This Article Full Text (PDF) eLetters: Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article link to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Greco, F. A. Search for Related Content PubMed Articles by Greco, F. A.

Paclitaxel/Carboplatin: How I Use Them

The Sarah Cannon-Minnie Pearl Cancer Center, 250 25th Avenue North, Suite 412, Nashville, TN 37203

1. Early Development of the Combination
   1. Langer et al. 24 h Paclitaxel infusion (135 175 220 mg/m²) Carboplatin AUC 7.5 Day 2. Severe myelosuppression. Response stage IV NSCLC 58%; one-year survival: 56%
      
   2. Natale et al. 3 h infusion Paclitaxel (up to 225 mg/m²); AUC 6, 7, 9. Lower doses Carboplatin same day (AUC 6). No severe thrombocytopenia. Moderate neutropenia (no worse than with Carboplatin alone). Response >50% (stage IIIB and IV) NSCLC; one-year survival: 58%
      
   3. Greco et al. 1 h infusion Paclitaxel (135-200 mg/m²) with Carboplatin AUC 5 and 6; plus oral etoposide 50/100 daily x 10 days. Very active regimen —small cell lung cancer. Survival probably better with higher doses
      
   4. Greco et al. 1 h infusion Paclitaxel 225 mg/m² plus Carboplatin (AUC 6) Stage IIIB and IV NSCLC. 100 patients, response 48%; one-year survival 49%
      
   5. Pharmacodynamic studies: There is no obvious pharmacologic interaction to explain the less-than-expected thrombocytopenia, and neutropenia, seen with this combination
      
   
   
2. Paclitaxel/Cisplatin
   1. Superior to Etoposide/Cisplatin in Stage IV NSCLC—ECOG study
      
   2. Why is Cisplatin used in 1997, given the comparative information with Carboplatin?
      
   
   
3. Several Randomized Studies in Progress (Stage IV NSCLC)
   1. Bristol; Paclitaxel/Carboplatin versus Etoposide/Cisplatin; results pending. European study is similar (teniposide); results pending
      
   2. SWOG; Paclitaxel/Carboplatin versus Nalvalbine/Cisplatin
      
   3. ECOG; Paclitaxel/Carboplatin versus Gemcitabine/Cisplatin versus Taxotere/Cisplatin versus Paclitaxel/Cisplatin
      
   4. CALGB; Pactitaxel/Carboplatin versus Paclitaxel
      
   
   
4. Current Therapy with Paclitaxel/Carboplatin at Sarah Cannon-Minnie Pearl Cancer Center
   1. Stage IB, II, IIIA NSCLC

      Neoadjuvant x 3 courses every 3 weeks
      

      Resection RT plus weekly Paclitaxel and Carboplatin for 6 weeks
      

      Unresectable RT plus weekly Paclitaxel and Carboplatin for 6 weeks
      

      Adjuvant IB x 3 courses only; II, IIIA x 3 courses, then RT and weekly chemotherapy as above
      

      
      
   2. Stage IIIB, IV

      New combinations: Paclitaxel/Carboplatin/Gemcitabine
      

      Paclitaxel/Carboplatin/Navelbine
      

      Paclitaxel/Carboplatin:100 patients; submitted for publication
      

      
      
   3. Small cell lung cancer

      Large phase II trials complete; Paclitaxel (135 and 200 mg/m²) plus Carboplatin (AUC 5 and 6) plus oral Etoposide 50/100 daily for 10 days q 3 weeks x 4 courses; RT limited stage
      

      Randomized trial now in progress
      

      Above high-dose regimen versus standard Carboplatin/Etoposide
      

      First dose level published in Cancer
      

      
      
   4. Esophageal carcinoma

      Neoadjuvant: Paclitaxel, Carboplatin, infusional 5-FU plus RT, then resection
      

      
      
   5. Locally advanced head and neck cancer and other advanced squamous cancers and urothelial cancers

      Paclitaxel 200 mg/m² plus Carboplatin (AUC 6) and infusional 5-FU 225 mg/m²/day for 6 weeks
      

      RT with weekly chemotherapy after induction for head and neck
      

      
      
   6. Carcinoma of unknown primary site

      Paclitaxel 200 mg/m², Carboplatin (AUC 6) and oral Etoposide 50/100 mg daily x 10 days q 3 weeks x 4 courses
      

      Response rate 50%; 13% CR; all subsets responding; median survival 13 months; accepted for publication in Journal of Clinical Oncology
      

      
      
   7. Ovarian cancer—Stage III, IV

      Paclitaxel 200 mg/m², Carboplatin (AUC 6) and oral Etoposide 50/100 x 10 days q 3 weeks x 6 courses second look laparotomy
      

      
      
   
   

This Article Full Text (PDF) eLetters: Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article link to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Greco, F. A. Search for Related Content PubMed Articles by Greco, F. A.