Combination treatment with docetaxel (Taxotere) and platinum compounds for non-small cell lung cancer

There is a strong rationale for combining docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) and platinum compounds for use in the treatment of non-small cell lung cancer (NSCLC). The compounds are active as single agents and have no overlapping toxicity profiles. The first dose-finding study reported a response rate of 46%, and recommended doses of 75 mg/m2 for docetaxel and 75 to 100 mg/m2 for cisplatin, given concomitantly every 3 weeks. Three other studies confirmed a response rate of 33% to 48% in previously untreated patients. Dose-limiting but rapidly reversible neutropenia was observed. A European trial has investigated the use of alternating cycles of docetaxel 100 mg/m2 and cisplatin 120 mg/m2 in patients with previously untreated metastatic or nonresectable NSCLC. Preliminary results indicate that the overall response rate (33% of 39 evaluable patients) is similar to that achieved with docetaxel alone. A second trial is investigating alternating therapy using docetaxel 100 mg/m2 and a combination of cisplatin 100 mg/m2 and vinorelbine 30 mg/m2. Response rates are higher (49%) and toxicities, especially hematologic toxicities, are lower than in the first study. A third trial is investigating sequential treatment using docetaxel 100 mg/m2, cisplatin 120 mg/m2, and vindesine 3 mg/m2. Preliminary results indicate a response rate of 30% among 25 patients enrolled thus far. Compared with monotherapy, docetaxel/platinum combinations appear to offer the potential for improved response rates in patients with NSCLC. The use of alternating schedules offers the further possible advantage of improving tolerability while retaining effective doses. Further studies are in progress or planned to elucidate optimal doses and schedules.