Challenging the platinum combinations in the chemotherapy of NSCLC
Challenging the platinum combinations in the chemotherapy of NSCLC
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DOI：
10.1016/s0169-5002(02)00168-x
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发表时间：
2002-12-01
期刊：
影响因子：
5.3
通讯作者：
Scagliotti, GV
中科院分区：
文献类型：
--
作者：
Douillard, JY;Eckardt, J;Scagliotti, GV
在既往未经治疗的局部晚期或转移性非小细胞肺癌（NSCLC）患者中，多西他赛和吉西他滨联合治疗具有活性且耐受性良好。在使用3周方案的II期研究中，缓解率（RR）范围为25%至50%，中位生存期为11至13个月。每周一次和每两周一次给药方案的初步数据表明，在降低中性粒细胞减少症风险的同时维持了疗效。一项随机III期试验显示，多西他赛和吉西他滨联合治疗与多西他赛加顺铂治疗一样有效，1年生存率为39%，中性粒细胞减少和胃肠道毒性显著降低。多西他赛与长春瑞滨联合治疗具有同等活性，相关毒性可管理。在II期研究中，平均缓解率为40%，在一项使用2周方案的研究中，1年生存率为60%。使用该组合时，中性粒细胞减少症是最常见的不良事件，而具有临床意义的神经病变不常见。在一项随机II期试验中，比较了多西他赛联合顺铂与多西他赛联合伊立替康。非铂双联体达到了相当的活性水平，但具有不同的毒性特征（更多的腹泻，但更少的恶心和呕吐）。多西他赛联合伊立替康和卡铂的1年生存率为55%。所有三种多西他赛联合治疗（吉西他滨、长春瑞滨和伊立替康）都可以提供一种有价值的铂类化疗替代方案，应在III期背景下进一步评估。(C)2002爱思唯尔科学爱尔兰有限公司保留所有权利。
In previously untreated patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) the combination of docetaxel and gemcitabine is active and well tolerated. In the phase II setting using a 3-week schedule, response rates (RR) ranged from 25 to 50%, and median survival from 11 to 13 months. Preliminary data with weekly and bi-weekly schedules indicate maintained efficacy while reducing the risk of neutropenia. A randomized phase III trial has shown that the combination of docetaxel and gemcitabine is as active as docetaxel plus cisplatin, achieving a 1-year survival rate of 39%, with significantly less neutropenia and gastro-intestinal toxicity. The combination of docetaxel with vinorelbine is equally active and the associated toxicities are manageable. In phase II studies the average response rate is 40%, and in one study using a 2-week schedule the 1-year survival rate was 60%. With this combination neutropenia is the commonest adverse event while clinically significant neuropathy is infrequent. In a randomized phase II trial, docetaxel plus cisplatin was compared to docetaxel plus irinotecan. The non-platinum doublet achieved comparable levels of activity, though with a different toxicity profile (more diarrhea but less nausea and vomiting). The combination of docetaxel with irinotecan and carboplatin has achieved 1-year survival of 55%. All three docetaxel combinations (gemcitabine, vinorelbine, and irinotecan) could provide a valuable alternative to platinum-based chemotherapy and should be further evaluated in phase III setting. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.