European perspectives on paclitaxel/platinum-based therapy for advanced non-small cell lung cancer

Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has shown high clinical antitumor activity in several tumor types, including ovarian, breast, and lung carcinoma. Preclinical studies have shown that paclitaxel has an additive effect when combined with platinum compounds. Early clinical trials confirmed these data and established the dose range for both drugs. In recent years, several studies were developed in Europe using the combination of paclitaxel and platinum in non-small cell lung cancer, and four large randomized trials have been completed in Europe. The first study compared paclitaxel/cisplatin with teniposide/cisplatin, which was the control arm of the European Organization for Research and Treatment of Cancer at that time. The second study evaluated the benefit of the addition of paclitaxel to cisplatin. The third study compared paclitaxel/cisplatin with paclitaxel/carboplatin, and the fourth compared two doses of paclitaxel combined with carboplatin. Another large randomized study is currently being performed by the European Organization for Research and Treatment of Cancer. Combinations using paclitaxel-based regimens in the preoperative setting are under investigation. An ongoing European Organization for Research and Treatment of Cancer trial compares surgery with radiotherapy following various induction chemotherapy combinations, among which paclitaxel/platinum is one of the most frequently used. Another induction regimen is currently being evaluated by the University Medical School of Essen and Institut Gustave Roussy in Villejuif, France. In this trial, paclitaxel/cisplatin is delivered before etoposide/cisplatin and concurrent radiotherapy followed by surgery in locally advanced non-small cell lung cancer. Preclinical studies underline the radiosensitizing effect of paclitaxel, and many clinical studies are being conducted with radiotherapy in association with paclitaxel alone or in combination with platinum compounds. The use of paclitaxel in regimens without platinum and in triplet combinations is also being studied, and the optimal manner in which to administer this active agent clearly is of interest.