Paclitaxel and gemcitabine versus carboplatin and gemcitabine in patients with advanced non-small-cell lung cancer. A phase III study of the Hellenic Cooperative Oncology Group

Abstract

BackgroundThis phase III study was designed to compare the combination paclitaxel (Taxol)–gemcitabine (PG) versus carboplatin–gemcitabine (CG) in patients with advanced inoperable non-small-cell lung cancer. MethodsChemotherapy-naive patients with performance status of zero or one were randomized to gemcitabine 1 gm/m2 on days 1 and 8 plus either paclitaxel 200 mg/m2 on day 1 (arm A) or carboplatin at an area under the concentration–time curve of 6 mg on day 1 (arm B) every 3 weeks. Primary end point was overall survival (OS). Secondary end points included objective response (OR), time to progression and toxicity. ResultsA total of 512 patients were enrolled and 452 eligible (arm A, 225; arm B, 227) were analyzed. All characteristics were well balanced with the exception of vena cava obstruction symptoms and lymph node involvement. Median survival was 9.97 months [95% confidence interval (CI) 8.74–12.0] for group A and 10.49 (95% CI 9.04–11.94) for group B. There was no difference in the OS, 1-year survival, OR and TtP. However, statistically significant differences were seen in toxicity. ConclusionThe two regimens are equally active. Myelotoxicity is worse in the CG group whereas alopecia, myalgia and neurotoxicity worse in the PG group.