Is Cisplatin Required for the Treatment of Non-Small-Cell Lung Cancer? Experience and Preliminary Results of a Phase I/II Trial with Topotecan and Vinorelbine
| Autor: | Nicolas Ketterer, J. Bauer, Roger Stupp, Mohamed Bakr, Bertrand Duvoisin, Lucien Perey, Serge Leyvraz, Alexandre Bodmer |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Male Oncology Cancer Research medicine.medical_specialty Lung Neoplasms medicine.medical_treatment Vinblastine Vinorelbine Sensitivity and Specificity Drug Administration Schedule Carcinoma Non-Small-Cell Lung Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Infusions Intravenous Lung cancer Aged Neoplasm Staging Chemotherapy Dose-Response Relationship Drug business.industry General Medicine Middle Aged medicine.disease Gemcitabine Surgery Survival Rate Irinotecan Regimen Treatment Outcome Docetaxel Female Topotecan Cisplatin business Follow-Up Studies medicine.drug |
| Zdroj: | Oncology. 61:35-41 |
| ISSN: | 1423-0232 0030-2414 |
| DOI: | 10.1159/000055390 |
| Popis: | Platinum-based chemotherapy is considered standard treatment for advanced non-small-cell lung cancer (NSCLC). However, toxicity of most platinum-based regimens is substantial and requires close monitoring and supportive care. Over the past decade, paclitaxel, docetaxel, vinorelbine, gemcitabine, irinotecan, and topotecan have been introduced into the clinic. These newer agents have shown promising activity against NSCLC with a favorable toxicity profile as single agents. For patients with metastatic NSCLC, palliation is the main goal of therapy. Therefore, treatment should be easy to administer on an outpatient basis. We explored a novel combination therapy avoiding platinum. Patients with recurrent or metastatic NSCLC were treated with intravenous (i.v.) topotecan (0.5–1.0 mg/m2/day × 5) and i.v. vinorelbine (20–30 mg/m2/day on day 1 and day 5) in 21-day cycles. Dose-limiting toxicity (DLT) was defined separately with or without the addition of granulocyte colony-stimulating factor (G-CSF) support. Twenty-nine patients have been enrolled to date. At i.v. topotecan doses of 0.75–1.0 mg/m2/day and i.v. vinorelbine of 25 mg/m2/day, neutropenia was frequent but of short duration (2) in the absence of G-CSF support was based on myelosuppression with neutropenic fever. With the addition of G-CSF, a DLT has not been reached. Nonhematologic toxicities included mild to moderate fatigue and constipation. An overall clinical response rate of 42% was achieved, with responses noted at all dose levels. At a short median follow-up of 15 months, the median survival for all patients is 13 months. In conclusion, the combination regimen of topotecan and vinorelbine is feasible for outpatient administration and is well tolerated with less toxicity than platinum-based regimens. Preliminary response data demonstrate good tumor activity, suggesting that this regimen could make an excellent palliative treatment for advanced NSCLC. |
| Databáze: | OpenAIRE |
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