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Chemotherapy Sequence Affects Lung Cancer Response

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By David Douglas

NEW YORK MAR 22, 2006 (Reuters Health) - Treatment with cisplatin followed by irinotecan appears to achieve better outcome in patients with nonsmall cell lung carcinoma than does treatment with the same drugs in the reverse order, according to Korean researchers.

"We found that the cisplatin-followed-by-irinotecan sequence was associated with a higher response rate," senior investigator Dr. Jin Soo Lee told Reuters Health. "We recommend administering cisplatin first and then irinotecan for future clinical use of this regimen."

In the February 15th issue of Cancer, Dr. Lee and colleagues at the National Cancer Center, Goyang point out that although the cisplatin plus irinotecan combination is effective for nonsmall cell lung carcinoma, they speculated that the administration sequence may affect patient response.

The researchers randomized 80 patients to receive irinotecan immediately followed by cisplatin, or cisplatin immediately followed by irinotecan on day 1.

Treatment was with irinotecan 80 mg per square meter on days 1 and 8, and cisplatin at 60 mg per square meter on day 1 of a 3-week cycle for a maximum of 6 cycles.

In the 77 patients available for assessment, the overall response rate was 47%, with a trend towards a better response (54%) in those given cisplatin followed by irinotecan compared with patients given irinotecan followed by cisplatin (39%).

The researchers note that administering cisplatin first may cause less toxicity than when the agents are given in the reverse order. When irinotecan was given before cisplatin, there were more episodes of severe nausea, neutropenia and other toxic side effects.


Cancer 2006;106:873-880.

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