Paclitaxel-based regimen outperforms standard therapy for small-cell lung cancer

Paclitaxel in combination with etoposide and carboplatin (TEC) is more effective and less toxic than a standard regimen used to treat small-cell lung cancer (SCLC), new findings by German researchers suggest.

Previous reports have shown that TEC is a safe and effective first-line treatment for SCLC. However, it was unclear if TEC offered any benefits over standard chemotherapy with carboplatin, etoposide, and vincristine (CEV).To investigate, Dr. Ulrich Gatzemeier, from Hospital Grosshansdorf in Hamburg, and colleagues assessed the outcomes of 614 patients with stage I to IV SCLC who were randomized to receive TEC or CEV. The treatments were given every 21 days for a maximum of six courses.During the 2-year study period, TEC-treated patients were 22% less likely to die than CEV-treated patients. Moreover, progression-free survival was significantly longer for TEC-treated patients. Treatment response rates, however, were similar for the two regimens.Another benefit of the TEC regimen was a reduction in hematologic toxicities, the authors note. Anemia, leukocytopenia, neutropenia, and thrombocytopenia were all less common in the TEC group than in the CEV group.The TEC regimen “was effective, safe, and well-tolerated, and therefore we conclude that its use is a reasonable treatment choice for at least some patients with SCLC,” Dr. Gatezemeier’s team notes.But in a related editorial, Dr. David H. Johnson, from Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, and colleagues comment that there are some issues with the study that make it unclear whether TEC is better than CEV or just etoposide plus a platinum drug-the regimen of choice in the US.”Virtually all experts in North America would agree that the way radiotherapy was given in the current study was less than ideal,” Dr. Johnson told Reuters Health.”In patients with limited stage disease, early radiotherapy combined with chemotherapy provides better outcomes than delayed radiotherapy,” he noted. In the current study, “radiotherapy was delayed and the overall survival of patients with limited stage disease was about 6 or 7 months less than reported in North American trials,” he added. “So right from the start, the researchers are giving inferior therapy,” Dr. Johnson said. “I think what is being shown is that TEC can modestly improve on an inferior therapy. In contrast, in patients with extensive disease, for which radiotherapy is not given, there was absolutely no difference in outcomes between the TEC and CEV groups.”A number of studies have come out, just like this one, in which various chemotherapy drugs are substituted for others, Dr. Johnson pointed out. “Really, I think this approach is sort of like rearranging deck chairs on the Titanic.”The next big advances in SCLC therapy will come from developing new agents, not from creating different combinations of old drugs, he added.(Source: J Natl Cancer Inst 2003;95:1099-1101,1118-1127: Reuters Health: Anthony J. Brown, MD: August 7, 2003: Oncolink)