Seminars in oncology
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Seminars in oncology · Feb 1999
ReviewReview of paclitaxel/carboplatin in advanced non-small cell lung cancer.
The management of non-small cell lung cancer (NSCLC) has advanced in the last two decades. The greatest benefit has been achieved with the development of newer chemotherapeutic agents with single-agent response rates > or =20%. Recent research has focused on adding these newer agents to established drugs for NSCLC, like cisplatin and carboplatin, yielding notable improvement in response and survival rates. ⋯ Phase III trials are under way to establish the specific role of this regimen in NSCLC. The success of this combination also is being expanded through studies investigating its combination in triplets with newer agents, with follow-up therapy via sequential regimens, and by the addition of biologically based treatments. The results of these trials will determine the preferred treatment approach to NSCLC for the next decade.
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Seminars in oncology · Feb 1999
ReviewPaclitaxel plus carboplatin in the treatment of ovarian cancer.
Two large, prospective randomized trials by the Gynecologic Oncology Group and the European Organization for Research and Treatment of Cancer have demonstrated the superiority of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ)/cisplatin compared with cisplatin/cyclophosphamide in previously untreated patients with advanced ovarian cancer. Patients receiving the paclitaxel combination had a higher overall response rate, a longer time to disease progression, and prolonged median survival. In an effort to reduce toxicity, investigators developed combinations of carboplatin/paclitaxel that were found by phase I/II trials to have activity comparable to cisplatin/paclitaxel but with less toxicity. ⋯ The Gynecologic Oncology Group has completed a randomized comparison of three versus six cycles of paclitaxel/carboplatin in early stage disease. This study will be followed by a trial in which all patients with poor-prognosis, early stage ovarian cancer receive three cycles of paclitaxel/carboplatin followed by randomization to no further treatment or to weekly paclitaxel. The combination of paclitaxel/carboplatin is currently the preferred regimen for the treatment of ovarian cancer.
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Seminars in oncology · Feb 1999
ReviewCombining new agents with anthracyclines in metastatic breast cancer: an overview of recent findings.
Historically, doxorubicin has been the most effective single agent in metastatic breast cancer, and the combination of doxorubicin with other active agents (as in the 5-fluorouracil/doxorubicin/cyclophosphamide protocol) has improved patient outcome. Results from phase II and several recent phase III studies provide evidence that new agents are also highly active in the treatment of metastatic breast cancer and suggest that they would be active in combination regimens with the anthracyclines. ⋯ Studies to date indicate that this high response rate is achieved without accompanying cardiotoxicity. Several other new agents, notably, paclitaxel, vinorelbine, and gemcitabine, also have been evaluated in combination with the anthracyclines.
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Seminars in oncology · Dec 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPhase III studies of single-agent docetaxel in patients with metastatic breast cancer who have progressed despite previous chemotherapy regimens: preliminary results.
A recent large phase III trial has for the first time demonstrated that choice of treatment can influence survival duration in patients with metastatic breast cancer who have progressed despite previous anthracycline-containing therapy. In a multicenter study, patients who received docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) experienced a longer median survival time (II.4 months v 8.7 months; P = .0097) as well as a longer time to progression (19 weeks v II weeks; P < .001) and higher overall response rate (30% v II.6%; P < .0001) than patients receiving treatment with mitomycin C and vinblastine. The toxicity profile was manageable and tolerable for both arms. ⋯ In this study, the duration of survival was not influenced by treatment. However, the higher response rate with docetaxel was achieved without the risk of potentially fatal cardiac toxicity seen in some patients who received doxorubicin. To date, docetaxel is the only single agent shown to have a potential superior activity when compared with doxorubicin in patients with progressive metastatic disease.