title: Cisplatin plus vinorelbine as first-line treatment for advanced non-small-cell lung cancer: Is a hemogram on day 8 essential?
abstract: One of the standard treatments for metastatic non-small-cell lung cancer patients is the combination of cisplatin plus vinorelbine. This regimen is associated with a high rate of severe neutropenia, and a hemogram is therefore routinely performed on day 8 before the administration of vinorelbine. However, no study has ever examined the rate of neutropenia detected in this hemogram or the rate of discontinuation of chemotherapy as a result. Since one of the objectives in the treatment of advanced lung cancer is to maintain quality of life, we have retrospectively analyzed a Spanish Lung Cancer Group study of cisplatin plus vinorelbine to address the question of whether this hemogram on day 8 could be avoided, thus eliminating unnecessary venipunctures without endangering patient safety. Between April 2004 and January 2006, 180 chemotherapy-naïve, advanced NSCLC patients were included from 35 centers. They received intravenous doses of cisplatin 75mg/m(2) on day 1 plus vinorelbine 25mg/m(2) on days 1 and 8, every 3 weeks, for a maximum of six cycles. Median age was 62.5 years; 87.2% were males; 80.6% were smokers; 48.2% were adenocarcinomas and 36% were squamous cell carcinomas; 17.2% were stage IIIB and 82.8% stage IV. Of 750 cycles analyzed, vinorelbine was administered on day 8 in 661 (88.1%), and the dose was reduced or canceled in 15 (2%) due to hematological toxicity. Among patients aged<70 with no dose modification in previous cycles, the likelihood of observing hematological toxicity at day 8 was only 0.8% (95% CI, 0.1-3%). We speculate that the hemogram on day 8 could potentially be avoided in this subgroup of patients while still maintaining an acceptable safety margin. Prospective clinical studies to further examine this hypothesis are warranted.
authors.affiliation: Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Madrid, Spain. mprovenciop@gmail.com
authors.forename: Mariano
authors.initials: M
authors.lastname: Provencio
authors.forename: Ramón
authors.initials: R
authors.lastname: de Las Peñas
authors.forename: Carlos
authors.initials: C
authors.lastname: Camps
authors.forename: Angel
authors.initials: A
authors.lastname: Artal
authors.forename: Bartomeu
authors.initials: B
authors.lastname: Massuti
authors.forename: Manuel
authors.initials: M
authors.lastname: Cobo
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Pérez
authors.forename: Antonio
authors.initials: A
authors.lastname: Sánchez
authors.forename: Rafael
authors.initials: R
authors.lastname: Rosell
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009503:Neutropenia / Q000209:etiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000077235:Vinorelbine; D028761:Withholding Treatment
chemical_list: D014747:Vinblastine; D002945:Cisplatin; D000077235:Vinorelbine