimen to control local and metastatic non-small cell lung cancer than the current standard. This report reviews the range of experience with paclitaxel-based combined-modality therapy.
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Seminars in oncology · Feb 1999
ReviewSetting a new standard--irinotecan (Campto) in the second-line therapy of colorectal cancer: final results of two phase III studies and implications for clinical practice.
The final results of two very important randomized trials of irinotecan (Campto, Rhône-Poulenc Rorer, Antony, France) as second-line treatment for patients with advanced colorectal cancer are presented. In one trial, the new topoisomerase inhibitor was compared with best supportive care; in the other, its use was compared with the strategy of high-dose 5-fluorouracil (5-FU) infusion. ⋯ In the comparison with infusional 5-FU, the more effective antitumor activity of irinotecan may have helped maintain quality of life. These results have implications for clinical practice: following failure on 5-FU, irinotecan must now be considered the best available option for treatment.