ECOG 1594 PDF

N Engl J Med. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. Comment in N Engl J Med. BACKGROUND: We conducted a randomized study to determine whether any of three chemotherapy regimens was superior to cisplatin and paclitaxel in patients with advanced non-small-cell lung cancer. METHODS: A total of patients with advanced non-small-cell lung cancer were randomly assigned to a reference regimen of cisplatin and paclitaxel or to one of three experimental regimens: cisplatin and gemcitabine, cisplatin and docetaxel, or carboplatin and paclitaxel. The response rate and survival did not differ significantly between patients assigned to receive cisplatin and paclitaxel and those assigned to receive any of the three experimental regimens.

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Fesho The results of several large phase III studies are reviewed below. Median age of patients enrolled in randomised clinical trials is often significantly lower than that observed in clinical practice [ ], and eligibility criteria request good renal, hepatic and cardiac function, as well as absence of other significant co-morbidities.

PS2 patients reported the worst scores at baseline assessment. Lung Cancer Highlights Cisplatin-based therapy for elderly patients with advanced non-small-cell lung cancer: This raises the eecog of whether time to progression will ultimately become the most important measure in NSCLC trials rather than survival. All these observations, as underlined by the authors, reinforce the perception that PS2 patients need special consideration when receiving chemotherapy. Unfortunately, at the time of diagnosis, the majority of patients already have metastatic disease and a systemic, palliative treatment is the only therapeutic option.

The development of the taxanes, paclitaxel and docetaxel, represents significant advance in the treatment of solid tumors, particularly breast and lung cancers. Lung Cancer Highlights In that study, a comparison of mean score with mean score after 6 weeks was planned. As for the role of carboplatin, the results of the CALGB study, comparing paclitaxel plus carboplatin versus paclitaxel alone, must be considered [ 37 ].

Stronger evidence is expected from new clinical research specifically focused on PS2 patients. Early results of a randomized phase III trial of platinum-containing doublets versus a nonplatinum doublet in the treatment of advanced non-small cell lung cancer: The overall response rates were Patient characteristics for ECOG Prognostic factors in advanced non-small-cell lung cancer: Differences in trial design, patient characteristics, and treatment delivery between this trial and the TAX trial likely for the outcome variations observed with the taxane-platinum regimen between these trials.

The response rate and survival did not differ significantly between patients assigned to receive cisplatin and paclitaxel and those assigned to receive any of the three experimental regimens. Preferences for chemotherapy in patients with advanced non-small-cell lung cancer: Related Content Load related web page information. Paclitaxel is a natural product isolated from the Pacific yew, whereas docetaxel is a semisynthetic taxane analogue of eclg European yew.

Nonhematologic toxicity was unusual. For this latter sub-group, there is no treatment widely accepted as standard and oncologists have to choose among several treatment options for which PS2 patients are potential candidates: ZD, a small-molecule tyrosine-kinase inhibitor targeted against the epidermal growth factor receptor, is one of the most promising new biological agents. Prognostic factors ecogg patients with advanced non-small cell lung cancer: The phase III studies reviewed here demonstrate a benefit of the DC doublet in terms of all these end points.

In adverse event terms, the taxane-platinum combination of paclitaxel-carboplatin demonstrated less grade 3 or 4 neutropenia and lower rates of febrile neutropenia than other taxane-platinum combinations but higher rates of irreversible grade 3 or 4 peripheral neuropathy than any of the other taxane-platinum combinations. This Article The Oncologist August vol. Results of ECOG Patients were stratified by performance status, weight loss, stage and presence of brain metastases.

Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. The end points for these large randomized clinical trials were survival, response rate, adverse events, and quality of life QOL. For example, the affinity eocg docetaxel for the tubulin-binding site is twice that of paclitaxel, and docetaxel is twice as efficient as paclitaxel at decreasing the critical tubulin concentration required for the formation of microtubules [ 7 ].

There was an imbalance by sex with more men being in the CP-alone arm. Related Posts.

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Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer.

Fesho The results of several large phase III studies are reviewed below. Median age of patients enrolled in randomised clinical trials is often significantly lower than that observed in clinical practice [ ], and eligibility criteria request good renal, hepatic and cardiac function, as well as absence of other significant co-morbidities. PS2 patients reported the worst scores at baseline assessment. Lung Cancer Highlights Cisplatin-based therapy for elderly patients with advanced non-small-cell lung cancer: This raises the eecog of whether time to progression will ultimately become the most important measure in NSCLC trials rather than survival. All these observations, as underlined by the authors, reinforce the perception that PS2 patients need special consideration when receiving chemotherapy. Unfortunately, at the time of diagnosis, the majority of patients already have metastatic disease and a systemic, palliative treatment is the only therapeutic option.

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Gogal In conclusion, docetaxel has markedly impacted the treatment of advanced NSCLC and continued evaluation in earlier-stage disease is warranted. Aftersome advantage of chemotherapy versus supportive care alone has been shown not only with platinum-based combination chemotherapy [ ] but also with many new cytotoxic agents e. The original sample size was significantly larger, but the trial was stopped early when the interim analysis showed a significant benefit to the experimental arm in terms of improved overall survival. N Engl J Med ; These are important studies to compare because they were conducted at nearly the same time and in very similar though not identical patient populations. Furthermore, there is an undeniable demand for specific treatment by patients and their relatives: Overall survival was the primary endpoint of this study. The relative merits of each of these end points may vary depending on the stages of NSCLC being treated i.

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