Defining the role of paclitaxel in lung cancer: summary of recent studies and implications for future directions

Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) was first reported to have activity in advanced non-small cell lung cancer (NSCLC) in 1993 and in advanced small cell lung cancer (SCLC) in 1995. Since these original reports, single-agent activity has been confirmed in both NSCLC and SCLC. In NSCLC, the 20% to 25% response rate and median survival times (approximately 40 weeks) are superior to previously reported single-agent therapy. In SCLC, the response rate (> or =50%) and median survival (10 months) are similar to the best previously reported agents. Paclitaxel can be combined safely with both cisplatin and carboplatin. In advanced NSCLC, these two drug combinations produce higher response rates (39% to 42%) than either drug alone. The median survival times reported with the combinations (39 to 45 weeks) are slightly longer than with single-agent paclitaxel. Paclitaxel and cisplatin combinations were shown to be superior to cisplatin and podophyllotoxin combinations in randomized trials. Paclitaxel and paclitaxel plus carboplatin combinations can be safely combined with chest radiotherapy in patients with stage III NSCLC. Response rates and survival times are at least as good as prior best therapies and the results of randomized trials are eagerly awaited. Similarly, paclitaxel and carboplatin combinations produce high response rates when given before surgery for operable patients, and the results of randomized trials are needed to confirm the value of this approach. Paclitaxel-based combinations in advanced SCLC can be administered safely and provide high response rates and relatively long survival times. Randomized trials comparing these combinations to older etoposide/cisplatin combinations are in progress.