Docetaxel (Taxotere) and neoadjuvant chemotherapy for non-small cell lung cancer

In locally advanced non-small cell lung cancer with ipsilateral (N2) or contralateral (N3) mediastinal node involvement, the presence of micrometastases results in a poor outcome when patients are treated by surgery alone. The prognosis is also bad in inoperable locally advanced disease (T4) treated solely by radiotherapy. Compared with surgery or radiotherapy alone, the additional use of cisplatin-based induction chemotherapy has been shown to significantly increase the prospects of long-term survival in these patients. Data from the first large, randomized study of docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) 100 mg/m2 every 3 weeks in neoadjuvant chemotherapy show good activity in stage III patients who have completed treatment. Toxicity was acceptable. Febrile neutropenia was experienced by 22% of patients, complicating only 3% of the 233 cycles administered. Several ongoing phase I/II studies are investigating neoadjuvant regimens in which docetaxel is combined with agents such as cisplatin and carboplatin. In preliminary results from a study of docetaxel plus cisplatin, an objective response was seen in 70% of 20 evaluable patients. It is hoped that the use of docetaxel in single-agent or combination induction regimens will prove to prolong patient survival.