However, while gemcitabine and carboplatin has a higher incidence of myelosuppression, the incidence of nausea and alopecia is much lower than with cisplatin plus etoposide, and patients tend to be able to tolerate more rounds of treatment, British investigators report in the January issue of Thorax.
Dr. S. M. Lee of University College Hospital in London and colleagues randomized 241 previously untreated patients with SCLC with extensive disease or a poor prognosis to six 3-week cycles of either gemcitabine and carboplatin (GC) or cisplatin plus etoposide (PE).
Ninety percent (216) of the patients died during the study period. There was no difference in overall survival between the two groups. Median survival was 8.0 months with GC and 8.1 months with PE. Median progression-free survival was 5.9 months with GC and 6.3 months with PE.
Grade 3/4 myelosuppression was more common with GC than PE, with anemia occurring in 14% of GC and 2% of PE patients, leucopenia in 32% of GC and 13% of PE patients, and thrombocytopenia developing in 22% of GC and 4% of PE patients. However, hospital admissions, infections and mortality were no higher in the GC group than the PE group.
Grade 2/3 alopecia was much less common with GC, occurring in 17% compared with 68% of PE patients. Nausea occurred in 26% of GC patients and 43% of PE patients.
The six cycles of treatment were completed by 89% of GC patients compared with 66% of PE patients. More patients on PE reported distress over alopecia and impaired cognitive functioning on quality-of-life questionnaires than GC patients.
"GC is as effective as PE in terms of overall survival and progression-free survival and has a toxicity profile more acceptable to patients," Dr. Lee's team concludes.
Thorax 2009;64:75-80.
Source : http://www.medscape.com/viewarticle/586190
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