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Oral cancer treatment: developments in chemotherapy and beyond
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More information about this seller Contact this seller 9. More information about this seller Contact this seller Churchill Ltd. London From: Librairie du Bassin Bordeaux, France. London, Third edition. Volume 1 seul. Seller Inventory L A randomized phase II clinical trial demonstrated the feasibility of selecting therapy based on RRM1 expression, and reported high response rates with such a pharmacogenomic treatment selection Simon G et al.
Based on these results, a confirmatory phase III study is in progress. Such novel and individualized strategies will lead to further optimization therapy in the foreseeable future. Carboplatin-based regimens are easy to administer in the outpatient setting and have favorable nonhematologic toxicity profiles compared with cisplatin-based regimens.
Several studies have been conducted to compare carboplatin-based regimens with cisplatin-based combinations in the first-line treatment of advanced NSCLC [ 10 , 22 , 29 ]. While some studies have suggested a slight advantage to cisplatin-based regimens, it is unclear whether this counter-balances the higher degree of toxicity found.
Recent Advances Chemotherapy
A meta-analysis of studies comparing cisplatin- and carboplatin-based regimens demonstrated a slightly longer survival time for regimens that included cisplatin with a newer agent [ 30 ]. This observation was confirmed in another meta-analysis that used individual patient data to compare the efficacy of cisplatin-based regimens with that of carboplatin-based regimens for advanced NSCLC [ 31 ]. Overall, there was a slightly higher response rate with cisplatin-based regimens. Though there was no significant survival difference, studies that used a third-generation agent gemcitabine or a taxane in combination with cisplatin yielded a slight advantage over carboplatin-based regimens.
Because systemic chemotherapy is administered with the primary goal of palliation, the debate continues as to whether the marginal superiority of the cisplatin-based regimens justifies their use in routine patient care, given that the associated adverse events may have a negative effect on patient quality of life.
In a curative setting, as is the case in the earlier stages of NSCLC adjuvant therapy , cisplatin-based regimens may be preferred over carboplatin-based regimens. Carboplatin-based regimens are commonly used in the U. The use of nonplatinum regimens has been widely investigated with a view to improving the therapeutic index of chemotherapy for patients with advanced NSCLC. The advantage of excluding platinum compounds is that they are associated with considerable toxicity.
Randomized trials that have directly compared platinum-based regimens with nonplatinum combinations have demonstrated comparable results [ 13 , 14 ]. A recent randomized study compared carboplatin plus paclitaxel with carboplatin plus gemcitabine and the nonplatinum regimen of gemcitabine plus paclitaxel for advanced NSCLC [ 14 ]. All three regimens demonstrated comparable response rates and median survival times. Although the toxicity profiles were different in each arm, there was no clear advantage to the nonplatinum regimen. The observations were confirmed by a recent meta-analysis of all studies comparing platinum-based regimens with nonplatinum combinations, which demonstrated comparable 1-year survival rates [ 32 ].