RATIONALE: Drugs used in chemotherapy, such as vinorelbine, gemcitabine, docetaxel, paclitaxel, and carboplatin, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which combination chemotherapy regimen is more effective in treating non-small cell lung cancer.

PURPOSE: This randomized phase III trial is studying how well giving vinorelbine together with gemcitabine and docetaxel works compared to giving paclitaxel together with carboplatin in treating patients with stage IIIB, stage IV, or recurrent non-small cell lung cancer.

Condition	Treatment or Intervention	Phase
Adenocarcinoma of the Lung large cell lung cancer recurrent non-small cell lung cancer Squamous Cell Lung Cancer stage IIIB non-small cell lung cancer stage IV non-small cell lung cancer	Drug: carboplatin  Drug: docetaxel  Drug: gemcitabine  Drug: paclitaxel  Drug: vinorelbine  Procedure: chemotherapy	Phase III

Further Study Details: 

OBJECTIVES: Primary

• Compare the therapeutic effect of vinorelbine, gemcitabine, and docetaxel vs paclitaxel and carboplatin in patients with advanced non-small cell lung cancer.
• Compare the overall survival of patients treated with these regimens.

Secondary

• Compare the response rate in patients treated with these regimens.
• Compare the toxicity of these regimens in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients receive vinorelbine IV and gemcitabine IV on days 1 and 8. Treatment repeats every 21 days for 3 courses. Patients then receive docetaxel IV on day 1. Treatment repeats every 21 days for 3 courses.
• Arm II: Patients receive carboplatin IV and paclitaxel IV on day 1. Treatment repeats every 21 days for 6 courses. Patients are followed for 1 year.

PROJECTED ACCRUAL: A total of 400 patients (200 per treatment arm) will be accrued for this study within 2 years.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed primary non-small cell lung cancer (NSCLC) meeting criteria for 1 of the following:
• Newly diagnosed selected stage IIIB (T4 lesion due to malignant pleural effusion) disease
• Newly diagnosed stage IV disease
• Recurrent disease after prior surgery and/or radiotherapy
• The following cellular subtypes are allowed:
• Adenocarcinoma
• Large cell carcinoma
• Squamous cell carcinoma
• Unspecified carcinoma
• Measurable or nonmeasurable disease by CT scan, MRI, x-ray, physical examination, or bone scintigraphy
• Pleural effusions, ascites, and laboratory parameters are not allowed as the only evidence of disease
• Disease must be present outside area of prior surgical resection
• Disease must be present outside area of prior radiotherapy OR new lesion documented
• No known brain metastases by CT scan or MRI within the past 6 weeks
• No pleural or pericardial effusions requiring treatment

PATIENT CHARACTERISTICS: Age

• 18 and over

Performance status

• Zubrod 0-1

Life expectancy

• Not specified

Hematopoietic

• Absolute granulocyte count ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 9 g/dL

Hepatic

• Bilirubin ≤ 2 times upper limit of normal (ULN)
• SGOT or SGPT ≤ 2 times ULN
• Alkaline phosphatase ≤ 2 times ULN

Renal

• Creatinine ≤ ULN
• Creatinine clearance ≥ 50 mL/min

Cardiovascular

• No uncontrolled hypertension
• No unstable angina
• No congestive heart failure
• No myocardial infarction within the past year
• No ventricular arrhythmia requiring medical intervention

Other

• Not pregnant or nursing
• Fertile patients must use effective contraception
• No prior allergic drug reaction attributed to Cremophor or polysorbate 80
• No disorder associated with lung cancer with life-threatening consequences
• No motor or sensory neuropathy ≥ grade 2
• No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or adequately treated stage I or II cancer currently in complete remission
• No uncontrolled diabetes

PRIOR CONCURRENT THERAPY: Biologic therapy

• No prior biologic therapy for NSCLC

Chemotherapy

• No prior systemic chemotherapy for NSCLC

Endocrine therapy

• No prior or concurrent steroid-type hormonal therapy (e.g., ethinyl estradiol)

Radiotherapy

• See Disease Characteristics
• At least 3 weeks since prior radiotherapy and recovered

Surgery

• See Disease Characteristics
• At least 2 weeks since prior thoracic or other major surgery and recovered

Other

• No prior or concurrent azole antifungal therapy (e.g., ketoconazole, miconazole, or itraconazole)
• No prior or concurrent macrolides (e.g., erythromycin or clarithromycin)
• No prior or concurrent cyclosporine, terfenadine, benzodiazepines (e.g., diazepam, triazolam, or midazolam), or retinoids
• No prior or concurrent calcium antagonists (e.g., diltiazem, nifedipine, or verapamil)

Japan
      Asahikawa Medical College, Asahikawa,  078 8510,  Japan; Recruiting
      Aso Iizuka Hospital, Fukuoka,  820-0018,  Japan; Recruiting
      Fujisawa City Hospital, Kanagawa,  251-8550,  Japan; Recruiting
      Koseiren Takaoka Hospital, Toyama,  933-8555,  Japan; Recruiting
      Kyoto-Katsura Hospital, Kyoto,  615-8256,  Japan; Recruiting
      Nagoya University Hospital, Aichi,  466-8560,  Japan; Recruiting
      National Cancer Center Hospital East, Chiba-ken,  277-8577,  Japan; Recruiting
      National Hospital Organization - Medical Center of Kure, Hiroshima,  737-0023,  Japan; Recruiting
      National Hospital Organization - Dohoku National Hospital, Hokkaido,  070-0901,  Japan; Recruiting
      National Hospital Organization - Ehime National Hospital, Ehime,  791-0281,  Japan; Recruiting
      National Hospital Organization - Kochi Hospital, Kochi-shi,  780-8065,  Japan; Recruiting
      National Hospital Organization - Okayama Medical Center, Okayama,  701-1192,  Japan; Recruiting
      National Hospital Organization - Okinawa Hospital, Okinawa,  901-2214,  Japan; Recruiting
      National Hospital Organization - Osaka National Hospital, Osaka,  591-8555,  Japan; Recruiting
      Ogaki Municipal Hospital, Ogaki-shi,  503-8502,  Japan; Recruiting
      Osaka General Medical Center, Osaka-shi,  558-0056,  Japan; Recruiting
      Osaka Saiseikai Nakatsu Hospital, Osaka,  530-0012,  Japan; Recruiting
      Saitama Cancer Center, Saitama,  362-0803,  Japan; Recruiting
      Takamatsu Red Cross Hospital, Takamatsu,  760-8571,  Japan; Recruiting
      Takatsuki Red Cross Hospital, Osaka,  569-1096,  Japan; Recruiting
      Tokyo Medical and Dental University, Tokyo,  113-8519,  Japan; Recruiting
      Tokyo Medical University, Tokyo,  160,  Japan; Recruiting
      Tottori University Hospital, Tottori,  683-8504,  Japan; Recruiting
      Toyama Medical and Pharmaceutical University Hospital, Toyama,  930-0194,  Japan; Recruiting

Study chairs or principal investigators

Masaaki Kawahara, MD,  Study Chair,  National Hospital Organization - Osaka National Hospital   

Study ID Numbers:  CDR0000355138; JMTO-LC00-03; NCT00079287
Record last reviewed:  August 2004
Last Updated:  March 10, 2005
Record first received:  March 8, 2004
ClinicalTrials.gov Identifier:  NCT00079287
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08