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Indian Journal of Medical and Paediatric Oncology
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Year : 2005  |  Volume : 26  |  Issue : 1  |  Page : 5-11

Retrospective non-randomized comparative analysis of experience with two cisplatin based regimens in first line combination chemotherapy of advanced non-small cell lung cancer

Dept. of Oncology, Saroka University Medical Center, P.O.B 15184101, Israel

Correspondence Address:
K Lavrenkov
Dept. of Oncology, Saroka University Medical Center, P.O.B 15184101, Israel

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Source of Support: None, Conflict of Interest: None

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Background: There is no single-standard treatment for locally advanced non-small cell lung cancer (NSCLC), but platinum based chemotherapy with one of the new generation agents is regarded as most effective for patients with good performance status. The purpose of this study is retrospective comparative analysis of response, toxicity and survival of two chemotherapy regimens containing cisplatin, combined with gemcitabine (GP) or vinorelbine (VP) in previously untreated patients with advanced NSCLC. Patient and Methods: Between 1998-2001, 60 patients (51 males and 9 females) with stage III B-IV NSCLC received chemotherapy. Fifty two patients (86.7 percent) presented with locally advanced (stage IIIB - 11 patients, 18.3 percent) or metastatic (stage IV - 41 patients, 68.4 percent), and 8 patients (13.3 percent) had metastases after previous radical surgery. The choice of chemotherapy regimen was a matter of distinction of treating physician. 31 patients received chemotherapy GP and 29 patients were treated with VP regimen. The groups were comparable in terms of age, performance state and stage of disease. Chemotherapy regimens consisted of either intravenous (i.v.) gemcitabine 1250 mg per m2 given over 30 minutes on days 1 and 8, and i.v. cisplatin 80 mg per m2 given over 2 hours on day 8, both repeated every 3 weeks, or i.v. vinorelbine 30 mg per m2 given over 10 minutes on days 1, 8 and 15 and i.v. cisplatin 80 mg per m2 given over 2 hours on day 1, both repeated every 4 weeks. Both regimens were planned to 6 cycles. Treatment was terminated in case of disease progression or unacceptable toxicity. All patients were evaluable for response and toxicity. Results: A total of 157 cycles of GP and 142 cycle of VP were given. Therapy was well-tolerated without any life threatening event. Grade III-IV toxicities for GP and VP regimens included vomiting in 0 percent vs 13.8 percent, neutropenia in 29 percent vs 68 percent (p=0.007), neutropenic fever 0 percent vs 10.3 percent, thrombocytopenia in 9.7 percent vs 0 percent, anemia in 3.2 percent vs 13.7 percent and peripheral neuropathy 0 percent vs 6.8 percent of patients respectively. Thirty one per cent of patients who received VP developed chemical phlebitis, that ultimated insertion of central venous access device. No complete responses (CR) were documented. Partial response (PR) was achieved in 29 percent of patients who received GP as compared with 20.7 percent of those treated with VP, the disease remained stable (SD) in 32.3 percent and 31 percent of patients respectively.. There was no statistically significant difference in survival between GP and VP groups. The median progression free survival was 7 months vs 4 months, the median survival was 12.5 vs 8.3 months and one-year survival was53 percent vs 45 percent respectively. Conclusions: To our experience, chemotherapy GP and VP for advanced NSCLC were both well tolerated. Though the rate of neutropenia was significantly higher in VP group, it was not life threatening. Response and survival analysis reveals no statistically significant difference between two regimens that correspond with data reported in the literature. Both GP and VP regimens may be used as a standard of care for advanced NSCLC.

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