***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: BACKGROUND It is increasingly important to have timely information about the economic impact of new cancer therapies in today 's cost-conscious environment . Nearly 170 000 people are diagnosed with lung cancer annually in the United States . We performed an economic analysis alongside Southwest Oncology Group Trial S9509 to estimate the cost-effectiveness of cisplatin plus vinorelbine versus carboplatin plus paclitaxel for patients with advanced non-small-cell lung cancer . There were no statistically significant differences in survival or cancer-related quality of life between the treatment arms . METHODS Use of both protocol and non protocol lung cancer-related health care was tracked for 24 months from the initiation of therapy . To determine expenditures , nationally st and ardized costs were applied to each type of health care service used , and these were summed over time . Lifetime expenditures and 95 % confidence intervals ( CIs ) for each arm of the trial were calculated with the use of a multivariate regression technique that accounts for censoring . Student 's t tests were used to compare the difference in costs between the arms . All statistical tests were two-sided . RESULTS Cancer-related health care costs over the period of observation averaged 40,292 dollars ( 95 % CI = 36,226 dollars to 44,359 dollars ) for patients in the cisplatin plus vinorelbine arm versus 48,940 dollars ( 95 % CI = 44,674 dollars to 53,208 dollars ) for patients in the carboplatin plus paclitaxel arm ( P = .004 ) , with a mean difference of 8648 dollars ( 95 % CI = 2634 dollars to 14,662 dollars ) . Protocol chemotherapy drugs and medical procedures costs were statistically significantly higher in the paclitaxel arm ( P = .0003 and P<.0001 , respectively ) , whereas protocol chemotherapy delivery costs were statistically significantly higher in the vinorelbine arm ( P<.0001 ) . There was no difference between the arms in costs for blood products , supportive care medications , non protocol -related inpatient or outpatient care , and non protocol chemotherapy . CONCLUSIONS Treatment with carboplatin plus paclitaxel is substantially and statistically significantly more expensive than treatment with cisplatin plus vinorelbine . The majority of the cost difference is due to the additional cost of the protocol chemotherapy ( approximately 12,000 dollars ) . Notable differences in costs of downstream health care were not apparent PURPOSE To compare two cisplatin based chemotherapy schedules in patients with advanced non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS A total of 332 patients with advanced NSCLC were r and omized to receive cisplatin 80 mg/m2 on day 1 either in combination with teniposide 100 mg/m2 on days 1 , 3 , and 5 ( arm A ) or paclitaxel 175 mg/m2 by 3-hour infusion on day 1 ( arm B ) ; cycles were repeated every 3 weeks . RESULTS Fifteen patients were ineligible ; patient characteristics were well balanced between the two arms : 71 % were male , 71 % had less than 5 % weight loss , 89 % had a World Health Organization ( WHO ) performance status of 0 to 1 , 51 % had adenocarcinoma , and 61 % had stage IV disease .  Hematologic toxicity was significantly more severe in arm A ( leukopenia , neutropenia , and thrombocytopenia grade 3 or 4 : 66 % v 19 % , 83 % v 55 % , 36 % v 2 % in arms A and B , respectively ) , which result ed in more febrile neutropenia ( 27 % v 3 % in arms A and B , respectively ) , dose reductions , and treatment delays . There were a total of nine toxic deaths , six due to neutropenic sepsis : five in arm A and one in arm B. In contrast , arthralgia/myalgia ( grade 2 or 3 , 4 % v 17 % ) , peripheral neurotoxicity ( grade 2 or 3 , 6 % v 29 % ) , and hypersensitivity reactions ( 1 % v 7 % , all grade s ) were significantly more frequent in arm B. The frequency and severity of other toxicities were comparable between the two arms . Responses were one complete and 44 partial on arm A ( 28 % ) and two complete and 61 partial ( 41 % ) on arm B ( P = .018 ) . There was no significant difference in survival , with median and 1-year survivals 9.9 versus 9.7 months and 41 % versus 43 % , respectively in arm A and B. Progression-free survival was 4.9 and 5.4 months in arm A and B , respectively . Selected centers participated in a quality -of-life ( QoL ) assessment , which was performed by the European Organization for Research and Treatment of Cancer ( EORTC ) QLQ-C30 and LC-13 administered at baseline and every 6 weeks thereafter . Arm B achieved a better score at week 6 for emotional , cognitive and social functioning , global health status , fatigue , and appetite loss , which was lost at 12 weeks . In conclusion , arm B appears superior to arm A with regard to response rate , side effects , and QoL. CONCLUSION Although survival was not improved , arm B offers a better palliation for advanced NSCLC patients than arm PURPOSE Treatment with cisplatin-based chemotherapy provides a modest survival advantage over supportive care alone in advanced non-small-cell lung cancer ( NSCLC ) . To determine whether a new agent , paclitaxel , would further improve survival in NSCLC , the Eastern Cooperative Oncology Group conducted a r and omized trial comparing paclitaxel plus cisplatin to a st and ard chemotherapy regimen consisting of cisplatin and etoposide . PATIENTS AND METHODS The study was carried out by a multi-institutional cooperative group in chemotherapy-naive stage IIIB to IV NSCLC patients r and omized to receive paclitaxel plus cisplatin or etoposide plus cisplatin . Paclitaxel was administered at two different dose levels ( 135 mg/m(2 ) and 250 mg/m(2 ) ) , and etoposide was given at a dose of 100 mg/m(2 ) daily on days 1 to 3 . Each regimen was repeated every 21 days and each included cisplatin ( 75 mg/m(2 ) ) . RESULTS The characteristics of the 599 patients were well-balanced across the three treatment groups . Superior survival was observed with the combined paclitaxel regimens ( median survival time , 9.9 months ; 1-year survival rate , 38.9 % ) compared with etoposide plus cisplatin ( median survival time , 7.6 months ; 1-year survival rate , 31.8 % ; P = . 048 ) . Comparing survival for the two dose levels of paclitaxel revealed no significant difference . The median survival duration for the stage IIIB subgroup was 7.9 months for etoposide plus cisplatin patients versus 13.1 months for all paclitaxel patients ( P = .152 ) . For the stage IV subgroup , the median survival time for etoposide plus cisplatin was 7.6 months compared with 8.9 months for paclitaxel ( P = .246 ) . With the exceptions of increased granulocytopenia on the low-dose paclitaxel regimen and increased myalgias , neurotoxicity , and , possibly , increased treatment-related cardiac events with high-dose paclitaxel , toxicity was similar across all three arms . Quality of life ( QOL ) declined significantly over the 6 months . However , QOL scores were not significantly different among the regimens . CONCLUSION As a result of these observations , paclitaxel ( 135 mg/m(2 ) ) combined with cisplatin has replaced etoposide plus cisplatin as the reference regimen in our recently completed phase III trial Purpose : The main purpose of this paper is to present the results of a r and omized trial comparing the effects of two chemotherapy regimens on the Quality of life ( QOL ) of patients with advanced non-small-cell lung cancer ( NSCLC ) . Trials in advanced stage disease represent an important treatment context for QOL assessment . A second purpose of this paper is to examine methods for h and ling the level of missing data commonly observed in the advanced stage disease context . Methods : Patients were r and omized to receive cisplatin plus vinorelbine or carboplatin plus paclitaxel .  The QOL of 222 patients was assessed with the Functional Assessment of Cancer Therapy – Lung ( FACT-L ) prior to r and omization ; follow-up assessment s occurred at 13 and 25 weeks . Three methods were used to analyze the QOL data : ( 1 ) cross-sectional analysis of four patient categories ( improved , stable , missing , and declined ) based on changes in the FACT-L score , ( 2 ) a mixed linear model , and ( 3 ) a pattern mixture model . The longitudinal analyses addressed two potential data biases . Results : Question naire su bmi ssion rates were 91 % at baseline , 68 % at 13 weeks , and 47 % at 25 weeks . The cross-sectional and mixed linear model analyses did not show significant differences by treatment arm in patient-reported QOL . The pattern mixture model analysis , more appropriate given non-ignorable missing data , also found no statistically significant effect of treatment on patient QOL . Conclusion : We present a sensitivity analysis approach with multiple methods for analyzing treatment effects on patient QOL in the presence of substantial , non-ignorable missing data in an advanced stage disease clinical trial . We conclude that the two treatment arms did not differ statistically in their effects on patient QOL over a 25-week treatment period PURPOSE To evaluate whether two commonly used newer platinum-based regimens offer any advantage over vinorelbine-cisplatin ( reference regimen ) in response rate for patients with advanced non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS Chemotherapy-naive patients were r and omized to receive gemcitabine 1,250 mg/m(2 ) days 1 and 8 plus cisplatin 75 mg/m(2 ) day 2 every 21 days ( GC arm ) , or paclitaxel 225 mg/m(2 ) ( 3-hour infusion ) then carboplatin ( area under the concentration-time curve of 6 mg/mL x min ) , both on day 1 every 21 days ( PCb arm ) , or vinorelbine 25 mg/m(2)/wk for 12 weeks then every other week plus cisplatin 100 mg/m(2 ) day 1 every 28 days ( VC arm ) . RESULTS Six hundred twelve patients were r and omized to treatment ( 205 GC , 204 PCb , and 203 VC ) . Overall response rates for the GC ( 30 % ) and PCb ( 32 % ) arms were not significantly different from that of the VC arm ( 30 % ) . There were no differences in overall survival , time to disease progression , or time to treatment failure . Median survival for the GC , PCb , and VC groups was 9.8 , 9.9 , and 9.5 months , respectively . Neutropenia was significantly higher on the VC arm ( GC 17 % or PCb 35 % v VC 43 % of cycles , P < .001 ) , as was thrombocytopenia on the GC arm ( GC 16 % v VC 0.1 % of cycles , P < .001 ) . Alopecia and peripheral neurotoxicity were most common on the PCb arm , as was nausea/vomiting on the VC arm ( P < .05 ) . CONCLUSION Efficacy end points were not significantly different between experimental and reference arms , although toxicities showed differences . These findings suggest that chemotherapy in NSCLC has reached a therapeutic plateau PURPOSE To compare the activity and tolerability of docetaxel/gemcitabine ( DG ) and vinorelbine/cisplatin ( VC ) combinations in chemotherapy-naive non-small-cell lung cancer ( NSCLC ) patients . PATIENTS AND METHODS Patients with advanced NSCLC were r and omly assigned to receive either DG ( gemcitabine 1,000 mg/m(2 ) [ days 1 and 8 ] plus docetaxel 100 mg/m(2 ) [ day 8 ] ) or VC ( vinorelbine 30 mg/m(2 ) [ days 1 and 8 ] plus cisplatin 80 mg/m(2 ) [ day 8 ] ) and prophylactic recombinant human granulocyte colony-stimulating factor ( 150 microg/m(2 ) subcutaneously [ day 9 through 15 ] ) every 3 weeks . Results A total of 413 r and omly assigned patients were analyzed for response and toxicity ( DG , n = 197 ; VC , n = 192 ) . Median survival was 9.0 and 9.7 months ( P = .965 ) for DG and VC arms , respectively ; the corresponding 1-year survival rates were 34.3 % and 40.8 % , respectively . Overall response rate was 30 % ( 95 % CI , 23.9 % to 36.3 % ) and 39.2 % ( 95 % CI , 32.5 % to 45.9 % ; P = .053 ) for DG and VC , respectively . Toxicity was as follows ( DG v VC ) : grade 2 to 4 anemia , 3 
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Of these , only one trial found a significant difference in QOL between the comparator arms : paclitaxel plus cisplatin was better than teniposide plus cisplatin .
CONCLUSION Based on our review , it seems unlikely that a major difference exists in the global QOL associated with st and ard chemotherapy regimens for advanced NSCLC .