Gemcitabine-docetaxel versus gemcitabine - cisplatin as first-line therapy in patients with advanced non-small cell lung cancer

Abstract

Lung cancer is the leading cause of cancer deaths worldwide in men, and second most common in women. Worldwide, lung cancer occurred in approximately 1.8 million patients in 2012 and caused an estimated 1.6 million deaths 1. Non-small-cell lung cancer (NSCLC) represents more than 80% of lung cancer diagnoses and has an overall 5-year survival rate of approximately 16%, which decreases precipitously among patients diagnosed with late stage disease 2. Despite enthusiasm for the use of molecular testing and molecularly targeted agents in patients with advanced non-small cell lung cancer (NSCLC), most patients are not candidates for upfront treatment with molecular agents. Moreover, many candidate patients can't afford the vastly increased cost of such novel agents. Chemotherapy therefore remains the first-line treatment for most patients with stage IV non-small cell lung cancer (NSCLC) 3. Multiple individual randomised studies and several meta-analyses have shown a survival benefit for platinumbased chemotherapy compared with best supportive care in patients with good performance status 4,5 , but at the cost of severe toxicities. Combinations with better toxicity profile but with equal or improved efficacy are eagerly needed. Nonplatinum combinations have been tested and are considered alternative regimens for those who cannot tolerate platinum-based chemotherapy. Among these combinations, the combination of gemcitabine and docetaxel has emerged as one of the most promising, showing equivalent efficacy with, and less toxicity than, cisplatin-based chemotherapies 6 .