Weekly Paclitaxel/Docetaxel Combined with a Platinum in the Treatment of Advanced Non-Small Cell Lung Cancer: a Study on Efficacy, Safety and Pre-medication

Objectives: To evaluate the efficacy and safety of a weekly taxane schedule in the treatment of advanced non small cell lung cancers (NSCLCs) and to generate anoptimal pre-medication protocol for weekly taxane. Methods: From December 2001 to June 2006, 78 patients with advanced NSCLCs were recruited from the Department of Chemotherapy, Jiangsu Cancer Hospital and Research Institute. Paclitaxel was delivered at 80-100mg/m2 on days 1 and 8 (11cases), or 50-80mg/m(2) on days 1, 8 and 15 (23cases), while docetaxel was given with the same schedules at 35-45 mg/m(2) (30cases), or 25-35mg/m(2) (14cases). In all cases this was combined with a platinum-based drug (cisplatin, oxaliplatin or carboplatin), followed by a 1 week rest. Four pre-medications were attempted were also compared. Results: All 78 patients received a total of 202 courses of treatment. Dose limiting toxicity was myelosuppression. Grades 3 and 4 leukopenia occurred in 19.2% (15/78). Of the 56 eligible patients who completed at least 2 courses, none had a complete response, 20 achieved a partial response and 5 showedprogression. Toxicity of pre-medications was indicated by: hypersensitivity (1 case), hypopotassemia (8 cases), myasthenia (5 cases), hiccups (1 case) and infection (2 cases). No treatment related deaths occurred. Conclusions: Weekly administration of paclitaxel/docetaxel is a safe and active protocol for advanced NSCLCs. Our recommendations for weekly pre-medication with taxane are: dexamethasone 2.25mg-7.5mg orally 12h and 2h before, promethazine and cimetidine 30min before paclitaxel; oral dexamethasone 4.5mg-7.5mg twice daily for three consecutive days (the day before, the day of, and the day after docetaxel), promethazine and cimetidine 30min before docetaxel.