Cisplatin and Vinorelbine Standard of Care in Lung Cancer

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The combination of cisplatin with vinorelbine should be the standard of care for non–small-cell lung cancer (NSCLC) after complete resection, as there is now clear evidence that it provides major benefits, attendees at the 31st Congress of the European Society of Medical Oncology (ESMO) heard yesterday. The conclusions come from the latest meta-analysis of the Lung Adjuvant Cisplatin Evaluation (LACE), presented at the meeting by Jean-Yves Douillard, MD, from the Centre R Gauducheau in Nante-St. Herblain, France.

Compared with no adjuvant chemotherapy, the combination significantly increased overall survival by 8.9% at 5 years (P = .0007), Dr. Douillard said.

The benefit was seen in patients with stage 2 and stage 3 disease, and the increases in survival were statistically significant and "clinically very meaningful," he commented at a press conference. Survival in stage 2 was 54.6 months with chemotherapy vs 42.3 months without, with an absolute benefit of 12.3%, while in stage 3, survival was 39.8 vs 24.9 months, a benefit of 15%. "These patients really benefit and they should be treated in this way," he said.

However, there was no benefit in patients with stage 1 disease; survival was 66.8 months with chemotherapy vs 65.1 months without. Why the combination should be effective in the later stages and not at this earlier stage is unknown, Dr. Douillard commented, but a hypothesis is that the drugs may offer better control of distant disease, and patients in the later stages have more metastases.

The results that Dr. Douillard was presenting come from a meta-analysis of 4 trials using the cisplatin and vinorelbine combination, together totaling 1888 patients. This is an additional meta-analysis from LACE to that reported earlier this year, at the American Society for Clinical Oncology meeting, he explained. That one looked at cisplatin in combination with various drugs and found a survival benefit of 5.3%, which was statistically significant. However, many of the other drugs used in the combinations are old and no longer used, eg, etoposide, he commented. "Vinorelbine is the only 'modern' drug, and the one for which there are the most data available."

The combination of cisplatin with vinorelbine appears to be the most promising, but the role of each drug as well as their optimum dose still needs further study, Dr. Douillard told the meeting.

Discussant for this paper and cochair of the session was Vittorio Franciosi, MD, from the University Hospital in Parma, Italy. He agreed with the conclusions that cisplatin and vinorelbine should be the standard of care. So did cochair Roy Bremnes, MD, from the University of Tromso, in Norway, and he pointed out that in many countries around the world it already was the standard of care. The use of adjuvant chemotherapy after resection in NSCLC is fairly new, but most countries are now using it, and most are opting for cisplatin and vinorelbine, because these are the drugs with the most data to support their use, he commented to Medscape.

ESMO 31st Congress: Abstract 7100. Presented Oct 1, 2006.

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