One-hour paclitaxel in the treatment of non-small cell lung cancer

This review describes studies with two paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ)-containing treatments for non-small cell lung cancer (NSCLC). In an ongoing study, 100 patients with previously untreated stage IIIB or IV NSCLC received combination therapy comprised of paclitaxel 225 mg/m2 via 1-hour infusion and carboplatin, dosed to an area under the concentration-time curve of 6.0. Both drugs were given intravenously and cycles were repeated every 21 days. Patients with objective responses or stable disease after two courses continued for a maximum of 10 treatment courses. Of the 100 patients, 36% had an objective response, including three complete responses. An additional 33% had stable disease/minor response. The regimen was well tolerated. Grade 3/4 peripheral neuropathy, which usually appeared during or after the fourth treatment course, was noted in 18% of patients. An earlier study evaluated combined-modality therapy in 33 patients with unresectable stage IIIA or IIIB NSCLC. Two courses of intravenous induction chemotherapy were initially administered (paclitaxel 135 mg/m2 via 1-hour infusion, day 1; cisplatin 60 mg/m2, day 2; and etoposide 100 mg/m2, days 1 to 3). After two courses, radiation therapy was initiated at 1.8 to 2.0 Gy daily (median total dose, 60 Gy). Patients also received chemotherapy concurrent with radiation: paclitaxel 135 mg/m2 over 1 hour on day 1, cisplatin 5 mg/m2 days 2 to 5 and 8 to 12, and etoposide 25 mg/m2 days 1 to 5 and 8 to 12. Cycles were repeated every 21 days. Of the 29 patients who completed therapy, 41% achieved complete responses and 41% had partial responses. Median survival exceeds 14 months, and 30% of patients continue progression free 12 to 29 months after completion of therapy. Grade 3/4 esophagitis was observed in 51% of participants and usually occurred during the final 2 weeks of combined-modality therapy. The combination of paclitaxel and carboplatin is active and well tolerated in patients with advanced NSCLC, and paclitaxel-based combined-modality therapy produced a high rate of complete and partial responses and encouraging survival data. Continued investigation and refinement of these regimens is ongoing.