Triplet chemotherapy with gemcitabine, a platinum, and a third agent in the treatment of advanced non-small cell lung cancer.

Cisplatin-based chemotherapy regimens were shown to prolong survival, relieve symptoms, and improve quality of life in a cost-effective manner in patients with advanced non-small cell lung cancer. New chemotherapeutic agents introduced in the 1990s, such as gemcitabine, paclitaxel, docetaxel, vinorelbine, and irinotecan, were shown to be as effective or more effective than cisplatin. The doublet combination of these new agents with cisplatin or carboplatin was more active than either as single agents, and randomized trials showed that new combinations such as gemcitabine/ cisplatin, vinorelbine/cisplatin, and paclitaxel/cisplatin were preferred to cisplatin alone or to etoposide/cisplatin. Gemcitabine has a mild toxicity profile that allows it to be combined easily in triplet combinations with other doublets. Phase I-II trials of such triplet combinations show that each drug can be given safely in full dosage. Preliminary efficacy results of these gemcitabine-based triplet combinations are encouraging. Randomized trials comparing triplets such as gemcitabine/paclitaxel/carboplatin with the corresponding doublets are indicated.