Non-platinum-based first-line followed by platinum-based second-line chemotherapy or the reverse sequence in patients with advanced non-small cell lung cancer: a retrospective analysis by the lung cancer group of the Hellenic Oncology Research Group.
BACKGROUND
Non-platinum-containing regimens have been proposed as alternatives to platinum-based doublets in the first-line treatment of patients with non-small cell lung cancer (NSCLC). However, conflicting results about their equivalence have been reported.


METHODS
We reviewed the records of patients enrolled in randomized controlled first-line trials conducted by the Hellenic Oncology Research Group from February 1997 to September 2006. The outcome of patients treated with first-line non-platinum-based chemotherapy who received platinum-based chemotherapy upon progression (cohort A) or platinum-based first-line chemotherapy followed by non-platinum-containing second-line chemotherapy (cohort B) was retrospectively analyzed.


RESULTS
Two-hundred and sixty-seven patients were identified in cohort A, and 123 in cohort B. Median follow-up time was 12.5 and 15.7 months for cohorts A and B. A significantly higher response rate and time to tumor progression (TTP) was recorded for patients treated with platinum-based compared to those receiving non-platinum-based first-line chemotherapy (45.5 vs. 21.3%, p < 0.0001 and 5.8 vs. 3.1 months, p= 0.002, respectively). Platinum-based regimens administered as second-line treatment resulted in a 13.1% response rate. TTP for second-line chemotherapy did not differ significantly between the two cohorts. Median overall survival was 13.3 and 15.7 months for cohorts A and B (p = 0.538).


CONCLUSIONS
Both sequences resulted in similar efficacy in terms of overall survival. Encouraging median survival was achieved for selected patients with NSCLC who received both first- and second-line chemotherapy.
Department of Medical Oncology, University General Hospital of Heraklion, GR-711 10 Heraklion, Crete.
Sofia
S
Agelaki
Dora
D
Hatzidaki
Athanasios
A
Kotsakis
Pavlos
P
Papakotoulas
Aris
A
Polyzos
Nikolaos
N
Ziras
Ioannis
I
Gioulbasanis
Athanasios
A
Karampeazis
Athina
A
Agelidou
Xanthi
X
Tsiafaki
Vassilis
V
Chandrinos
Maria
M
Lerikou
Vassilis
V
Georgoulias
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006115:Greece; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010984:Platinum / Q000737:chemistry*; D012189:Retrospective Studies; D016896:Treatment Outcome
D010984:Platinum