Saturday, February 20, 2010

Study, Part: How Does This Apply to Moi?

First, you really need to read the whole darn thing.

Second, I am not part of the first generation or second generation in the study.

I'm part of the third generation, participating through US Oncology, a national oncology firm that runs Fairfax Northern Virginia Hematology Oncology where I receive weekly Taxol-only chemo. I also receive Herceptin, but that is not chemo, it's hormonal therapy.

Here's what the first and second generation parts of the study have shown that has effected me:

Much has been learned about the optimum dose and schedule for administration of paclitaxel and docetaxel from trials in patients with advanced disease. CALGB 9342 demonstrated that increasing the paclitaxel dose above 175 mg/m2 every 3 weeks did not improve the response rate, time to progression, or overall survival.54 CALGB 9840 and the Anglo-Celtic IV trials established that paclitaxel 80 mg/m2 once per week was more effective than paclitaxel 175 mg/m2 every 3 weeks.55, 56 With regard to docetaxel, increasing the dose from 60 mg/m2 to 100 mg/m2 every 3 weeks was associated with an improved response rate and time to progression, at the expense of increased toxic effects.57 The TAX 311 trial by the US Oncology Group demonstrated that 100 mg/m2 docetaxel every 3 weeks was more effective than 175 mg/m2 paclitaxel.58
In the adjuvant setting, once-weekly paclitaxel at 80 mg/m2 or docetaxel every 3 weeks at 100 mg/m2 is superior to paclitaxel at 175 mg/m2 every 3 weeks following four cycles of AC.59 Two other studies by the MD Anderson and US Oncology groups also support the superiority of once-weekly paclitaxel over paclitaxel administration every 3 weeks. In the MD Anderson study, once-weekly paclitaxel followed by four cycles of FAC was associated with an increased pathologic complete response rate compared with paclitaxel 225 mg/m2 every 3 weeks followed by FAC (28% versus 16%).60 However, improvements in the pathologic complete response rate have not always been accompanied by a long-term benefit in DFS or overall survival.61 Similarly, the US Oncology Group trial demonstrated superior 5-year overall survival with doxorubicin and paclitaxel followed by once-weekly paclitaxel (AP→P1) compared with standard AC→P3 with paclitaxel administered every 3 weeks (90% versus 87%, HR 0.74, P = 0.04).62With regard to sequential or concurrent administration, the BIG 02-98 trial demonstrated an improvement in DFS with sequential but not concurrent administration of docetaxel and anthracycline therapy.47 Whether the timing of taxane therapy in relation to that of anthracyclines is important remains an open question, as most of the available sequential taxane trials administered a taxane following anthracycline therapy—the MDACC, FinHER and HORG trials are notable exceptions.

1 comment:

  1. Interesting stuff - thanks for posting the links.