Figlin R A, Crowley J J, Jacobs E L, Muirhead M, Goodwin J W, Rinehart J J, Livingston R B
Department of Medicine, University of California at Los Angeles.
Cancer. 1996 Sep 1;78(5):998-1003. doi: 10.1002/(SICI)1097-0142(19960901)78:5<998::AID-CNCR9>3.0.CO;2-8.
The combined use of cisplatin and carboplatin chemotherapy offers a unique means of platinum dose intensification. Response rates using either of these agents in combination with etoposide are comparable. In a Phase II trial, the authors investigated the combination of cisplatin and carboplatin with etoposide for the treatment of patients with advanced nonsmall cell lung carcinoma.
Eligible patients were chemotherapy naive and had histologically confirmed, evaluable, or measurable selected Stage IIIB and Stage IV nonsmall cell lung carcinoma. Based upon the results of an earlier Phase I and II pilot study, patients received carboplatin, 225 mg/m2, on Day 1; cisplatin, 50 mg/m2, on Days 2 and 3; and etoposide, 75 mg/m2, on Days 1, 2, and 3 every-4-weeks.
Eighty-three patients (75 eligible patients) received chemotherapy with cisplatin, carboplatin, and etoposide. Two patients refused therapy after registration and were not analyzable. Thirty-six of the remaining 75 patients had Grade 4 toxicities, mostly hematologic, and 6 patients died of toxicity. The confirmed response rate was 24% (95% confidence interval, 15-35%). Median progression-free survival was 4 months and the median survival was 8 months.
Combination cisplatin, carboplatin, and etoposide chemotherapy appears to be no better than cisplatin/etoposide or carboplatin/etoposide for the treatment of patients with nonsmall cell lung carcinoma. The toxicity of this regimen may be higher, and therefore it cannot be recommended for general use.
顺铂和卡铂联合化疗提供了一种独特的铂剂量强化方法。这两种药物与依托泊苷联合使用时的缓解率相当。在一项II期试验中，作者研究了顺铂、卡铂与依托泊苷联合用于治疗晚期非小细胞肺癌患者的情况。
符合条件的患者此前未接受过化疗，组织学确诊为可评估或可测量的IIIb期和IV期非小细胞肺癌。根据早期I期和II期预试验的结果，患者每4周在第1天接受卡铂225mg/m²，在第2天和第3天接受顺铂50mg/m²，在第1、2、3天接受依托泊苷75mg/m²。
83例患者（75例符合条件的患者）接受了顺铂、卡铂和依托泊苷化疗。2例患者登记后拒绝治疗，无法进行分析。其余75例患者中有36例出现4级毒性，主要为血液学毒性，6例患者死于毒性反应。确认的缓解率为24%（95%置信区间，15 - 35%）。无进展生存期的中位数为4个月，总生存期的中位数为8个月。
顺铂、卡铂和依托泊苷联合化疗在治疗非小细胞肺癌患者方面似乎并不优于顺铂/依托泊苷或卡铂/依托泊苷。该方案的毒性可能更高，因此不推荐常规使用。
