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By Anthony J. Brown, MD

NEW YORK (Reuters Health) – Two reports published in the January 10th issue of The New England Journal of Medicine provide insight into the efficacy and limitations of current chemotherapy regimens for lung cancer.

One report finds that four regimens commonly used to treat non-small-cell lung cancer (NSCLC) achieve similar results, while the other shows that irinotecan plus cisplatin is superior to etoposide plus cisplatin for the treatment of small-cell lung cancer.

Dr. Joan H. Schiller, from the University of Wisconsin at Madison, and colleagues randomized 1207 patients with advanced NSCLC to receive cisplatin and paclitaxel, cisplatin and gemcitabine, cisplatin and docetaxel, or carboplatin and paclitaxel.

The overall treatment response rate was 19%, the authors note. The median survival was 7.9 months and 1- and 2-year survival rates were 33% and 11%, respectively. The response rate and survival did not differ significantly between the four treatment groups.

The time to disease progression was significantly prolonged with the cisplatin/gemcitabine regimen compared with the cisplatin/paclitaxel regimen, but the former was more likely to produce severe renal toxicity than the latter.

In the other study, Dr. Nagahiro Saijo, from the National Cancer Center in Tokyo, and colleagues assessed the outcomes of 154 patients with metastatic small-cell lung cancer who were randomized to receive irinotecan plus cisplatin or etoposide plus cisplatin. The study was intended to include 230 patients, but was terminated early due to clear differences in outcome between the groups.

The median survival of the irinotecan group was 12.8 months compared with only 9.4 months for the etoposide group (p = 0.002). At 2 years, 19.5% of patients in the irinotecan group were alive, while only 5.2% of patients in the etoposide group still remained.

The etoposide regimen was associated with a greater frequency of severe or life-threatening myelosuppression, while the irinotecan regimen was tied to an increased risk of severe or life-threatening diarrhea, the researchers state.

In a related editorial, Dr. Desmond N. Carney, from Mater Misericordiae Hospital in Dublin, Ireland, points to the need to find other treatments for lung cancer rather than chemotherapy.

"The first study includes all of the new drugs that have been hyped over the last 10 years," Dr. Carney told Reuters Health. "The median survival was 8 months, no different than the median survival we were achieving in 1985," he said. "Here we are in 2002, we've spent the last 10 years developing these drugs, and we haven't gotten anywhere."

Dr. Carney believes that "we need to pull back and redirect our efforts." The molecular biology of these tumors needs to be studied further to allow the development of directed therapy, he said. "I think chemotherapy has a role, but if we don't start thinking differently we will be in the same place 20 years from now," he added.

"The results of the small-cell lung cancer study are the first positive ones in nearly 20 years," Dr. Carney noted. "The gain in survival is only 3 months, but at least it's a gain," he said. "However, further studies are needed to confirm the current results."