Seminars in oncology
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Seminars in oncology · Dec 1996
Clinical TrialPreliminary results of a phase I/II clinical trial of paclitaxel and carboplatin in non-small cell lung cancer.
Forty-nine patients with non-small cell lung cancer were treated in a study designed to establish the maximum tolerated dose of outpatient paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), given by 3-hour infusion, combined with a fixed dose of carboplatin (area under the concentration-time curve [AUC] = 6, Calvert method). The study population included 31 men and 18 women with previously untreated, unresectable stage III or IV non-small cell lung cancer. Patients had a median age of 62 years (age range, 46 to 81 years) and a median Southwest Oncology Group performance status of 1 (range, 0 to 2). ⋯ Objective responses were documented in 26 of 42 patients with objectively measurable disease, for an overall response rate of 62%. Although these data are preliminary, this regimen appears to be efficacious and cost-effective, and warrants further study. Paclitaxel 225 mg/m2 combined with carboplatin (AUC = 6) every 3 weeks is recommended for follow-up phase II and III clinical trials.
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Seminars in oncology · Dec 1996
Clinical TrialPhase I dose-escalation trial of paclitaxel and ifosfamide in patients with advanced non-small cell lung cancer.
This phase I dose-escalation study was undertaken to determine the maximum tolerated doses of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and ifosfamide that could be administered without growth factors to previously untreated patients with non-small cell lung cancer. Forty patients with advanced non-small cell lung cancer were treated with a 3-hour infusion of paclitaxel and a 1-hour infusion of ifosfamide, repeated every 3 weeks. Groups of three patients each entered at escalating dose levels in a traditional phase I design. ⋯ The median survival was 9.1 months (range, 1 to 12 months). In summary, outpatient paclitaxel given over 3 hours and single-dose ifosfamide given over 1 hour may be combined safely without hematopoietic growth factors for the treatment of patients with non-small cell lung cancer. The recommended doses for phase II study are paclitaxel 225 mg/m2 and ifosfamide 4 g/m2, every 3 weeks.
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Seminars in oncology · Dec 1996
Multicenter Study Clinical TrialPaclitaxel plus carboplatin and concurrent radiation therapy for patients with locally advanced non-small cell lung cancer.
Previously untreated patients with stages IIIA or IIIB non-small cell lung cancer entered this phase II study to evaluate the activity and toxicity of combined paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and carboplatin and concurrent radiation. Patients received paclitaxel 50 mg/m2/wk as a 1-hour infusion and carboplatin area under the concentration-time curve of 2/wk for 7 weeks with radiation to the primary tumor and regional lymph nodes (44 Gy) followed by a boost to the tumor (22 Gy). In addition, patients received two additional cycles of paclitaxel 200 mg/m2 and carboplatin (area under the concentration-time curve of 6) 3 weeks apart. ⋯ Seven of the nine patients recovered from the esophagitis within 2 weeks and received the additional two cycles of paclitaxel 200 mg/m2 and carboplatin (area under the concentration-time curve of 6). Only one patient (4%) had grade 4 pneumonitis; this patient also recovered within 2 weeks and received the final two doses of combined chemotherapy. Therapy with paclitaxel, carboplatin, and concurrent radiation is a promising treatment for patients with locally advanced non-small cell lung cancer; it has a high response rate and acceptable toxicity.
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Seminars in oncology · Dec 1996
ReviewCombination paclitaxel and platinum in the treatment of lung cancer: US experience.
Despite marked improvements in the treatment options available for patients with lung cancers, more than 85% of patients ultimately relapse and die of their disease. Among the most auspicious of new agents available to treat lung cancers, paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) also has been the most extensively studied. ⋯ In combination therapy, paclitaxel/cisplatin has been shown to be superior to etoposide/cisplatin in the treatment of non-small cell lung cancer. Further study is needed to clarify the optimal role of paclitaxel in combination therapy and to define its optimal dose and schedule in therapy for lung cancers.
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Seminars in oncology · Dec 1996
Randomized Controlled Trial Clinical TrialPaclitaxel and carboplatin as neoadjuvant chemotherapy in operable (stage I and II) and locally advanced (stage IIIA-N2) non-small cell lung cancer.
In 1995, a randomized intergroup study of neoadjuvant chemotherapy followed by either surgery or radiotherapy in the treatment of non-small cell lung cancer was started under the auspices of the European Organization for Research and Treatment of Cancer (EORTC 08941). The objective of this study is to investigate whether surgery or radiotherapy represents superior locoregional treatment, in terms of survival and quality of life, for patients with stage IIIA(N2) non-small cell lung cancer who have achieved a response after three courses of neoadjuvant chemotherapy. A phase II side study will investigate the clinical and pathologic response rate (if applicable), as well as acute and late side effects during or after consecutive surgery and/or radiotherapy of combination paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and carboplatin. ⋯ Depending on the response rate and early and late side effects observed in this well-defined, prognostically favorable group of patients, it will be decided whether and how to use the same combination chemotherapy in an ongoing randomized trial currently being conducted by the Dutch Lung Cancer Study Group (DLCSG 94-2). In the latter trial, patients with stage I and II non-small cell lung cancer are randomized to immediate surgery or two courses of neoadjuvant chemotherapy. Responding patients will receive another two courses of chemotherapy before surgery; nonresponders will go directly to surgery.