Seminars in oncology
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Seminars in oncology · Jun 1999
ReviewDocetaxel (Taxotere) and neoadjuvant chemotherapy for non-small cell lung cancer.
In locally advanced non-small cell lung cancer with ipsilateral (N2) or contralateral (N3) mediastinal node involvement, the presence of micrometastases results in a poor outcome when patients are treated by surgery alone. The prognosis is also bad in inoperable locally advanced disease (T4) treated solely by radiotherapy. Compared with surgery or radiotherapy alone, the additional use of cisplatin-based induction chemotherapy has been shown to significantly increase the prospects of long-term survival in these patients. ⋯ Several ongoing phase I/II studies are investigating neoadjuvant regimens in which docetaxel is combined with agents such as cisplatin and carboplatin. In preliminary results from a study of docetaxel plus cisplatin, an objective response was seen in 70% of 20 evaluable patients. It is hoped that the use of docetaxel in single-agent or combination induction regimens will prove to prolong patient survival.
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Seminars in oncology · Jun 1999
Multicenter Study Clinical TrialOverview of docetaxel (Taxotere)/cisplatin combination in non-small cell lung cancer.
Cisplatin-based chemotherapy is effective in non-small cell lung cancer (NSCLC), although it prolongs survival only modestly. Single-agent docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) is highly active against NSCLC. The activity and tolerability of two docetaxel/ cisplatin regimens were therefore investigated in two multicenter phase II studies, one in Australia and one in France. ⋯ Other severe toxicities were rare, with severe stomatitis and severe neurosensory side effects reported in 2% and 1%, respectively, of treated patients. No severe fluid retention occurred. Docetaxel/cisplatin, administered as two different schedules, is well tolerated and exhibits efficacy in the range of the most established combinations in the treatment of advanced NSCLC.
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Seminars in oncology · Jun 1999
ReviewDocetaxel (Taxotere) in combination with platinum-based regimens in non-small cell lung cancer: results and future developments.
The combination of docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) with cisplatin is feasible, has manageable toxicity, and is active in stage IIIB/IV non-small cell lung cancer. The four phase II trials completed to date show response rates ranging from 32% to 48% and median survival durations of 8 to 13 months. ⋯ Overall, this combination is also well tolerated. However, it will be necessary to use both docetaxel/platinum regimens at earlier stages in the disease if a significant impact is to be made on survival.
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Seminars in oncology · Jun 1999
ReviewEmerging role of docetaxel (Taxotere) in the adjuvant therapy of breast cancer.
The need for improved adjuvant chemotherapy programs for breast cancer patients is emphasized by the 1998 overview analysis of adjuvant trials, which demonstrates that although there has been substantial incremental advances in adjuvant therapy, relapse and death are prevented in less than half of women with micrometastatic disease. Because both docetaxel (Taxotere; Rhône-Pouleuc Rorer, Collegeville, PA) and paclitaxel have substantial non-cross-resistance with anthracyclines and therefore activity in anthracycline-resistant breast cancer, defining their roles in the adjuvant therapy of breast cancer is an area of great interest and active clinical investigation. ⋯ Ongoing or soon-to-open adjuvant trials are evaluating the impact of docetaxel added to conventional adjuvant anthracyclines regimens, substituted for anthracyclines, used in combination with anthracyclines, and in direct comparison to paclitaxel. The results of these ongoing adjuvant trials will define the role of docetaxel in adjuvant chemotherapy programs for the management of patients with breast cancer and are eagerly awaited.
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Seminars in oncology · Jun 1999
ReviewDoxorubicin/taxane combinations: cardiac toxicity and pharmacokinetics.
Doxorubicin and the taxanes, paclitaxel and docetaxel (Taxotere; Rhône-Poulenc Rorer, Collegeville, PA), are among the most active cytotoxic agents for the treatment of metastatic breast cancer. Given their activity, relative non-cross-resistance, partially non-overlapping toxicities, and differing mechanisms of action, there is a clear rationale for combining these agents for both advanced and early stage disease. Phase I and II trials have been reported for both doxorubicin/paclitaxel and doxorubicin/docetaxel. ⋯ This is likely explained by a pharmacokinetic interference of doxorubicin elimination by paclitaxel, an effect that is highly dependent on the interval between administration of the drugs and the duration of the paclitaxel drug infusion. Such an interaction has not been observed with doxorubicin/docetaxel, providing an explanation for the lack of enhanced cardiotoxicity with docetaxel-containing combination. Phase III trials comparing doxorubicin/taxane combinations with standard regimens have been completed and are in progress, and should help define whether the use of these drugs in combination offers any advantage over their use in a sequential fashion in both early and advanced disease.