Comparison of Four Chemotherapy Regimens for Advanced Non-Small-Cell Lung Cancer

doi:10.1056/NEJMoa011954

Volume 346:92-98		January 10, 2002		Number 2

Comparison of Four Chemotherapy Regimens for Advanced Non–Small-Cell Lung Cancer

Joan H. Schiller, M.D., David Harrington, Ph.D., Chandra P. Belani, M.D., Corey Langer, M.D., Alan Sandler, M.D., James Krook, M.D., Junming Zhu, Ph.D., David H. Johnson, M.D., for the Eastern Cooperative Oncology Group

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by Carney, D. N.

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ABSTRACT

Background We conducted a randomized study to determine whetherany of three chemotherapy regimens was superior to cisplatinand paclitaxel in patients with advanced non–small-celllung cancer.

Methods A total of 1207 patients with advanced non–small-celllung cancer were randomly assigned to a reference regimen ofcisplatin and paclitaxel or to one of three experimental regimens:cisplatin and gemcitabine, cisplatin and docetaxel, or carboplatinand paclitaxel.

Results The response rate for all 1155 eligible patients was19 percent, with a median survival of 7.9 months (95 percentconfidence interval, 7.3 to 8.5), a 1-year survival rate of33 percent (95 percent confidence interval, 30 to 36 percent),and a 2-year survival rate of 11 percent (95 percent confidenceinterval, 8 to 12 percent). The response rate and survival didnot differ significantly between patients assigned to receivecisplatin and paclitaxel and those assigned to receive any ofthe three experimental regimens. Treatment with cisplatin andgemcitabine was associated with a significantly longer timeto the progression of disease than was treatment with cisplatinand paclitaxel but was more likely to cause grade 3, 4, or 5renal toxicity (in 9 percent of patients, vs. 3 percent of thosetreated with cisplatin plus paclitaxel). Patients with a performancestatus of 2 had a significantly lower rate of survival thandid those with a performance status of 0 or 1.

Conclusions None of four chemotherapy regimens offered a significantadvantage over the others in the treatment of advanced non–small-celllung cancer.

Source Information

From the University of Wisconsin Hospital and Clinics, Madison (J.H.S.); the Dana–Farber Cancer Institute, Boston (D.H., J.Z.); the University of Pittsburgh Cancer Institute, Pittsburgh (C.P.B.); the Fox Chase Cancer Center, Philadelphia (C.L.); Indiana University, Indianapolis (A.S.); the Duluth Clinic, Duluth, Minn. (J.K.); and Vanderbilt University, Nashville (D.H.J.).

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