Second-line paclitaxel in non-small cell lung cancer initially treated with cisplatin: a study by the European Lung Cancer Working Party

Abstract

In the context of a phase III trial comparing in advanced non-small cell lung cancer (NSCLC) sequential to conventional administration of cisplatin-based chemotherapy and paclitaxel, we evaluated the activity of paclitaxel as second-line chemotherapy and investigated any relation of its efficacy with the type of failure after cisplatin. Patients received three courses of induction GIP (gemcitabine, ifosfamide, cisplatin). Non-progressing patients were randomised between three further courses of GIP or three courses of paclitaxel. Second-line paclitaxel was given to patients with primary failure (PF) to GIP and to those progressing after randomisation to further GIP (secondary failure or SF). One hundred sixty patients received second-line paclitaxel. Response rates were 7.7% for PF and 11.6% for SF (P ¼ 0.42). Median survival times (calculated from paclitaxel start) were 4.1 and 7.1 months for PF and SF (P ¼ 0.002). In multivariate analysis, three variables were independently associated with better survival: SF (hazard ratio (HR) ¼ 1.55, 95% confidence interval (CI) 1.08 -2.22; P ¼ 0.02), normal haemoglobin level (HR ¼ 1.56, 95% CI 1.08 -2.26; P ¼ 0.02) and minimal weight loss (HR ¼ 1.79, 95% CI 1.26 -2.55; P ¼ 0.001). Paclitaxel in NSCLC patients, whether given for primary or for SF after cisplatin-based chemotherapy, demonstrates activity similar to other drugs considered active as second-line therapy.

Mitomycin plus vinorelbine salvage chemotherapy in non-small cell lung cancer: A prospective study

“…We also demonstrated that the type of failure to prior systemic treatment (PF versus SF) influenced PFS and survival similarly to a previous trial [26] where we found better survival for SF in comparison with PF patients (p = 0.002). In this study, we observed that SF patients had longer PFS (10 weeks) and they survived longer (29 weeks) than PF patients (8 and 24 weeks) but the difference was only statistically significant for PFS (p = 0.02).…”

Transcutaneous electrical acupoint stimulation (TEAS) ameliorates chemotherapy-induced bone marrow suppression in lung cancer patients

“…Bone marrow suppression is defined as a decrease of blood cell activity in the bone marrow, which is mainly manifested by a decrease of white blood cells and platelets, and less so of red blood cells. Within the chemotherapy, carboplatin decreases white blood cell count by 27% after 10-14 days of initiation of treatment (9). For nedaplatin, which suppresses the bone marrow function by 80%, making it more toxic than cisplatin.…”

Second and third line treatment in non-small cell lung cancer

“…Some patients seem to benefit more than other from a second line treatment with paclitaxel (e.g. patients with stable disease after a first line platinum-based therapy, or a longer time-to-relapse) [23].…”