Seminars in oncology
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Seminars in oncology · Feb 1999
ReviewReview of docetaxel and doxorubicin-based combinations in the management of breast cancer: from metastatic to adjuvant setting.
Considering the efficacy of docetaxel (Taxotere, Rhône-Poulenc Rorer, Antony, France) and doxorubicin in advanced breast cancer and their potential noncross-resistance, two pilot studies of docetaxel/doxorubicin (TA)-based combinations were conducted, one being a phase I dose-finding study of TA and the second a phase II study of docetaxel/doxorubicin/cyclophosphamide (TAC). The only significant toxicity, seen in both trials, was neutropenia and its consequences such as febrile neutropenia without significant documented infections. ⋯ In terms of efficacy, response rates in excess of 70% and 80% were noted in both studies, even for patients with visceral metastases. Several phase III randomized trials using TA or TAC are presently being performed in first-line metastatic breast cancer and most importantly in the adjuvant setting to assess whether TA-based combinations will change the natural history of breast cancer.
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Seminars in oncology · Feb 1999
ReviewA review of the efficacy and safety of docetaxel as monotherapy in metastatic breast cancer.
To date, although statistically significant, the overall impact of adjuvant chemotherapy on the survival of women with nonmetastatic breast cancer has been disappointing. Hence, new agents that have shown good activity against metastatic disease should be assessed quickly in the adjuvant setting. Docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) is one of the most promising drugs that has emerged in recent years, with phase II studies in previously untreated metastatic breast cancer indicating a high overall response rate of approximately 60%. ⋯ The high activity of docetaxel provides a compelling rationale for its study as a component of adjuvant therapies. Investigators in Brussels and Dublin have recently demonstrated the feasibility of two candidate adjuvant programs. Large phase II adjuvant trials involving docetaxel are now being assessed.
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Seminars in oncology · Feb 1999
ReviewThe current role and future prospects of paclitaxel in the treatment of small cell lung cancer.
When combination regimens containing a platinum compound and etoposide are used, median survivals in patients with extensive- and limited-stage small cell lung cancer are 7 to 10 months and 15 to 20 months, respectively. A recent randomized trial demonstrated equivalent efficacy and decreased toxicity with carboplatin/etoposide compared with cisplatin/etoposide. ⋯ Ongoing phase III trials will better define the contribution of paclitaxel to standard platinum/etoposide regimens. In addition, phase II trials of novel paclitaxel combinations (e.g., paclitaxel/topotecan, paclitaxel/carboplatin/topotecan) are ongoing.
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Seminars in oncology · Feb 1999
ReviewComparing irinotecan with best supportive care and infusional 5-fluorouracil: a critical evaluation of the results of two randomized phase III trials.
Two randomized phase III trials have been conducted in colorectal cancer patients with nonbulky metastatic disease who have failed first-line therapy with 5-fluorouracil (5-FU). In one trial, the use of 350 mg/m2 irinotecan was shown to significantly prolong survival relative to best supportive care. Patients receiving irinotecan also experienced higher quality of life than the controls. ⋯ The results of these trials have implications for everyday clinical practice. When appropriate, irinotecan should be offered to patients who have failed 5-FU. Irinotecan should be the reference arm for future studies of investigational second-line drugs; the potential of irinotecan (alone or in combination) in the first-line and adjuvant treatment of colorectal cancer now needs to be evaluated.
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Seminars in oncology · Feb 1999
ReviewIncorporation of paclitaxel and carboplatin in combined-modality therapy for locally advanced non-small cell lung cancer.
Combined chemotherapy and thoracic radiation therapy has emerged as a primary treatment option for locally advanced, unresectable non-small cell lung cancer (NSCLC). Randomized trials and subsequent metaanalyses have shown a clear survival benefit with platinum-based combination chemotherapy administered sequentially or concurrently with hyperfractionated thoracic radiation over radiation alone. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and carboplatin recently have been evaluated in numerous phase 1/11 trials at various doses in both sequential and concurrent schedules with thoracic radiation in patients with locally advanced and unresectable NSCLC. ⋯ Numerous phase II and III trials are currently planned or under way to further define the efficacy of this novel combination of paclitaxel/carboplatin in combined-modality programs in an attempt to determine the optimal administration sequence of chemotherapy and thoracic radiation. These combined-modality programs are now being integrated into trials for early stage, potentially resectable disease. Thus, NSCLC is in fact a systemic disease requiring a multidisciplinary approach for optimal management.