Actualités sur la Gemcitabine (Gemzar®) dans le Cancer Bronchique non à Petites Cellules

Abstract

Review of current data on gemcitabine (Gemzar®) in non-small cell lung cancer

The efficacy of gemcitabine in advanced non-small cell lung cancer (NSCLC) has been established for several years. Gemcitabine can be used as monotherapy, particularly for elderly patients, or in association with cisplatin. The combination of cisplatin plus gemcitabine is a standard regimen in first-line chemotherapy for advanced NSCLC. During the 10th World Conference on Lung Cancer in Vancouver, some 80 abstracts relating to gemcitabine were presented, and there was a symposium on ‘The Present and Future Treatment of Thoracic Cancer’. One of the most interesting presentations was a meta-analysis comparing overall survival and progression-free survival using gemcitabine plus a platinum compound with other platinum-based comparators. This meta-analysis shows a significant benefit in favor of the gemcitabine-platinum combination in terms of overall survival and progression-free survival. Carboplatin can be substituted for cisplatin plus gemcitabine with a significant improvement in patient tolerability and without a significant loss of efficacy. This regimen can be particularly useful for elderly patients with a good performance status. In a French phase III randomized study, the combination of gemcitabine plus docetaxel was shown to be not only as effective as the cisplatin-vinorelbine doublet in terms of survival, but also less toxic. Further studies are necessary to assess the safety and efficacy profiles of gemcitabine in concurrent chemoradiation for stage IIIB NSCLC.

Résumé

La gemcitabine est un nouvel anticancéreux appartenant á la famille des antimétabolites. Son efficacité dans les cancers bronchiques á petites cellules (CBNPC) avancés est démontrée depuis plusieurs années. L’association gemcitabine—cisplatine est devenue une des chimiothérapies de référence dans le traitement de premiére ligne des CBNPC. Le 10ème Congrés Mondial sur le Cancer du Poumon a été l’occasion de confirmer la place de la gemcitabine dans la stratégie thérapeutique des CBNPC. La méta-analyse des essais randomisés comparant les associations gemcitabine—platine et les chimiothérapies á base de platine montre un bénéfice significatif en termes de survie sans progression et de survie globale en faveur des schémas gemcitabine—platine. L’association gemcitabine—carboplatine apparaŷt aussi efficace que le schéma gemcitabine—cisplatine. L’étude française confirme l’intérêt de l’association gemcitabine—docétaxel en traitement de premiére ligne des CBNPC avancés.