Effectiveness of gemcitabine as second-line chemotherapy in non-small cell lung cancer.

The role of a second-line chemotherapy after an initial treatment with a platinum-based regimen remains largely undefined. In this retrospective clinical effectiveness study, gemcitabine as monotherapy was evaluated in the second-line chemotherapy in 34 non-small cell lung cancer (NSCLC) cases that had been previously received chemotherapy and did not respond to the treatment or presented with relapses. Gemcitabine was given intravenous at a dose of 1250 mg/m2 on days one, eight every three weeks. Median age was 50 years and squamous cell carcinoma was the most common malignancy (44.1%). No patient had a complete response, 7 (20.6%) patients had a partial response. The median survival was 29 weeks. The 1-year survival probability was estimated at 26.5%. Median time to disease progression was 13 weeks. Gemcitabine was well tolerated in this patient population. Among totally 119 chemotherapy cycles, we observed grade 3 and 4 toxicities only in 2.5% of cycles. As a result of the study, single agent gemcitabine is found to be tolerable and to have moderate effectiveness in the second-line chemotherapy in NSCLC. It should be placed among treatment options.

[Comparing cisplatin plus etoposide with combination of mitomycin, ifosfamide and cisplatin in advanced non-small cell lung cancer patients]. / Ileri evre küçük hücreli disi akciger karsinomunda sisplatin-etoposid ile mitomisin-ifosfamid-sisplatin kombinasyonlarinin karsilastirilmasi

Cisplatin-etoposide (CE) and mitomycin, ifosfamide and cisplatin (MIC) combinations are active conventional regimens in non-small cell lung cancer (NSCLC). In this retrospective study, we compared response rates, survival, duration of response, time-to-progression and toxicity of CE with MIC regimens in treatment of previously untreated patients with stage IIIB and IV NSCLC. We first determined the patients with NSCLC who had stage IIIB or IV and received CE or MIC between January 1997 and December 2002 in our clinic. Out of the eligible patients, 45 received MIC, 167 received CE. In addition 45 MIC patients, we included 46 of the 167 CE patients in the study by selecting one patient of every three patient randomly. In CE protocol, cisplatin 80 mg/m(2) on day 1 and etoposide 100 mg/m(2) on days 1, 2, 3 (every three weeks); in MIC protocol, mitomycin 6 mg/m(2), ifosfamide 3 g/m(2), cisplatin 50 mg/m(2) on day 1 (every three weeks) were performed. For statistical analysis, chi-square, t-test, Kaplan-Meier survival analysis, Cox regression analysis and logistic regression analysis were used by SPSS 11.5 computer program. The overall response rate was 33.3% in the MIC arm and 34.8% in the CE arm. A respective median survival was 28 weeks for the MIC arm and 35 weeks for the CE arm. Median duration of response and time to progression in each groups were 23 and 14 weeks in MIC arm and 32 and 22 weeks respectively. There was no statistical difference for response rates, duration of survival and response, time top progression and toxicity between the two arms. We consider that the combinations of MIC and CE have similar activity and they can be used confidently in advanced NSCLC.

A prospective, multicentre clinical trial comparing cisplatin plus gemcitabine with cisplatin plus etoposide in patients with locally advanced and metastatic non-small cell lung cancer.

OBJECTIVE: Cisplatin-gemcitabine (PG) and cisplatin-etoposide (PE) combinations are active regimens for non-small cell lung cancer (NSCLC). The present study aimed to compare PG with PE in the treatment of patients with stage IIIB and IV NSCLC. METHODOLOGY: We conducted a prospective, multicentre trial. A total of 166 patients were enrolled into the study and received either gemcitabine (1,000 mg/m(2)) on days 1, 8 and 15 plus cisplatin (80 mg/m(2)) on day 2 every 4 weeks, or etoposide (100 mg/m(2)) on days 1, 2 and 3 plus cisplatin (80 mg/m(2)) on day 1 every 3 weeks. RESULTS: The overall response rate was superior in the PG group (54.8%vs 39.0%, P=0.045). There was no significant difference in survival between the two groups, with respective median and 1-year survival of 38 weeks and 33.3% for the PG group, and 34 weeks and 23.2% for the PE group. There was also no statistical difference for time to progression between the two groups. Neutropenia and thrombocytopenia were seen more frequently in the PG group (grade 3 neutropenia, 33.3%vs 15.9%, P=0.012; grade 3 thrombocytopenia, 27.4%vs 3.7%, P<0.001 and grade 4 thrombocytopenia, 10.7%vs 1.2%, P=0.018). CONCLUSION: PG is an active chemotherapy regimen and has a better response rate than PE in advanced NSCLC, although there was no difference in time to progression and overall survival. A higher incidence of haematological toxicity was seen with PG than with PE.