Concurrent paclitaxel-containing regimens and thoracic radiation therapy for limited-disease small cell lung cancer

Therapy for limited-disease (LD) small cell lung cancer (SCLC) includes combined modality therapy using radiation (XRT) and systemic chemotherapy. Because such therapy is effective in treating the disease, LD SCLC is now considered potentially curable. Based on data from the Intergroup study, the current standard chemotherapy regimen is etoposide plus either cisplatin or carboplatin administered concomitantly with XRT given once or twice daily. Paclitaxel has demonstrated efficacy in the treatment of extensive-disease (ED) SCLC and in vitro data suggest that the agent has significant radiosensitizing potential. The Sarah Cannon Cancer Center, Nashville, TN, recently reported the results of two sequential phase II studies evaluating two paclitaxel doses in combination with cisplatin and etoposide for SCLC; patients with LD SCLC also received XRT. Patients with LD SCLC demonstrated a higher overall response rate to the higher-dose regimen; median survival was 17 months with the lower-dose regimen and more than 16 months with the higher-dose regimen. Three additional studies are under way to further evaluate the role of paclitaxel in combination with cisplatin, etoposide, and XRT therapy for the treatment of LD SCLC. Although the number of evaluable patients is limited and all studies are ongoing, preliminary results thus far appear encouraging.