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Carboplatin/Taxol Weekly vs. Every 3 Weeks

Carboplatin/Taxol Weekly vs. Every 3 Weeks

Question

I was recently diagnosed with non-resectable Stage IIIB non-small lung cancer. My treatment to date has been 33 radiation therapy treatments concurrently with 7 low-dose carboplatin and taxol chemotherapy treatments given weekly with radiation therapy. There is a question as to the next course of treatment: low-dose chemotherapy (3 weeks on, 1 week off) or high-dose chemotherapy (once monthly), both using the same chemotherapy drugs that I have already received. Is there research supporting one regimen over the other? I am trying to choose the best option for my continued treatment. Thank you for your response.

Answer

Barbara Campling, MD, Medical Oncologist, responds:

Your treatment for Stage IIIB non-small cell lung cancer has been appropriate. Radiation therapy is the most important and only potentially curative modality of treatment for this stage of NSCLC, and the concurrent use of chemotherapy has been shown to enhance the efficacy of radiation therapy. You have now been advised to undergo "consolidation" chemotherapy following completion of radiation therapy. It is not known how much benefit the "consolidation" chemotherapy adds to the "definitive" concurrent chemotherapy and radiation therapy that you have already received. Some trials have not shown a benefit to giving additional chemotherapy, which adds toxicity and patient morbidity, while others with newer chemotherapy agents have shown clinical benefits. You have been offered two choices: either "low-dose" (3 weeks on, 1 week off) or "high-dose" (once monthly) carboplatin and taxol. If you are going to go ahead with consolidation chemotherapy, you should have full doses. A full dose of taxol would be 200-225 mg per meter squared given every three weeks. A full dose of carboplatin would be an AUC (area under the concentration-time curve) of 6, given every three weeks. It is also unclear how many cycles of consolidation chemotherapy are necessary. We usually give two full-dose cycles.