|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Journal of Clinical Oncology, Vol 23, No 25 (September 1), 2005: pp. 6270-6271 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.01.7640
In Reply:St Bartholomew's Hospital, London, United Kingdom
Cancer Research UK and University College London Cancer Trials Centre, London, United Kingdom
University College Hospitals Trust, London, United Kingdom
Royal Marsden Hospital, London, United Kingdom
Guy's and St Thomas' National Health Service Trust, London, United Kingdom
Weston Park Hospital, Sheffield, United Kingdom
Norfolk and Norwich University Hospital, Norfolk, United Kingdom
Ninewells Hospital, University of Dundee, Dundee, United Kingdom We thank Drs Berghmans and Sculier for their comments on our recent article.1 Their letter raises an interesting difference between the United Kingdom experience1-3 and the experience of the European Lung Cancer Working Party (ELCWP)4-6 with the mitomycin/ifosfamide/cisplatin (MIC) regimen, with respect to compliance in the administration of the target number of chemotherapy cycles. We can only speculate, as they do, as to the possible reasons for the larger proportions of patients completing three and four cycles of MIC in the ELCWP trials. Our recent study recruited from a wide number of treatment centers around the United Kingdom (24 sites; median, 13 patients randomly assigned per site; range, 1 to 69 patients) and patient treatment reflected standard practice at that time. Recruitment took place between 1999 and 2001. There might be a difference between British and other European populations. The fact that the ELCWP reported lower rates of stopping chemotherapy for "unacceptable toxicity" may indicate differences in tolerance and acceptability. However, other factors are also relevant. Our study recruited patients with advanced stage IIIB and IV non–small-cell lung cancer in whom the treatment intent was palliative, in contrast with two of the Sculier et al trials,4,6 in which patients received induction/neoadjuvant chemotherapy before consolidation with radical radiotherapy, where the treatment intention was potentially curative and the threshold for stopping chemotherapy for "unacceptable toxicity" was therefore likely to be higher. In the Sculier et al trials only three cycles were planned at the outset, with two trials offering the possibility of administering more than three cycles after the planned treatment to some patients. Patients might have found the initial prospect of three cycles of therapy easier to cope with than the four planned cycles in our trial. In our trial, the proportion of cycles administered was balanced between the arms, indicating that the level of caution was consistent, and caution in administering chemotherapy therefore could not explain the superiority of gemcitabine and carboplatin over MIC. The main end points of the trial were survival and quality of life. Although it is becoming routine to use computed tomography scans to assess response, the advantage is marginal for patients with disease measurable by a simple chest x-ray, with no disease outside the thorax. In the United Kingdom at the time the patients were recruited, the availability of computed tomography scanning was limited in some centers. The imaging technique used to assess response is very unlikely to affect the com-parison between the two chemotherapy regimens. Authors' Disclosures of Potential Conflicts of Interest
Although all authors completed the disclosure declaration, the following authors or their immediate family members indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.
Dollar Amount Codes (A) < $10,000 (B) $10,000-99,999 (C)
REFERENCES
1. Rudd RM, Gower NH, Spiro SG, et al: Gemcitabine plus carboplatin versus mitomycin, ifosfamide, and cisplatin in patients with stage IIIB or IV non-small-cell lung cancer: A phase III randomized study of the London Lung Cancer Group. J Clin Oncol 23:142-153, 2005 2. Cullen MH, Joshi R, Chetiyawardana AD, et al: Mitomycin, ifosfamide and cisplatin in non-small cell lung cancer: Treatment good enough to compare. Br J Cancer 58:359-361, 1988[Medline]
3. Cullen MH, Billingham LJ, Woodroffe CM, et al: Mitomycin, ifosfamide, and cisplatin in unresectable non-small-cell lung cancer: Effects on survival and quality of life. J Clin Oncol 17:3188-3194, 1999
4. Sculier JP, Paesmans M, Lafitte JJ, et al: A randomised phase III trial comparing consolidation treatment with further chemotherapy to chest irradiation in patients with initially unresectable locoregional non-small-cell lung cancer responding to induction chemotherapy: European Lung Cancer Working Party. Ann Oncol 10:295-303, 1999 5. Sculier JP, Lafitte JJ, Paesmans M, et al: Phase III randomized trial comparing moderate-dose cisplatin to combined cisplatin and carboplatin in addition to mitomycin and ifosfamide in patients with stage IV non-small-cell lung cancer. Br J Cancer 83:1128-1135, 2000[CrossRef][Medline]
6. Sculier JP, Lafitte JJ, Berghmans T, et al: A phase III randomised study comparing two different dose-intensity regimens as induction chemotherapy followed by thoracic irradiation in patients with advanced locoregional non-small-cell lung cancer. Ann Oncol 15:399-409, 2004
Related Correspondence
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
$100,000 (N/R) Not Required
