Triplet Platinum-based Combination Sequential Chemotherapy Improves Survival Outcome and Quality of Life of Advanced Non-small Cell Lung Cancer Patients

Background: Maintenance chemotherapy is one strategy pursued in recent years with intent to break throughthe chemotherapy plateau for advanced non-small cell lung cancer (NSCLC). However, given the toxicity,platinum-based combinations are rarely given for this purpose. We carried out the present prospective studyof triplet platinum-based combination sequential chemotherapy in advanced NSCLC to investigate if patientscould tolerate and benefit from such intensive treatment.
Methods: From Dec 2003 to Dec 2007, 190 stage IIIBand IV NSCLC patients in Sun yat-sen University sequentially received the 3 platinum-based combination (TPNP-GP) treatment (T: paclitaxol175mg/m2 d1; N: vinorelbine25mg/m2 d1 and 8; G: gemcitabine1g/m2 d1 and8; P: cisplatin20mg/m2 d1-5; repeated every 3 weeks). Patients were followed up to at least 3 years to obtainsurvival data. Treatment toxicities and the quality of life (QOL) were assessed during the whole treatment.
Results: There were 187 patients evaluable. The TP, NP and GP response rates with sequential use were 42.8%(80/187), 41.1% (65/158) and 28.8% (21/73) respectively. Median survival time was 18.2 months and the 1, 2 and3 year overall survival (OS) rates were 78.7%, 38.5% and 21.3%. Patients receiving > 6 cycles of chemotherapyhad significantly longer OS and TTP (MST 25.3 vs. 14.5 months, TTP 15.1 vs. 9.1 months). The QOL on thewhole for the patients was improved after chemotherapy.
Conclusions: The sequential chemotherapy strategywith triplet platinum-based combination regimens can improve the survival outcome and the quality of life ofadvanced non-small cell lung cancer patients.