Journal of Clinical Oncology, Vol 17, Issue 8
(August), 1999: 2309
© 1999 American Society for Clinical Oncology
Cisplatin, Etoposide, and Paclitaxel in the Treatment of Patients With Extensive Small-Cell Lung Carcinoma
Bonnie S. Glisson,
Jonathan M. Kurie,
Roman Perez-Soler,
Nikolous J. Fox,
William K. Murphy,
Frank V. Fossella,
Jin S. Lee,
Michael B. Ross,
David A. Nyberg,
Katherine M.W. Pisters,
Dong M. Shin,
Waun Ki Hong
From the The University of Texas M.D. Anderson Cancer Center, Houston, and OnCare Texas, Inc, d/b/a Texas Cancer Care, Arlington, TX, and M.D. Anderson Cancer Center–Orlando, Orlando, FL.
Address reprint requests to Bonnie S. Glisson, MD, Box 80, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; email bglisson{at}mdanderson.org
PURPOSE: The combination of cisplatin, etoposide, and paclitaxel was studied in patients with extensive small-cell lung cancer in a phase I component followed by a phase II trial to determine the maximum-tolerated dose (MTD), characterize toxicity, and estimate response and median survival rates.
PATIENTS AND METHODS: Forty-one patients were treated between October 1993 and April 1997. Doses for the initial cohort were cisplatin 75 mg/m2 on day 1, etoposide 80 mg/m2/d on days 1 to 3, and paclitaxel 130 mg/m2 on day 1 over 3 hours. Cycles were repeated every 3 weeks for up to six cycles. The MTD was reached in the first six patients. In these six patients and in the next 35 patients, who were entered onto the phase II trial, response and survival were estimated.
RESULTS: At the initial dose level, one of six patients developed febrile neutropenia, and five of six achieved targeted neutropenia (nadir absolute granulocyte count, 100 to 1,000/µL) without any other dose-limiting toxicity, defining this level as the MTD. Grade 4 neutropenia was observed in 88 (47%) of 188 total courses administered at or less than the MTD. Neutropenia was associated with fever in only 17 (9%) of 188 courses, but two patients experienced neutropenic sepsis that was fatal. Nonhematologic toxicity greater than grade 2 was observed in 10 (5%) of 188 total courses, with fatigue, peripheral neuropathy, and nausea/vomiting most common. The overall objective response rate was 90% of 38 assessable patients: six complete responses (16%) and 28 partial responses(74%). Median progression-free and overall survival durations were 31 and 47 weeks, respectively.
CONCLUSION: The combination of cisplatin, etoposide, and paclitaxel produced response and survival rates similar to those of other combinations and was well tolerated.
Part of the research described in this article was published in abstract form (Proc Am Soc Clin Oncol 16:455a, 1997 [abstr 1635]) and was presented as a poster at the Annual Meeting of the American Society of Clinical Oncology, Denver, CO, May 17-20, 1997.
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