[MOL] NSCLC Info. [03120] Medicine On Line

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Journal Summary
Non-Cisplatin Combination May Make Good Choice for Lung Cancer
By Joel B. Finkelstein

The combination of vinorelbine and gemcitabine for treating stage IIIB/IV non-small cell lung cancer may offer a good alternative to cisplatin therapy and its "notorious GI side effects," based on a phase II trial of 40 patients.

Treatment with vinorelbine (Navelbine) plus gemcitabine (Gemzar) yielded a high overall response rate of 72.5 percent. Two patients experienced a complete response and 27 had a partial response, according to the study conducted by Yuh-Min Chen, M.D., Ph.D., of the Veterans General Hospital in Taipei, Taiwan, and associates.

The median duration of response was just over seven months in the 40 patients. Median survival was 11 months, and nearly half of the patients were still alive after one year. The study was published in the June issue of Chest.

The main toxicities of concern were hematologic, with about 50 percent of the patients experiencing severe leukopenia and neutropenia. Although the only treatment-related death was due to neutropenic sepsis, three patients experienced febrile neutropenia. Severe thrombocytopenia was seen in 12.5 percent of the patients and anemia in 20 percent. Other side effects included skin rashes and fatigue or flu-like syndromes.

Nausea and vomiting were reported in a minority of patients. However, the study's participants were given antiemetic prophylaxis with dexamethasone and metoclopramide.

The researchers noted that histology seemed to offer some predictive value. Among patients with adenocarcinoma or unspecified cell type, the response rate was close to 90 percent, while in patients with squamous cell carcinoma the response rate was below 50 percent.

The treatment protocol consisted of six four-week cycles with infusions of vinorelbine and gemcitabine given on days 1, 8 and 15. The majority of patients (31) required dose reductions due to myelosuppression, severe fatigue or hepatotoxicity. In the end, the average doses patients received were 15 mg/m2/week of vinorelbine and 600 mg/m2/week of gemcitabine.

A Multicenter Phase II Trial of Vinorelbine Plus Gemcitabine in Previously Untreated Inoperable (Stage IIIB/IV) Non-small Cell Lung Cancer. Yuh-Min Chen, M.D., Ph.D., F.C.C.P.; Kuang-Yao Yang, M.D.; Tsang-Wu Liu, M.D.; Chun-Ming Tsai, M.D.; Jacqueline Ming-Liu, M.D.; and Jacqueline Whang-Peng, M.D. Chest, Vol. 117, No. 6 (June 2000), pp. 1583-1589

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