The Oncologist, Vol. 2, No. 3, 190-a–190,
June 1997
© 1997 AlphaMed Press
SPECIAL FEATURE
BRIEF REPORT |
Taxotere (Docetaxel): How I Use It in Lung Cancer
James R. Rigas, M.D.
Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756
Surgery remains the mainstay of curative treatment for non-small cell lung cancer (NSCLC). Cisplatin-based chemotherapy regimens of the 1980s have been shown to have a small, but significant, impact on survival for patients with stage III and IV disease. New agents have shown encouraging single-agent activity in NSCLC and the cisplatin combination regimens may further advance the treatment of this disease. Docetaxel is one such new agent which has shown promising single-agent activity in NSCLC. The results of six single-agent phase II trials and three cipsplatin combination trials are described below.
Three hundred and seventy-nine (379) patients with advanced or recurrent NSCLC have been enrolled into nine trials of docetaxel administered intravenously every 21 days. Seven of the trials enrolled 291 chemotherapy-naïve patients (four single-agent phase II trials, n = 160; and three phase I/II cisplatin combination trials, n = 131), and two of the trials enrolled 88 patients who failed prior platinum-containing chemotherapy. Response rate in the intent-to-treat analyses for single-agent phase II trials of 160 chemotherapy-naïve patients was 27% (95% confidence interval: 20%-34%). The median and one-year survival for the single-agent phase II trials was 9.2 months and 39%. Response rate for 88 platinum-treated patients was 17% (95% confidence interval: 10%-27%) and the median and one-year survival for these previously platinum-treated patients was 9.0 months and 38%. Respnse rate for 131 patients treated in the phase I/II cisplatin combination trials was 38% (95% confidence interval: 30%-46%). The median and estimated one-year survival for the docetaxel and cisplatin combination trials was 10.0 months and 40%. Leukopenia, alopecia, fluid retention, infusion-related reactions, onycholysis, and rash were adverse events observed in these trials. Dexamethasone premedication lessens the frequency and severity of fluid retention, infusion-related reactions, and rash. Docetaxel, as a single agent and combination with cisplatin, demonstrates significant activity in NSCLC. Trials of docetaxel in combination with carboplatin, cisplatin, vinorelbine, gemcitabine, irinotecan, and thoracic radiation are in progress. Trials of docetaxel, as primary chemotherapy for stage III NSCLC, are warranted.
