***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to assess whether a combination of gemcitabine ( GEM ) with either paclitaxel ( PTX ) or vinorelbine ( VNR ) could be more effective than GEM or PTX alone in elderly or unfit advanced non-small-cell lung cancer ( NSCLC ) patients . A total of 264 NSCLC patients aged > 70 years with ECOG performance status (PS)⩽2 , or younger with PS=2 , were r and omly treated with : GEM 1200 mg m−2 on days 1 , 8 and 15 every 28 days ; PTX 100 mg m−2 on days 1 , 8 and 15 every 28 days ; GEM 1000 mg m−2 plus PTX 80 mg m−2 ( GT ) on days 1 and 8 every 21 days ; GEM 1000 mg m−2 plus VNR 25 mg m−2 ( GV ) on days 1 and 8 every 21 days . In all arms , an intra- patients dose escalation was applied over the first three courses , provided that no toxicity of WHO grade ⩾2 had previously occurred . At present time , 217 ( 82 % ) patients had died . The median ( months ) and 1-year survival probability were 5.1 and 29 % for GEM , 6.4 and 25 % for PTX , 9.2 and 44 % for GT , and 9.7 and 32 % for GV . Multivariate analysis showed that PS⩽1 ( hazard ratio (HR)=0.67 ; 95 % CI 0.51–0.90 ) , and doublet treatments ( HR=0.76 ; 95 % CI 0.59–0.99 ) were significantly associated with longer survival . Doublets produced no more toxicity than single agents . GT should be considered a reference regimen for elderly NSCLC patients with PS⩽1 PURPOSE The objective of this trial was to compare two vinorelbine-based doublets with carboplatin ( CBDCA-VC ) or with gemcitabine ( VG ) in patients with stage IIIB-IV non-small cell lung cancer ( NSCLC ) . PATIENTS AND METHODS A total of 316 patients with advanced NSCLC previously untreated were r and omized to either vinorelbine 30 mg/m(2 ) D1,8 with carboplatin AUC 5 D1 ( VC ) or vinorelbine 25mg/m(2 ) with gemcitabine ( VG ) 1000 mg/m(2 ) both given D1,8 every 3 weeks . The primary endpoint was response rate with secondary parameters being survival ( OS ) , progression-free survival ( PFS ) , tolerance and clinical benefit . RESULTS The median number of cycles was four in each arm with a total of 1268 cycles . The objective response ( OR ) on intent-to-treat was 20.8 % in VC and 28 % in VG ( p=0.15 ) . Median PFS was 3.9 months in VC and 4.4 months ( mo ) in VG ( p=0.18 ) . Median survival was significantly longer ( p=0.01 ) for VG with 11.5 mo compared to 8.6 mo in VC with 1 year survival at 48.9 and 34.4 % , respectively . Tolerance was better in the VG arm as compared to the VC patients . Four toxic deaths were recorded in the VC group . Clinical benefit response rate was 32.4 % compared to 40.9 % in 111 and 110 evaluable patients in VC and VG , respectively . CONCLUSION VG compared to VC result ed in a similar overall response rate , favourable median survival and a better toxicity profile . For non-cisplatin-based chemotherapy , VG is a useful alternative This r and omised multicentre trial was conducted to establish the optimal duration of palliative chemotherapy in advanced non-small-cell lung cancer ( NSCLC ) . We compared a policy of three vs six courses of new-generation platinum-based combination chemotherapy with regard to effects on quality of life ( QoL ) and survival .  Patients with stage IIIB or IV NSCLC and WHO performance status ( PS ) 0–2 were r and omised to receive three ( C3 ) or six ( C6 ) courses of carboplatin ( area under the curve ( AUC ) 4 , Chatelut 's formula , equivalent to Calvert 's AUC 5 ) on day 1 and vinorelbine 25 mg m−2 on days 1 and 8 of a 3-week cycle . Key end points were QoL at 18 weeks , measured with EORTC Quality of Life Question naire (QLQ)-C30 and QLQ-LC13 , and overall survival . Secondary end points were progression-free survival and need of palliative radiotherapy . Two hundred and ninety-seven patients were r and omised ( C3 150 , C6 147 ) . Their median age was 65 years , 30 % had PS 2 and 76 % stage IV disease . Seventy-eight and 54 % of C3 and C6 patients , respectively , completed all scheduled chemotherapy courses . Compliance with QoL question naires was 88 % . There were no significant group differences in global QoL , pain or fatigue up to 26 weeks . The dyspnoea palliation rate was lower in the C3 arm at 18 and 26 weeks ( P<0.05 ) , but this finding was inconsistent across different methods of analysis . Median survival in the C3 group was 28 vs 32 weeks in the C6 group ( P=0.75 , HR 1.04 , 95 % CI 0.82–1.31 ) . One- and 2-year survival rates were 25 and 9 % vs 25 and 5 % in the C3 and C6 arm , respectively . Median progression-free survival was 16 and 21 weeks in the C3 and C6 groups , respectively ( P=0.21 , HR 0.86 , 95 % CI 0.68–1.08 ) . In conclusion , palliative chemotherapy with carboplatin and vinorelbine beyond three courses conveys no survival or consistent QoL benefits in advanced NSCLC To determine a st and ard combination chemotherapy for patients with advanced non-small-cell lung cancer ( NSCLC ) , we conducted a phase III trial of irinotecan ( CPT-11 ) to test the hypotheses that CPT-11+cisplatin is superior to cisplatin+vindesine and that CPT-11 monotherapy is not inferior to cisplatin+vindesine . A total of 398 patients with previously untreated NSCLC were r and omised to receive cisplatin+CPT-11 ( CPT-P ) , cisplatin+vindesine ( VDS-P ) or CPT-11 alone ( CPT ) . In the CPT-P arm , CPT-11 60 mg m−2 was administered on days 1 , 8 and 15 , and cisplatin 80 mg m−2 was administered on day 1 . In the VDS-P arm , cisplatin 80 mg m−2 was administered on day 1 , and vindesine 3 mg m−2 was administered on days 1 , 8 and 15 . In the CPT arm , CPT-11 100 mg m−2 was administered on days 1 , 8 and 15 . The median survival time was 50.0 weeks for patients on CPT-P , 45.6 weeks for those on VDS-P and 46.0 weeks for those on CPT ( P=0.115 , CPT-P vs VDS-P ; P=0.089 , CPT vs VDS-P ) , and the hazard ratio was 0.85 ( 95 % confidence interval ( CI ) : 0.65–1.11 ) for CPT-P vs VDS-P and 0.83 ( 0.64–1.09 ) for CPT vs VDS-P. The response rate was 43.7 % for patients on CPT-P  , 31.7 % for those on VDS-P and 20.5 % for those on CPT . Major adverse reactions were grade 4 neutropenia observed in 37 , 54 and 8 % of the patients on CPT-P , VDS-P and CPT , respectively ; and grade s 3 and 4 diarrhoea observed in 12 , 3 and 15 % of the patients , respectively . CPT-P therapy produces comparable survival to VDS-P in patients with advanced NSCLC . CPT-11 monotherapy is not inferior to VDS-P in terms of survival . The CPT-11-containing regimen is one of the most efficacious and well tolerated in the treatment of advanced NSCLC OBJECTIVE To determine , in stage IV non-small-cell lung cancer ( NSCLC ) , if the combination of gemcitabine-a new active drug-with ifosfamide ( IG ) or with the cisplatin-carboplatin association ( CCG ) will improve survival ( primary end point ) in comparison with a first-generation regimen , cisplatin-carboplatin-ifosfamide ( CCI ) . PATIENTS AND METHODS A total of 284 chemotherapy-naïve patients with metastatic NSCLC were r and omised . Four were ineligible and 16 were not assessable for responses . Cisplatin was given at 60 mg/m2 on day 1 , carboplatin AUC 3 mg.min/ml on day 1 , ifosfamide 4.5 g/m2 on day 1 and gemcitabine 1 g/m2 on days 1 , 8 and 15 . Courses were repeated every 4 weeks . Response was assessed after three courses and chemotherapy was continued in responding patients until best response . There were 94 eligible patients in the CCI arm , 92 in CCG and 94 in the IG arm . RESULTS The objective response rates for CCI , CCG and IG were 23 % [ 95 % confidence interval ( CI ) 15 % to 32 % ] , 29 % ( 95 % CI 20 % to 39 % ) and 25 % ( 95 % CI 16 % to 33 % ) , respectively ( P = 0.61 ) . Median survival time was 24 , 34 and 30 weeks , respectively ( P = 0.20 ) . One-year survival was 23 , 33 and 35 % , and 2-year survival was 11 , 14 and 17 % , respectively . In some subgroups ( older patients , women ) , there was a significant survival advantage for CCG and IG compared with CCI . Toxicity was tolerable : severe alopecia was less frequent in the CCG arm , and IG was associated with significantly more thrombopenia while CCG was associated with more leucopenia . CONCLUSION In stage IV NSCLC , treatment with regimens including the new drug gemcitabine were associated with a better but not statistically significant observed survival compared with a classical first-generation cisplatin-containing regimen . The non-platinum combination of gemcitabine was as effective as its combination with platinum The aim of this study was to compare the efficacy of single‐agent weekly docetaxel with the combination of docetaxel and gemcitabine in elderly and /or poor performance status patients with advanced nonsmall cell lung cancer ( NSCLC ) PURPOSE The purpose of this study was to determine whether the addition of the epidermal growth factor receptor tyrosine kinase inhibitor gefitinib ( Iressa , ZD1839 ; AstraZeneca , Wilmington , DE ) to st and ard first-line gemcitabine and cisplatin provides clinical benefit over gemcitabine and cisplatin alone in patients with advanced or metastatic non-small-cell lung cancer ( NSCLC ) .  Gefitinib has demonstrated encouraging efficacy in advanced NSCLC in phase II trials in pretreated patients , and a phase I trial of gefitinib in combination with gemcitabine and cisplatin showed favorable tolerability . PATIENTS AND METHODS This was a phase III r and omized , double-blind , placebo-controlled , multicenter trial in chemotherapy-naive patients with unresectable stage III or IV NSCLC . All patients received up to six cycles of chemotherapy ( cisplatin 80 mg/m(2 ) on day 1 and gemcitabine 1,250 mg/m(2 ) on days 1 and 8 of the 3-week cycle ) plus either gefitinib 500 mg/d , gefitinib 250 mg/d , or placebo . Daily gefitinib or placebo was continued until disease progression . End points included overall survival ( primary ) , time to progression , response rates , and safety evaluation . RESULTS A total of 1,093 patients were enrolled . There was no difference in efficacy end points between the treatment groups : for the gefitinib 500 mg/d , gefitinib 250 mg/d , and placebo groups , respectively , median survival times were 9.9 , 9.9 , and 10.9 months ( global ordered log-rank [ GOLrank ] P = .4560 ) , median times to progression were 5.5 , 5.8 , and 6.0 months ( GOLrank ; P = .7633 ) , and response rates were 49.7 % , 50.3 % , and 44.8 % . No significant unexpected adverse events were seen . CONCLUSION Gefitinib in combination with gemcitabine and cisplatin in chemotherapy-naive patients with advanced NSCLC did 
    Output:
    
R and omized studies suggest that platinum-based doublets ( platinum plus new agent ) are the st and ard of care for first-line systemic therapy .
No one new agent is clearly superior for use in combination with a platinum agent .
The survival advantage of platinum-based doublets over nonplatinum combinations or older combinations is modest .
The addition of bevacizumab to carboplatin and paclitaxel has shown improved survival , although multiple exclusion criteria limit the applicability of these data to a subset of patients .
In patients at least 70 years of age or with Eastern Collaborative Oncology Group performance status 2 , a new single agent is an alternative .
Treatment beyond four to six cycles impedes quality of life without prolonging life .
Emerging data suggest that the choice of chemotherapy agent may be influenced by histologic subtype .
In NSCLC , a combination of a platinum agent plus a new agent continues to be the st and ard of care .