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Dose-Dense Chemotherapy Regimen for Non-Small Cell Lung Canc

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Treatment of advanced non-small cell lung cancer with dose-dense Navelbine® (vinorelbine) and Taxotere® (docetaxel), coupled with Neupogen® (filgrastim) to reduce the risk of low white blood cell levels, is feasible, safe, and may prove to be more effective than conventional platinum-based regimens, according to a study published in the journal Cancer .

Lung cancer remains the leading cause of cancer death in the US. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 75%-80% of all lung cancers. Survival for patients with advanced lung cancer is poor; less than 10% of patients are expected to survive for five years or longer.

Initial treatment of advanced NSCLC often involves a platinum-based chemotherapy regimen. In an attempt to reduce toxic effects of treatment while maintaining or even increasing effectiveness, researchers are evaluating alternative chemotherapy regimens that are not platinum-based.

Researchers in the US evaluated a non-platinum-based chemotherapy regimen for the treatment of advanced NSCLC. The study involved 61 patients with stage IIIB or stage IV NSCLC who were treated with dose-dense Navelbine and Taxotere. Dose-dense chemotherapy is administered with shortened intervals between cycles; for example, chemotherapy that is usually given every three weeks may be given every two weeks.

While dose-dense regimens may kill more cancer cells, they also allow less time for bone marrow recovery. Inadequate bone marrow recovery may lead to low white blood cell levels (neutropenia) and an increased risk for infection. To prevent this complication, all patients in the study were also treated with Neupogen, a drug that stimulates the growth of white blood cells.

Treatment with up to eight cycles of this chemotherapy regimen resulted in the following:

Complete or partial disappearance of detectable cancer was achieved in 27% of patients.

Response to treatment lasted for a median of 6 months.

Median overall survival was 13 months, with 56% of patients surviving for at least one year.

Febrile neutropenia (low white blood cell count coupled with fever) occurred in 15% of patients.

The researchers conclude that the effectiveness of dose-dense Navelbine and Taxotere appears to be comparable to, if not better than, the effectiveness of the standard platinum-based chemotherapy regimens. Randomized clinical trials will be necessary to confirm this finding.

Reference: Page RD, Smith FP, Geils GF et al. Dose-Dense Vinorelbine and Docetaxel with Filgrastim Support in Patients with Advanced Nonsmall Cell Lung Carcinoma. Cancer. 2005;104:1956-61.

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