Annals of Oncology 10:S69-S72, 1999
© 1999 European Society for Medical Oncology
Docetaxel (Taxotere®) in the neo-adjuvant setting in non-small-cell lung cancer
Department of Internal Medicine, Division of Pulmonary Medicine & Clinical Physiology Helsinki, Finland
Correspondence to: Dr K. Mattson, Helsinki University Hospital, Department of Internal Medicine, Division of Pulmonary Medicine & Clinical Physiology, Haartmaninkatu 4, FIN 00290 Helsinki, Finland E-mail: karin.mattson{at}huch.fi
Background: There is a potential for neo-adjuvant chemotherapy to provide significant benefit in outcome for patients with locally advanced non-small-cell lung cancer (NSCLC). Patients with N2/T3 NSCLC have a poor prognosis when treated by surgery alone since micrometastases result in relapse in the majority of cases. The same is true of patients with N3/T4 disease treated only with radiotherapy. Systemic therapy is therefor required, and cisplatin-based induction chemotherapy prior to surgery or radiotherapy has been shown to improve survival when compared with surgery or radiotherapy alone. Docetaxel has been shown to have significant activity in stage IV NSCLC and ongoing phase III trials are comparing single agent docetaxel or doceatxel in combination with cis-platin or VP16 before local treatment to local treatment alone.
Design: Patients with locally-advanced (stage Ilia or Illb) NSCLC receive three cycles of docetaxel (100 mg/m2) followed by appropriate local therapy, or local therapy alone. Local therapy for stage Ilia patients is surgery (with or without radiotherapy depending on completeness of resection) and for stage Illb patients curative intent radiotherapy.
In another on-going study in stage Ilia NSCLC, docetaxel (75 mg/m2) is given in combination with cisplatin (40 mg/m2) followed by surgery. Patients must have histologically or cyto-logically confirmed NSCLC, have received no prior treatment for the disease and are suitable to undergo surgery or radical radiotherapy, as appropriate.
Results: Initial results from the phase III comparative study show that single agent docetaxel in the neo-adjuvant setting is effective and associated with acceptable toxicity. Two hundred of the planned two hundred ninety-two patients have been accrued to the single-agent docetaxel neo-adjuvant study. In the first 49 evaluable patients in the docetaxel arm, 1 CR and 18 PR have been achieved (response rate 39%) and no patients receiving docetaxel neo-adjuvant therapy have progressed. All patients were able to receive the full doses of docetaxel.
Conclusion: The details of time-to-progression and survival in this study will eventually confirm the results from recent small trials of neo-adjuvant chemotherapy in locally-advanced NSCLC.
docetaxel, neo-adjuvant, non-small-cell lung cancer, Taxotere