Docetaxel (Taxotere) in combination with radiation therapy and the potential of weekly administration in elderly and/or poor performance status patients with advanced non-small cell lung cancer.
A randomized phase II trial conducted by the Cancer and Leukemia Group B in patients with unresectable non-small cell lung cancer showed that induction chemotherapy followed by concurrent radiotherapy and chemotherapy was feasible when cisplatin was administered together with either gemcitabine, vinorelbine, or paclitaxel. The dominant toxicity was esophagitis. Preliminary survival data are encouraging. Other trials in progress or planned will elucidate the relative contributions of induction and concurrent therapy to outcome. A phase I study has shown that it is feasible to combine docetaxel (Taxotere: Aventis, Antony, France) with concomitant radiotherapy in patients with advanced non-small cell lung or esophageal cancer. Giving the drug once every 3 weeks during standard radiotherapy, the maximum tolerated dose is 40 mg/m2 per cycle. The dose-limiting toxicities are neutropenia and esophagitis. However, it is possible to escalate the total docetaxel dose to 60 mg/m2 per cycle by weekly administration of 20 mg/m2. Beyond this point, esophagitis is dose limiting. In the palliative-intent treatment setting, the weekly administration of docetaxel is also likely to be a helpful new approach to administering the drug in subgroups of patients such as the elderly and those with concomitant disease. Weekly docetaxel (36 mg/m2/wk) was administered to patients with advanced non-small cell lung cancer who were elderly (median age, 71 years) or had poor performance status. In this unfavorable group, weekly docetaxel produced a 19% objective response rate and with further follow-up, 1-year survival is 28%. This level of activity is similar to other single agents recently evaluated in more favorable patient groups. The lack of myelosuppression seen with weekly administration suggests that the dose intensity of docetaxel could be maintained in combination regimens.
Hainsworth
J D
JD
Sarah Cannon Cancer Center, Nashville, TN, USA.
Vokes
E E
EE
D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000532:radiotherapy; D003131:Combined Modality Therapy; D000077143:Docetaxel; D004334:Drug Administration Schedule; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D043823:Taxoids
D000972:Antineoplastic Agents, Phytogenic; D011838:Radiation-Sensitizing Agents; D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel