Weekly paclitaxel/ docetaxel combined with a platinum in the treatment of advanced non-small cell lung cancer: a study on efficacy, safety and pre-medication.

Objectives: To evaluate the efficacy and safety of a weekly taxane schedule in the treatment of advanced non small cell lung cancers (NSCLCs) and to generate an optimal pre-medication protocol for weekly taxane.

Methods: From December 2001 to June 2006, 78 patients with advanced NSCLCs were recruited from the Department of Chemotherapy, Jiangsu Cancer Hospital and Research Institute. Paclitaxel was delivered at 80-100mg/m2 on days 1 and 8 (11 cases), or 50-80 mg/m2 on days 1, 8 and 15 (23 cases), while docetaxel was given with the same schedules at 35-45 mg/m2 (30cases), or 25-35 mg/m2 (14 cases). In all cases this was combined with a platinum-based drug (cisplatin, oxaliplatin or carboplatin) , followed by a 1 week rest. Four pre-medications were attempted were also compared.

Results: All 78 patients received a total of 202 courses of treatment. Dose limiting toxicity was myelosuppression. Grades 3 and 4 leukopenia occurred in 19.2% (15/78). Of the 56 eligible patients who completed at least 2 courses, none had a complete response, 20 achieved a partial response and 5 showed progression. Toxicity of pre-medications was indicated by: hypersensitivity (1 case), hypopotassemia (8 cases), myasthenia (5 cases), hiccups (1 case) and infection (2 cases). No treatment related deaths occurred.

Conclusions: Weekly administration of paclitaxel /docetaxel is a safe and active protocol for advanced NSCLCs. Our recommendations for weekly pre-medication with taxane are: dexamethasone 2.25mg-7.5mg orally 12h and 2h before, promethazine and cimetidine 30 min before paclitaxel; oral dexamethasone 4.5mg-7.5mg twice daily for three consecutive days (the day before, the day of, and the day after docetaxel), promethazine and cimetidine 30 min before docetaxel.