Correspondence to: Reza Malayeri, M.D., Department of Academic Haematology, Royal Free Hospital, Pond St., London NW3 2PF, U.K. (e-mail: r.malayeri{at}rfc.ucl.ac.uk).
In their paper, Ramsey et al. (1) describe an economic analysis of vinorelbine plus cisplatin versus paclitaxel plus carboplatin for advanced non-small-cell lung cancer. This analysis, however, was done alongside a Southwest Oncology Group multicenter, randomized clinical trial (2). It does not necessarily reflect the real situation and may be biased, aiming at finding a costbenefit for vinorelbine plus cisplatin. This analysis does not consider the fact that hospitalization is often required for the administration of vinorelbine plus cisplatin, particularly for patients with a less favorable performance status, thus increasing the cost of this treatment. All patients entering this clinical trial had to have a performance status of 0 or 1, and the trial concluded that vinorelbine plus cisplatin was much more toxic.
The real situation shows that in most instances, vinorelbine plus cisplatin can only be administered in inpatients who have a good performance status. Administration of the paclitaxel plus carboplatin combination, however, does not require hospitalization and had the lowest incidence of grade 3 and 4 toxicities among patients with a performance status of 2 compared with paclitaxel plus cisplatin, gemcitabine plus cisplatin, and docetaxel plus cisplatin in a recent publication (3). Another publication showed that poor-performance patients with advanced non-small-cell lung cancer might not benefit from vinorelbine plus cisplatin compared with vinorelbine alone (4).
Paclitaxel plus carboplatin and vinorelbine plus cisplatin are currently regarded as two standard protocols for the treatment of advanced non-small-cell lung cancer, although several other platin-containing regimens have been shown to have similar efficacy [for review see (5)]. Economic analysis could be helpful in deciding which regimen should be used, but all aspects must be taken into consideration, and the analysis of cost should not be biased.
REFERENCES
1 Ramsey SD, Moinpour CM, Lovato LC, Crowley JJ, Grevstad P, Presant CA, et al. Economic analysis of vinorelbine plus cisplatin versus paclitaxel plus carboplatin for advanced non-small-cell lung cancer. J Natl Cancer Inst 2002;94:2917.
2 Kelly K, Crowley J, Bunn PA Jr, Presant CA, Grevstad PK, Moinpour CM, et al. Randomized phase III trial of paclitaxel plus carboplatin versus vinorelbine plus cisplatin in the treatment of patients with advanced non-small-cell lung cancer: a Southwest Oncology Group trial. J Clin Oncol 2001;19:32108.
3 Sweeney CJ, Zhu J, Sandler AB, Schiller J, Belani CP, Langer C, et al. Outcome of patients with a performance status of 2 in Eastern Cooperative Oncology Group Study E1594: a Phase II trial in patients with metastatic non-small-cell lung carcinoma. Cancer 2001;92:263947.[Medline]
4 Soria JC, Brisgand D, Le Chevalier T. Do all patients with advanced non-small-cell lung cancer benefit from cisplatin-based combination therapy? Ann Oncol 2001;12:166770.[Abstract]
5 Malayeri R, Pirker R, Huber H. New drugs in the palliative chemotherapy of advanced non-small-cell lung cancer. Onkologie 2001;24:41621.[Medline]
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