Elsevier

Lung Cancer

Volume 31, Issues 2–3, March 2001, Pages 267-270
Lung Cancer

Cisplatin and vinorelbine as second-line chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) resistant to taxol plus gemcitabine

https://doi.org/10.1016/S0169-5002(00)00176-8Get rights and content

Abstract

The aim of the study was to evaluate the activity of cisplatin (CDDP) plus vinorelbine (VNR) in patients with advanced non-small cell lung cancer (NSCLC) progressing after paclitaxel plus gemcitabine. Treatment consisted of CDDP 80 mg/m2 administered on day 1 and VNR 25 mg/m2 administered on day 1 and 8, repeated every 3 weeks. Nine patients who relapsed after partial response and eight patients refractory to prior CT received a minimum of two treatment cycles: three patients achieved a PR (18%; 95% CI: 4–43%), four had stable disease and 10 had disease progression. All responses were observed among the nine patients responsive to prior treatment. Median survival was 35 weeks. No patients required dose-reduction, treatment discontinuation or delay because of toxicity. Our results indicate a reasonable antitumor efficacy and no relevant toxicity of a second-line CDDP-based chemotherapy in patients with advanced NSCLC. We recommend the use of this regimen for patients not refractory to primary treatment.

Introduction

First-line Cisplatin (CDDP)-based polichemotherapy prolongs survival and improves quality of life in patients with advanced non-small cell lung cancer (NSCLC) [1]. To our knowledge, no studies have tested the activity of CDDP-based regimens as second-line chemotherapy (CT) in patients with NSCLC resistant to a first-line combination of new drugs not containing CDDP.

Cisplatin plus vinorelbine (VNR) is an active combination in patients with advanced NSCLC, with a response-rate as first-line treatment ranging between 26 and 43% in randomized studies [2], [3], [4], [5].

Between November 1997 and March 1999, we treated 35 chemo-naive patients with advanced NSCLC in a dose-escalation study with paclitaxel (TAX) plus Gemcitabine (GEM) given weekly [6]. In the present study we analysed the outcome of 17 of these patients that were successively treated with CDDP plus VNR at the time of progression.

Section snippets

Patients and methods

Seventeen patients with advanced NSCLC resistant to weekly TAX and GEM were treated in our institute with CDDP plus VNR as second-line chemotherapy. Three patients received external radiotherapy after first-line CT on non-parameter sites (mediastinum, two patients; bone, one patient). We considered refractory to the previous treatment patients with progressive disease while receiving CT and patients with no disease response after receiving a minimum of two cycles of CT [7]. Treatment consisted

Results

Between June 1998 and September 1999, 17 patients with advanced NSCLC were treated with a second-line CT with CDDP plus VNR. All patients progressed after TAX plus GEM given weekly, administered as first-line CT in a previous dose-escalation study. The median interval between the last course of first-line CT and the first course of second-line CT in sensitive cancers was 17 weeks (range: 4–34 weeks). Patients characteristics are reported in Table 1.

Eight patients were considered refractory to

Discussion

We treated with Cisplatin (CDDP) plus Vinorelbine (VNR) 17 patients with NSCLC progressing after a first-line chemotherapy with paclitaxel (TAX) plus Gemcitabine (GCB). Three patients achieved a partial response (18%, 95% CI: 4–43%), four had stable disease and 10 had disease progression. All responses were observed among the nine patients that achieved a PR maintained at least until the end of the prior treatment. Time to progression of the responders was 16+, 28 and 50 weeks.

At a median

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