title: Randomized Phase II trial of paclitaxel and carboplatin followed by gemcitabine switch-maintenance therapy versus gemcitabine and carboplatin followed by gemcitabine continuation-maintenance therapy in previously untreated advanced non-small cell lung cancer.
abstract: BACKGROUND
  In recent years, maintenance chemotherapy is increasingly being recognized as a new treatment strategy to improve the outcome of advanced non-small cell lung cancer (NSCLC). However, the optimal maintenance strategy is still controversial. Gemcitabine is a promising candidate for single-agent maintenance therapy because of little toxicity and good tolerability. We have conducted a randomized phase II study to evaluate the validity of single-agent maintenance chemotherapy of gemcitabine and to compare continuation- and switch-maintenance.
  
  
  METHODS
  Chemonaïve patients with stage IIIB/IV NSCLC were randomly assigned 1:1 to either arm A or B. Patients received paclitaxel (200 mg/m2, day 1) plus carboplatin (AUC 6 mg/mL/min, day 1) every 3 weeks in arm A, or gemcitabine (1000 mg/m2, days 1 and 8) plus carboplatin (AUC 5 mg/mL/min, day1) every 3 weeks in arm B. Non-progressive patients following 3 cycles of induction chemotherapy received maintenance gemcitabine (1000 mg/m2, days 1 and 8) every 3 weeks. (
  
  
  BACKGROUND
  UMIN000008252) RESULTS: The study was stopped because of delayed accrual at interim analysis. Of the randomly assigned 50 patients, 49 except for one in arm B were evaluable. Median progression-free survival (PFS) was 4.6 months for arm A vs. 3.5 months for arm B (HR = 1.03; 95% CI, 0.45-2.27; p = 0.95) and median overall survival (OS) was 15.0 months for arm A vs. 14.8 months for arm B (HR = 0.79; 95% CI, 0.40-1.51; p = 0.60), showing no difference between the two arms. The response rate, disease control rate, and the transit rate to maintenance phase were 36.0% (9/25), 64.0% (16/25), and 48% (12/25) for arm A vs. 16.7% (4/24), 50.0% (12/24), and 33% (8/24) for arm B, which were also statistically similar between the two arms (p = 0.13, p = 0.32, and p = 0.30, respectively). Both induction regimens were tolerable, except that more patients experienced peripheral neuropathy in arm A. Toxicities during the maintenance phase were also minimal.
  
  
  CONCLUSIONS
  Survival and overall response were not significantly different between the two arms. Gemcitabine may be well-tolerable and feasible for maintenance therapy.
authors.affiliation: Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Minami
authors.forename: Takashi
authors.initials: T
authors.lastname: Kijima
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shiroyama
authors.forename: Kohei
authors.initials: K
authors.lastname: Okafuji
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hirashima
authors.forename: Junji
authors.initials: J
authors.lastname: Uchida
authors.forename: Fumio
authors.initials: F
authors.lastname: Imamura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Osaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ogata
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Namba
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Isao
authors.initials: I
authors.lastname: Tachibana
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Komuta
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawase
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D016190:Carboplatin; D017239:Paclitaxel; D000093542:Gemcitabine