Update on gemcitabine/carboplatin in patients with advanced non-small cell lung cancer

Platinum-based chemotherapy regimens comprise a standard treatment approach for patients with advanced and metastatic non-small cell lung cancer (NSCLC). Based on results from randomized studies and meta-analyses, it has been established that such therapy significantly improves survival and maintains or improves quality of life relative to best supportive care. Combinations of cisplatin or carboplatin with gemcitabine, a newer-generation nucleoside antimetabolite with single-agent activity of 20% to 26% in advanced NSCLC, have shown antitumor activity and are well tolerated. In many studies in the advanced-disease setting, carboplatin has replaced cisplatin because of its improved nonhematologic toxicity profile and greater ease of administration. Encouraging results in the phase II setting have led to the design and implementation of several phase III studies of gemcitabine/carboplatin in the treatment of patients with advanced NSCLC. Results of three phase III trials involving more than 900 patients not previously treated with chemotherapy are discussed herein. These studies compared gemcitabine/carboplatin versus gemcitabine alone, gemcitabine/carboplatin versus gemcitabine/cisplatin, and gemcitabine/carboplatin versus mitomycin/ifosfamide/cisplatin (MIP), a regimen commonly used in Europe. Results show that gemcitabine/carboplatin efficacy was equivalent or superior to that achieved with single-agent gemcitabine or other platinum-based treatments. The regimen was well tolerated overall, and available data from one study show a significant improvement in quality of life. Thus, gemcitabine/carboplatin appears to be a viable option in the first-line treatment of advanced NSCLC. The results of one study reviewed suggest that gemcitabine/carboplatin can be considered for the treatment of patients over 70 years old.