Although clinical trials have used various durations of induction therapy, both faculty members routinely use 4 cycles as done in the ongoing Phase III ECOG-E5508 trial comparing 3 maintenance regimens after carboplatin/paclitaxel/bevacizumab. Interestingly, the oncologists we surveyed more commonly use 6 cycles. Dr Wakelee believes this “more is better” approach is understandable but not supported by data, noting that toxicity, particularly platinum-related fatigue, nausea, neutropenia and thrombocytopenia, tends to be cumulative. This somewhat unexpected practice gap seems ripe for additional investigation and discussion.

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Socinski MA et al. Phase III trial comparing a defined duration of therapy versus continuous therapy followed by second-line therapy in advanced-stage IIIB/IV non-small-cell lung cancer. J Clin Oncol 2002;20(5):1335-43. Abstract

Sandler A et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 2006;355(24):2542-50. Abstract