A phase I/II study of docetaxel, etoposide, and carboplatin before concurrent chemoradiotherapy with cisplatin and etoposide in limited-stage small cell lung cancer

• Published in: Investigational new drugs 2006-05, Vol.24 (3), p.213-221
• Main Authors: Sunpaweravong, Patrapim, Magree, Lyn, Rabinovitch, Rachel, Bunn, Paul, Kelly, Karen
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer therapies; Carboplatin; Carboplatin - administration & dosage; Carboplatin - adverse effects; Carcinoma, Small Cell - drug therapy; Carcinoma, Small Cell - radiotherapy; Chemoradiotherapy; Chemotherapy; Cisplatin; Cisplatin - administration & dosage; Cisplatin - adverse effects; Combined Modality Therapy; Docetaxel; Drug dosages; Esophagitis; Etoposide; Etoposide - administration & dosage; Etoposide - adverse effects; Female; Growth factors; Humans; Leukopenia; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - radiotherapy; Male; Maximum Tolerated Dose; Middle Aged; Neutropenia; Neutropenia - chemically induced; Oncology; Patients; Radiation; Radiation therapy; Response rates; Small cell lung carcinoma; Survival; Taxoids - administration & dosage; Taxoids - adverse effects; Toxicity; Treatment Outcome; Tumors
• ISSN: 0167-6997; 1573-0646
• DOI: 10.1007/s10637-005-3669-3

Limited stage small cell lung cancer (LS-SCLC) is an infrequent but aggressive tumor. No major advances in the treatment of this disease have been achieved in recent years. This study was conducted to determine the maximum-tolerated dose (MTD) and efficacy of docetaxel, etoposide, and carboplatin (DEC) given before definitive chest radiotherapy with concurrent cisplatin and etoposide. Seventeen untreated LS-SCLC patients received docetaxel 50 mg/m2, etoposide 50-80 mg/m2, and carboplatin AUC = 5-6, intravenously on day 1 followed by etoposide 100-160 mg/m2 orally on days 2 and 3 every 21 days for two cycles followed by once daily radiotherapy to a total dose of 50 Gy given concurrently with cisplatin (60 mg/m2, d1) and etoposide (120 mg/m2, d1 and 240 mg/m2 day 2-3) for 2 cycles. All patients were assessable for toxicity and 15 for response. The most frequent toxicity was grade 3 and 4 neutropenia in 41% of patients during DEC and in 57% with chemoradiation. The MTD for DEC was docetaxel 50 mg/m2 plus carboplatin AUC = 5 and etoposide 50/100 mg/m2 with growth factor support. Significant nonhematologic toxicities were primarily radiation-related esophagitis (43%). One patient (6%) died from toxicity. The overall response rate was 82% with 10 patients (59%) achieving a complete response. The median survival was 12.1 months (95% CI, 6.4-17.8 months) and the 1-year survival rate was 47%. This novel approach produced similar efficacy results to current two drug regimens but was associated with significant neutropenia. Alternative strategies to increase complete response rates and survival are needed.