Lung cancer claims more deaths than breast, prostate and colon cancer combined. Most patients have advanced disease at presentation. The 5-year survival rate for advanced lung cancer is 15%.

Chemotherapy prolongs survival in patients presenting with advanced disease and good performance status. However, many physicians and patients are convinced that chemotherapy is highly toxic and has a negative effect on quality of life.

The Cancer and Leukemia Group B (CALGB) designed a trial to answer definitively the question of whether combination chemotherapy improves survival in advanced lung cancer. This trial compared aggressive chemotherapy with paclitaxel plus carboplatin to paclitaxel alone in patients with advanced disease.

Although the primary efficacy endpoint of this study was survival, investigators also evaluated quality of life. Dr. Lilenbaum explained that it is helpful to consider quality of life when choosing between strategies that seem to have comparable efficacy. In addition, the cost effectiveness of each regimen was studied.

The trial demonstrated that in fact, the more aggressive regimen prolonged survival compared with single agent regimen.

With a median follow-up of 12.5 months, median survival was 8.8 months for paclitaxel-carboplatin and 6.7 months for paclitaxel (P = 0.013). Even elderly patients had a survival benefit. Survival rates at 1 year were 37% and 33%, respectively, but this difference did not achieve statistical significance.

Toxicity was greatest in the combination chemotherapy group. Of patients on paclitaxel-carboplatin, 89% experienced at least one grade 3-4 toxicity, compared with 71% for paclitaxel. However, the increased toxicity was manageable .

Quality of life was similar between the combination chemotherapy and single agent therapy.

Utilization of health care resources such as antibiotics, transfusions, hospital admissions or visits to the emergency room can be used as a surrogate for cost effectiveness. Patients who received combination chemotherapy did not utilize more health care resources than those who received single agent treatment.

Based on this data, investigators believe combination chemotherapy should be the standard of care for patients with advanced non-small cell lung cancer and good performance status. Elderly patients with good performance status should also be considered for treatment.

(abstract #2)