Paclitaxel for Limited-Stage Small-Cell Lung Cancer
Authors: F. Anthony Greco, John D. Hainsworth, Nathan Levitan, Afshin Dowlati
Journal: Journal of Clinical Oncology (2000)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2000.18.19.3453 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11013291 Paclitaxel for Limited-Stage Small-Cell Lung Cancer F. Anthony GrecoxF. Anthony GrecoSearch for articles by this author , John D. HainsworthxJohn D. HainsworthSearch for articles by this author Nathan LevitanxNathan LevitanSearch for articles by this author , Afshin DowlatixAfshin DowlatiSearch for articles by this author Show More Sarah Cannon Cancer Center Nashville, TNIreland Cancer Center University Hospitals of Cleveland Cleveland, OH https://doi.org/10.1200/JCO.2000.18.19.3453 First Page Full Text PDF Figures and Tables © 2000 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse19102000In Reply:The letter from Drs Greco and Hainsworth suggests that a comparison of the results of their trial of paclitaxel-based therapy1 with ours2 would be of interest. Hainsworth et al treated patients with both limited and extensive small-cell lung cancer. Their higher-dose regimen consisted of paclitaxel (200 mg/m2), carboplatin (area under the concentration-time curve, 6), and etoposide (50 mg alternating with 100 mg orally every day for 21 days). Only two patients received granulocyte colony-stimulating factor. Radiotherapy was administered concurrently with cycles 3 and 4 to the subset of patients with limited-stage disease. The radiation field included the tumor volume that was present after the completion of chemotherapy cycle 2. For patients with limited-stage disease, the overall and complete response rates were 98% and 71%, respectively. Grade 3 or 4 leukopenia occurred in 38% of treatment courses. Although the authors display the toxicity data for their regimen without stratifying between those patients who did or did not receive thoracic irradiation, they comment that “the concurrent administration of two courses of chemotherapy with radiation therapy produced no unexpected or severe toxicity.” Grade 3 or 4 esophagitis occurred during concurrent chemoradiotherapy in 23% of patients with limited-stage disease.Our trial involved only patients with limited-stage disease. The regimen used in the phase II component of our trial differed from that of Hainsworth et al in that cisplatin (60 mg/m2) was used instead of carboplatin; paclitaxel was administered at a dose of 135 mg/m2 during cycles 1 and 2 (with concurrent radiotherapy) and at a dose of 170 mg/mg2 during cycles 3 and 4. Etoposide was administered at a dose of 60 mg/m2 intravenously daily for 3 days during cycles 1 and 2 and at a dose of 80 mg/m2 intravenously daily for 3 days during cycles 3 and 4. Granulocyte colony-stimulating factor was used after cycles 3 and 4. The overall and complete response rates were 96 and 39%, respectively. Grade 3 or 4 leukopenia occurred in 48% of treatment courses. Grade 3 or 4 esophagitis occurred in less than 10% of patients.What can we conclude from a comparison of these data? A principal difference between the two regimens pertains to the timing of radiotherapy. Hainsworth et al1 used radiotherapy during chemotherapy cycles 3 and 4, whereas our regimen incorporated radiotherapy during cycles 1 and 2. Patients treated by Hainsworth et al received radiation to a considerably smaller lung volume. There exist conflicting data pertaining to the importance of “early” versus “late” thoracic irradiation.3,4 The contrasting radiotherapy schedules may explain why Hainsworth et al were able to administer higher doses of chemotherapy without the use of growth factors. A higher incidence of esophagitis was observed in association with the Hainsworth regimen compared with ours. It is likely that patients who have already received two cycles of chemotherapy are more prone to the development of esophagitis when radiotherapy accompanies cycles 3 and 4. Evaluation of the paclitaxel/platinum/etoposide regimen for patients with limited-stage small-cell lung cancer in the phase III setting would more reliably determine the efficacy and toxicity of this regimen in comparison to conventional therapy.1. Hainsworth JD, Gray J, Greco FA, et al: Paclitaxel, carboplatin, and extended-schedule etoposide in the treatment of small-cell lung cancer: Comparison of sequential phase II trials using different dose-intensities. J Clin Oncol 15:: 3464,1977-3470, Google Scholar2. Levitan N, Dowlati A, Johnson D, et al: Multi-institutional phase I/II trial of paclitaxel, cisplatin, and etoposide with concurrent radiation for limited-stage small-cell lung carcinoma. J Clin Oncol 18:: 1102,2000-1109, Link, Google Scholar3. Murray M, Coy P, Pater J, et al: Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer: The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 11:: 336,1993-344, Link, Google Scholar4. Perry MC, Eaton WL, Propert KJ, et al: Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med 316:: 912,1987-918, Crossref, Medline, Google Scholar