Gemcitabine and taxane combinations in non small-cell lung cancer

Gemcitabine, docetaxel, and paclitaxel are among the most active agents available for the treatment of non small-cell lung cancer (NSCLC). Each has been shown to produce objective responses in approximately 20%-25% of previously untreated patients with advanced or metastatic NSCLC and to improve survival and quality of life when compared to best supportive care. In randomized clinical trials, these drugs have produced response rates and survival outcomes equal to older platinum-based regimens and, when combined with a platinum compound, have produced the best results achieved to date in this disease. Because of their effectiveness and moderate toxicity profiles, investigators have studied novel combinations of these new agents. Multiple phase II clinical trials have explored a variety of doses and schedules of gemcitabine combined with docetaxel or paclitaxel. Randomized clinical trials have shown that gemcitabine 1000-1100 mg/m2 administered on days 1 and 8 every 3 weeks combined with either docetaxel 100 mg/m2 on day 8 or paclitaxel 200 mg/m2 on day 1 can produce response rates and survival outcomes at least equivalent to the newer platinum-based taxane regimens. More recently, several investigators have explored weekly administration of either docetaxel or paclitaxel with gemcitabine. Preliminary results are encouraging and suggest that these novel gemcitabine/taxane regimens could provide an alternative to standard platinum-based regimens.