Seminars in oncology
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Seminars in oncology · Jun 1999
ReviewWeekly administration of docetaxel (Taxotere): summary of clinical data.
Docetaxel (Taxotere; Rhône-Poulence Rorer, Antony, France) is a highly efficacious antineoplastic agent; however, its administration every 3 weeks produces substantial myelosuppression. Based on recent observations that the administration of paclitaxel on a weekly schedule minimizes myelosuppression, investigation of weekly docetaxel has been initiated. A recently completed phase I study of weekly docetaxel demonstrates markedly decreased myelosuppression with this schedule. ⋯ When used concurrently with radiation therapy, weekly scheduling allowed a maximization of docetaxel dosing, with the maximum tolerated dose being 20 mg/m2/wk. It is likely that this novel schedule of docetaxel will allow the drug to be used with decreased toxicity and will facilitate its incorporation into active combination regimens. Further investigation of this novel schedule of administration is warranted.
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Lymphocytes are present in normal breast. A lymphocytic mastopathy characterized by a lymphocytic infiltrate within the breast epithelium has been described, but its relevance as a precursor lesion of mucosa-associated lymphoid tissue (MALT)-type lymphoma of the breast is uncertain. Lymphomas of the breast are uncommon, and a broad variety of histologic types have been reported. ⋯ Burkitt's or Burkitt-like lymphoma can bilaterally involve the breast of a young pregnant or lactating woman and typically behaves aggressively. Primary breast lymphomas behave similarly to lymphomas of similar histologic types and stages presenting at other sites. Treatment of primary breast lymphomas does not include surgery, but is typically based on local radiotherapy, often combined with systemic chemotherapy.
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Seminars in oncology · Jun 1999
ReviewNew approaches in the adjuvant and neoadjuvant therapy of non-small cell lung cancer, including docetaxel (Taxotere) combinations.
Among the issues debated in the therapy of early non-small cell lung cancer are whether postoperative chemotherapy improves survival, whether postoperative radiation therapy has some benefit either in local control or in the prevention of distant recurrence, and whether neoadjuvant treatment benefits patients with stage IIIA disease. The role of surgery is being investigated in the North American Intergroup Trial, in which concurrent chemoradiotherapy followed by surgery and postoperative chemotherapy is compared with concurrent chemoradiotherapy alone. ⋯ However, even in these patients, the detection of tumor DNA in serum is a clear indication for postoperative chemotherapy. A trial undertaken by the Spanish Lung Cancer Group is currently investigating a novel neoadjuvant regimen involving gemcitabine, cisplatin, and weekly docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) in patients with mediastinoscopically confirmed N2 disease.
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Seminars in oncology · Jun 1999
Clinical TrialDocetaxel (Taxotere) in combination with vinorelbine in non-small cell lung cancer.
Following encouraging preclinical evidence suggesting anticancer synergy when docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) and vinorelbine are administered together, a clinical trial was designed to determine the maximum tolerated dose of the combination when given with granulocyte colony-stimulating factor support to 27 patients with advanced non-small cell lung cancer. Doses were escalated in stages to a maximum of 45 mg/m2 vinorelbine and 60 mg/m2 docetaxel, both administered on day 1 of a 2-week cycle. Hematologic toxicity was mild, with febrile neutropenia complicating only four of the 209 cycles delivered. ⋯ Major response was seen in 37% of patients. The median survival was 9 months and 1-year survival was approximately 35%. The combination of 45 mg/m2 vinorelbine and 60 mg/m2 docetaxel has now moved into a phase II trial.
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Seminars in oncology · Jun 1999
Clinical TrialDocetaxel (Taxotere) administered in weekly schedules.
The administration of a weekly low-dose taxane markedly reduces the severity of myelosuppression compared with a once-every-3-week schedule and allows the dose intensity (mg/m2/wk) of treatment to be increased. The dose-limiting toxicity observed in a weekly phase I trial was fatigue/asthenia. The maximum tolerated dose of a weekly docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) phase I study was 43 mg/m2; 36 mg/m2 was recommended for further study. ⋯ Other studies have been conducted to evaluate the efficacy and safety of the weekly schedule. One such study is an ongoing phase II trial in elderly or medically unfit patients with previously untreated advanced non-small cell lung cancer in whom weekly docetaxel appears active and well tolerated. Further investigation of weekly docetaxel alone or in combination is warranted.