Hainsworth J D, Greco F A
Sarah Cannon Cancer Center, Centennial Medical Center, Nashville, TN 37203, USA.
Semin Oncol. 1996 Dec;23(6 Suppl 16):98-101.
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.
本综述描述了两项含紫杉醇（泰素；百时美施贵宝公司，新泽西州普林斯顿）的非小细胞肺癌（NSCLC）治疗研究。在一项正在进行的研究中，100例先前未接受过治疗的IIIB期或IV期NSCLC患者接受了联合治疗，包括通过1小时静脉输注给予225mg/m²紫杉醇和卡铂，卡铂剂量使浓度 - 时间曲线下面积达到6.0。两种药物均通过静脉给药，每21天重复一个周期。经过两个疗程后出现客观缓解或病情稳定的患者最多继续接受10个疗程的治疗。100例患者中，36%有客观缓解，包括3例完全缓解。另外33%病情稳定/有轻微缓解。该方案耐受性良好。18%的患者出现3/4级周围神经病变，通常在第四个疗程期间或之后出现。一项早期研究评估了33例不可切除的IIIA期或IIIB期NSCLC患者的综合治疗。最初给予两个疗程的静脉诱导化疗（第1天通过1小时静脉输注给予135mg/m²紫杉醇；第2天给予60mg/m²顺铂；第1至3天给予100mg/m²依托泊苷）。两个疗程后，开始每天1.8至2.0Gy的放射治疗（中位总剂量60Gy）。患者在放疗期间也接受化疗：第1天1小时内给予135mg/m²紫杉醇，第2至5天和第8至12天给予5mg/m²顺铂，第1至5天和第8至12天给予25mg/m²依托泊苷。每21天重复一个周期。在完成治疗的29例患者中，41%达到完全缓解，41%有部分缓解。中位生存期超过14个月，30%的患者在完成治疗后12至29个月无疾病进展。51%的参与者出现3/4级食管炎，通常发生在综合治疗的最后2周。紫杉醇和卡铂联合方案对晚期NSCLC患者有效且耐受性良好，基于紫杉醇的综合治疗产生了较高的完全缓解和部分缓解率以及令人鼓舞的生存数据。这些方案的持续研究和优化正在进行中。
