Pre-medications of weekly taxanes in advanced non-small cell lung cancer

Abstract

18210 Background: Taxane is a widely accepted treatment in advanced non-small cell lung cancer (NSCLC). However, a standard pre-medication for weekly taxane has not been established at present. We conducted this study to evaluate the efficacy,safety and pre-medication of weekly paclitaxel /docetaxel schedule in the treatment of advanced NSCLC and to obtain an optimal pre-medication protocol for weekly paclitaxel /docetaxel. Methods: From December 2001 to June 2006, 78 patients with advanced NSCLC (Stage III, IV) were recruited from Department of Chemotherapy, Jiangsu Cancer Hospital and Research Institute. Eleven cases were treated with paclitaxel 80–100 mg/m 2 by intravenous infusion(ivi)on days 1 and 8, 23 cases were treated with paclitaxel 50–80 mg/m2 ivi on days 1, 8 and 15, 14 cases were treated with docetaxel 25–35 mg/m2 ivi on days 1,8 and 15,30 cases were treated with docetaxel 35–45 mg/m2 ivi on days 1 and 8, all combined with a platinum(cisplatin, oxaliplatin or carboplatin), followed by 1 week rest. Four pre-medications were attempted. Results: All 78 patients received a total of 202 courses of treatment. Dose limiting toxicity was myelosuppression. Grade 3 and 4 leukopenia occurred in 19.2% (15/78) of patients. Of the 56 eligible patients who completed at least 2 courses, no patient had a complete response, 20 achieved a partial response and 5 patients showed progression. Toxicity profile of pre-medications included: hypersensitivity (1 case), hypopotassemia (8 cases), myasthenia (5 cases), hiccup (1 case), infection (2 cases). No treatment related death occurred in this study. Conclusions: Weekly administration of paclitaxel/docetaxel is a safe and active protocol for Chinese patients with advanced NSCLC. Our recommendations for weekly pre-medication of taxane are: dexamethasone 2.25 mg-7.5 mg orally 12 h and 2 h before, promethazine 25 mg intramuscularly and cimetidine 600 mg ivi 30 min before paclitaxel; oral dexamethasone 4.5 mg-7.5 mg twice daily for three consecutive days (the day before, the day of, and the day after docetaxel), promethazine 25 mg intramuscularly and cimetidine 600 mg ivi 30 min before docetaxel. No significant financial relationships to disclose.