Prophylactic G-CSF and antibiotics enable a significant dose-escalation of triplet-chemotherapy in non-small cell lung cancer

J. N.H. Timmer-Bonte, C. J.A. Punt, H. F.M. vd Heijden, C. E. van Die, J. Bussink, J. H. Beijnen, A. D.R. Huitema, V. C.G. Tjan-Heijnen

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

In advanced non-small cell lung cancer (NSCLC) the clinical benefit of a platinum-based doublet is only modest, therefore, attenuated dosed three-drug combinations are investigated. We hypothesized that with adequate support a full dosed chemotherapy triplet is feasible. The study was designed as a dose finding study of paclitaxel in chemotherapy-naive patients. Paclitaxel was given as a 3-h infusion on day 1, followed by fixed doses of teniposide (or etoposide) 100 mg/m2 days 1, 3, 5 and cisplatin 80 mg/m2 day 1 every 3 weeks. As myelotoxicity was expected to be the dose-limiting toxicity, prophylactic G-CSF and antibiotic support was evaluated. Indeed, paclitaxel 120 mg/m2 resulted in dose-limiting neutropenia, despite G-CSF support. Teniposide/etoposide day 1, 3, 5 was less myelotoxic compared to day 1, 2, 3. G-CSF support allowed paclitaxel dose-escalation to 250 mg/m2. The addition of prophylactic antibiotics enabled dose-escalation to 275 mg/m2 without reaching MTD. In conclusion, G-CSF and antibiotics prophylaxis enables the delivery of a full dosed chemotherapy triplet in previously untreated NSCLC patients.

Original languageEnglish
Pages (from-to)222-230
Number of pages9
JournalLung Cancer
Volume60
Issue number2
DOIs
Publication statusPublished - May 2008
Externally publishedYes

Keywords

  • Antibiotics
  • Chemotherapy-combinations
  • Cisplatin
  • Dose-finding study
  • Etoposide
  • G-CSF
  • NSCLC
  • Paclitaxel
  • Prophylaxis
  • Teniposide

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