Does triplet chemotherapy [gemcitabine, oxaliplatin and etoposide] have an impact on treatment outcome in advanced/metastatic non-small cell lung cancer?

ABSTRACT

Non-small-cell lung cancer [NSCLC] is the leading cause of cancer-related death. The combination of Vinca alkaloid and cisplatin represents a standard option for the initial therapy of patients with advanced NSCLC. A number of new anticancer agents have been tested and approved for the treatment of advanced NSCLC. Triplet agent chemotherapy has entered clinical practice in treatment of advanced cases of NSCLC. 28 evaluable patients of NSCLC with stage III-B or IV were enrolled in this study. One group received doublet regimen of cisplatin [120mg/m 2 D1, 22] and etoposide [120mg/m 2 D1-3 and recycle every 21 days]. Other group received triplet regimen of gemcitabine [800mg/ m 2 D1, 8] then oxaliplatin [80mg/ m 2 D1] and VP16 [120mg/ m 2 D1-3] with recycling every 21 days. Evaluation of response, toxicity and survival was performed. Age ranged from 36-75 years with a median age of 61 years. The main side effects were nephrotoxicity, neurotoxicity and gastrointestinal tract toxicity in doublet regimen, while hematological toxicity, orthostatic hypotension and neurotoxicity in triplet regimen group. Febrile neutropenia occurred in 37.5% in triplet regimen compared to 8.3% in doublet regime. Partial response was higher in triplet agent chemotherapy group. It occurred in 25% and 50% of cases triplet regimens respectively. Partial response occurred in 25% and 43.8% of cases of ECOG [0-1] in doublet and triplet regimens, compared to 8.3% and 12.5% of cases of ECOG-2 in both groups respectively. Improvement of dyspnea, hemoptysis, metastatic bony pains and quality of life was higher in patients of triplet regimen than doublet regimen cases. Median time to disease progression was 21 and 29 weeks in doublet and triplet regimens respectively. One-year survival was 33.3% and 56.3% in doublet and triplet regimens respectively. Even though hematological, neurotoxicities and orthostatic hypotension were higher in triplet drug regimen [gemcitabine, oxaliplatin, etoposide], but criteria of subjective improvement and objective response rate were in favor of triplet chemotherapy. Combination of oxaliplatin, gemcitabine and etposide increases efficacy and response in advanced and metastatic NSCLC cases. But it does not seem to have statistically significant effect on survival; so selection of cases that may benefit from the triplet drug regimen is important. It is recommended for metastatic or advanced cases with age