Comparison of docetaxel and docetaxel–irinotecan combination as second-line chemotherapy in advanced non-small-cell lung cancer: a randomized phase II trial

Background: The aim of this study was to evaluate whether docetaxel (taxotere) treatment with or without irinotecan improved patient outcomes with similar toxicity in recurrent non-small-cell lung cancer (NSCLC). Patients and methods: Patients with recurrent platinum-refractory NSCLC with Eastern Cooperative Oncology Group performance status of 0–2 were randomized to either docetaxel 30 mg/m2 and irinotecan 60 mg/m2 (days 1 and 8) or docetaxel 75 mg/m2 (day 1), both administered every 3 weeks. Results: A total of 130 patients were randomized. The response rate (RR) (20% versus 14%), overall survival (6.5 months versus 6.4 months) and 1-year survival (37% versus 34%) were similar in the combination and docetaxel arms, respectively. The combination arm demonstrated a longer time to tumor progression (TTP) (5.6 versus 4.8 months; P=0.065). Grade 3–4 neutropenia and anemia were similar in the combination and docetaxel arms. Grades 3–4 non-hematological toxicity (except diarrhea) was mild and was similar in the two groups. Grade 3–4 thrombocytopenia (17% versus 6%; P=0.04) and diarrhea (12% versus 3%; P=0.05) occurred more frequently in the combination arm. Conclusions: The administration of irinotecan with docetaxel in platinum-refractory NSCLC prolonged TTP, but did not improve significantly RR, median survival or 1-year survival. Second-line docetaxel monotherapy offers significant and reproducible efficacy in platinum-refractory NSCLC.