Neoadjuvant Chemotherapy with Cisplatin, Epirubicin and VP-16 for Stage IIIA-IIIB Non-Small-Cell Lung Cancer: A Pilot Study

[Evaluation of second-line chemotherapies most often used in recurrent epithelial ovarian cancer]

INTRODUCTION

Second-line chemotherapies result in a progression-free interval of 2,3-42 months.

AIM

The authors evaluated the efficacy of second-line paclitaxel-carboplatin, topotecan, and cisplatin-epirubicin-etoposide combinations.

METHODS

Paclitaxel-carboplatin (175 mg/m2 and AUC 5) in 3-week intervals and topotecan (1.5 mg/m2/d1-3) in 3-week intervals was given to 13 and 16 patients. The triple combination of cisplatin-epirubicin-etoposide was applied in 48 patients in 4-week courses, with doses of 33 mg/m2/d1-3, 60 mg/m2/d1, and 100 mg/m2/d1-3., respectively. The progression-free interval was calculated by the product limit method of Kaplan-Meier.

RESULTS

A significantly better progression-free interval was observed in treatments with paclitaxel-carboplatin and cisplatin-epirubicin-etoposide compared to the topotecan chemotherapy (5 and 5.5 months vs. 4 months, respectively, p = 0.0324 and p = 0.0087). A better progression-free interval was found in the platinum-sensitive tumors compared to the platinum-resistant ones by the above mentioned combinations (6 and 3.5 months, 7 and 4 months, and 6.5 and 3.5 months, respectively).

CONCLUSION

The lower priced cisplatin-epirubicin-etoposide combination resulted in a slightly better efficacy compared to the 2 other treatments both in platinum-sensitive and platinum-resistant tumors.

Survival outcome of inoperable non-small cell lung cancer patients receiving conventional dose epirubicin and Paclitaxel as first-line treatment

OBJECTIVE

High-dose epirubicin was shown to be effective in the treatment of inoperable non-small cell lung cancer (NSCLC). Paclitaxel is synergistic to a conventional dose of anthracyclines in the treatment of advanced cancer. A phase II study was designed to test the effectiveness of combining paclitaxel with a conventional dose of epirubicin in inoperable NSCLC patients.

METHODS

Eligibility criteria included inoperable stage IIIB or IV NSCLC patients, Eastern Cooperative Oncology Group performance status of 0-2, measurable or evaluable disease and adequate organ function. Epirubicin 70 mg/m2 intravenous infusion for 15 min was given on day 1. Paclitaxel 175 mg/m2 intravenous infusion for 3 h was given on day 2. Cycles were repeated every 21 days. Tumor response was evaluated every two cycles. Patients received treatment until disease progression, unacceptable toxicity or stable disease after cycle 6.

RESULTS

Thirty-eight patients received a total of 185 cycles (median 6 cycles). Seventeen patients responded to treatment (response rate 44.7%). Twenty-six (68%) patients received second-line chemotherapy. All patients were followed until their death. Median survival was 11.9 months (95% confidence interval 9.0-14.9 months). Median time-to-treatment-failure was 4.6 months.

CONCLUSION

Conventional dose epirubicin plus paclitaxel is effective as a first-line treatment for inoperable NSCLC patients.

Anthracyclines in non-small cell lung cancer

The literature concerning the use of anthracyclines in the treatment of non-small cell lung cancer (NSCLC) is reviewed here. Overall, the activity of doxorubicin (DOXO) is unsatisfactory, whereas, the analogous epidoxorubicin (EPI) yields a 30% response rate (RR) when administered at intermediate-high doses. All active drugs, including EPI, should be considered to design the most active combination. Mainly, in the setting, in which an objective response is very important, for instance the neo-adjuvant pre-operatory setting.