Seminars in oncology
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Seminars in oncology · Feb 1999
ReviewReview of docetaxel and doxorubicin-based combinations in the management of breast cancer: from metastatic to adjuvant setting.
Considering the efficacy of docetaxel (Taxotere, Rhône-Poulenc Rorer, Antony, France) and doxorubicin in advanced breast cancer and their potential noncross-resistance, two pilot studies of docetaxel/doxorubicin (TA)-based combinations were conducted, one being a phase I dose-finding study of TA and the second a phase II study of docetaxel/doxorubicin/cyclophosphamide (TAC). The only significant toxicity, seen in both trials, was neutropenia and its consequences such as febrile neutropenia without significant documented infections. ⋯ In terms of efficacy, response rates in excess of 70% and 80% were noted in both studies, even for patients with visceral metastases. Several phase III randomized trials using TA or TAC are presently being performed in first-line metastatic breast cancer and most importantly in the adjuvant setting to assess whether TA-based combinations will change the natural history of breast cancer.
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Seminars in oncology · Feb 1999
ReviewThe current role and future prospects of paclitaxel in the treatment of small cell lung cancer.
When combination regimens containing a platinum compound and etoposide are used, median survivals in patients with extensive- and limited-stage small cell lung cancer are 7 to 10 months and 15 to 20 months, respectively. A recent randomized trial demonstrated equivalent efficacy and decreased toxicity with carboplatin/etoposide compared with cisplatin/etoposide. ⋯ Ongoing phase III trials will better define the contribution of paclitaxel to standard platinum/etoposide regimens. In addition, phase II trials of novel paclitaxel combinations (e.g., paclitaxel/topotecan, paclitaxel/carboplatin/topotecan) are ongoing.
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Seminars in oncology · Feb 1999
ReviewCombining new agents with anthracyclines in metastatic breast cancer: an overview of recent findings.
Historically, doxorubicin has been the most effective single agent in metastatic breast cancer, and the combination of doxorubicin with other active agents (as in the 5-fluorouracil/doxorubicin/cyclophosphamide protocol) has improved patient outcome. Results from phase II and several recent phase III studies provide evidence that new agents are also highly active in the treatment of metastatic breast cancer and suggest that they would be active in combination regimens with the anthracyclines. ⋯ Studies to date indicate that this high response rate is achieved without accompanying cardiotoxicity. Several other new agents, notably, paclitaxel, vinorelbine, and gemcitabine, also have been evaluated in combination with the anthracyclines.
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Seminars in oncology · Dec 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPhase III studies of single-agent docetaxel in patients with metastatic breast cancer who have progressed despite previous chemotherapy regimens: preliminary results.
A recent large phase III trial has for the first time demonstrated that choice of treatment can influence survival duration in patients with metastatic breast cancer who have progressed despite previous anthracycline-containing therapy. In a multicenter study, patients who received docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) experienced a longer median survival time (II.4 months v 8.7 months; P = .0097) as well as a longer time to progression (19 weeks v II weeks; P < .001) and higher overall response rate (30% v II.6%; P < .0001) than patients receiving treatment with mitomycin C and vinblastine. The toxicity profile was manageable and tolerable for both arms. ⋯ In this study, the duration of survival was not influenced by treatment. However, the higher response rate with docetaxel was achieved without the risk of potentially fatal cardiac toxicity seen in some patients who received doxorubicin. To date, docetaxel is the only single agent shown to have a potential superior activity when compared with doxorubicin in patients with progressive metastatic disease.