Rational drug sequencing of paclitaxel, gemcitabine and carboplatin in patients with untreated stage IV and select stage IIIB non-small cell lung cancer

SummaryIntroductionTo conduct a phase II study evaluating the efficacy of rationally sequenced paclitaxel, gemcitabine, and carboplatin in patients with stage IV or select stage IIIB non-small cell lung cancer (NSCLC).MethodsPatients with select stages IIIB (pleural effusion) and IV NSCLC with an ECOG performance status of 0–1 and no prior chemotherapy for their disease were eligible to participate. Treatment was delivered as follows: paclitaxel at 70 mg/m2 followed by gemcitabine at 300 mg/m2 on day 1, with carboplatin (AUC 5) on day 2 of a 28-day cycle. Response was assessed after every two cycles of therapy. The primary endpoint of this trial was response rate, with secondary endpoints of time to progression and 1 year overall survival.ResultsTwenty patients were enrolled on protocol, one of whom never received chemotherapy. The median number of cycles delivered was 3 (range 0–8). A partial response rate of 42% (8/19; 95% CI: 20–67%) and a stable disease rate of 11% (2/19; 95% CI: 1–33%) were observed. The median overall survival time was 9.6 months (95% CI: 4.6–16.6), with a 1 year overall survival rate of 42.1% (95% CI: 24.9–71.3%). Eight patients (42%) stopped treatment due to toxicity.ConclusionPaclitaxel followed by gemcitabine and then carboplatin is an active, albeit complex, regimen in the treatment of patients with advanced NSCLC with insufficient advantage to justify continuation of this regimen.