Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy

被引:1887
作者
Shepherd, FA
Dancey, J
Ramlau, R
Mattson, K
Gralla, R
O'Rourke, M
Levitan, N
Gressot, L
Vincent, M
Burkes, R
Coughlin, S
Kim, Y
Berille, J
机构
[1] Univ Toronto, Toronto, ON, Canada
[2] London Reg Canc Ctr, London, ON N6A 4L6, Canada
[3] Reg Hosp Lung Dis & TB, Poznan, Poland
[4] Univ Helsinki, Helsinki, Finland
[5] Alton Ochsner Med Fdn & Ochsner Clin, New Orleans, LA 70121 USA
[6] Greenville Mem Med Ctr, Greenville, SC USA
[7] Univ Hosp Cleveland, Cleveland, OH 44106 USA
[8] Vet Affairs Med Ctr, Houston, TX 77030 USA
[9] Rhone Poulenc Rorer, Collegeville, PA USA
[10] Rhone Poulenc Rorer, Paris, France
关键词
D O I
10.1200/JCO.2000.18.10.2095
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To evaluate whether treatment with single-agent docetaxel would result in longer survival than would best supportive care in patients with nonsmall-cell lung cancer who had previously been treated with platinum-based chemotherapy. Secondary end points included assessment of response (docetaxel arm only), toxicity, and quality of life. Patients and Methods: Patients with performance statuses of 0 to 2 and stage IIIB/IV non-small-cell lung cancer with either measurable or evaluable lesions were eligible for entry onto the study if they had undergone one or more platinum-based chemotherapy regimens and if they had adequate hematology and biochemistry parameters. They were excluded if they had symptomatic brain metastases or if they had previously been heated with paclitaxel. Patients were stratified by performance status and best response to cisplatin chemotherapy and were then randomized to treatment with docetaxel 100 mg/m(2) (49 patients) or 75 mg/m(2) (55 patients) or best supportive care. Patients in both arms were assessed every 3 weeks. Results: One hundred four patients (103 of whom were eligible for entry onto the study) were well balanced for prognostic factors, Of 84 patients with measurable lesions, six (7.1%) achieved partial responses (three patients at each dose level). Time to progression was longer for docetaxel patients than for best supportive care patients (10.6 v 6.7 weeks, respectively; P <.001), as was median survival (7.0 v 4.6 months; log-rank test, P =.047). The difference was more significant for docetaxel 75 mg/m(2) patients, compared with corresponding best supportive care patients (7.5 v 4.6 months; log-rank test, P =.010; 1-year survival, 37% v 11%; chi(2) test, P =.003). Febrile neutropenia occurred in 11 patients treated with docetaxel 100 mg/m(2), three of whom died, and in one patient treated with docetaxel 75 mg/m(2). Grade 3 or 4 nonhematologic toxicity, with the exception of diarrhea, occurred at a similar rate in both the docetaxel and best supportive care groups. Conclusion: Treatment with docetaxel is associated with significant prolongation of survival, and at a dose of 75 mg/m(2), the benefits of docetaxel therapy outweigh the risks. J Clin Oncol 18:2095-2103. (C) 2000 by American Society of Clinical Oncology.
引用
收藏
页码:2095 / 2103
页数:9
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