CORRESPONDENCE Re: Economic Analysis of Vinorelbine Plus Cisplatin Versus Paclitaxel Plus

Ramsey et al. (1) de-scribe an economic analysis of vinorel-bine plus cisplatin versus paclitaxel plus carboplatin for advanced non-small-cell lung cancer. This analysis, however, was done alongside a Southwest Oncol-ogy Group multicenter, randomized clini-cal trial (2). It does not necessarily reflect the real situation and may be biased, aiming at finding a cost–benefit for vi-norelbine plus cisplatin. This analysis does not consider the fact that hospital-ization is often required for the admin-istration of vinorelbine plus cisplatin, particularly for patients with a less fa-vorable performance status, thus in-creasing the cost of this treatment. All patients entering this clinical trial had to have a performance status of 0 or 1, and the trial concluded that vinorelbine plus cisplatin was much more toxic. The real situation shows that in most instances, vinorelbine plus cisplatin can only be administered in inpatients who have a good performance status. Admin-istration of the paclitaxel plus carboplat-in combination, however, does not re-quire hospitalization and had the lowest incidence of grade 3 and 4 toxicities among patients with a performance sta-tus of 2 compared with paclitaxel plus cisplatin, gemcitabine plus cisplatin, and docetaxel plus cisplatin in a recent pub-lication (3). Another publication showed that poor-performance patients with ad-vanced non-small-cell lung cancer might not benefit from vinorelbine plus cisplatin compared with vinorelbine alone (4). Paclitaxel plus carboplatin and vi-norelbine plus cisplatin are currently re-garded as two standard protocols for the treatment of advanced non-small-cell lung cancer, although several other platin-containing regimens have been shown to have similar efficacy [for review see (5)]. Economic analysis could be helpful in deciding which regimen should be used, but all aspects must be taken into consideration, and the analysis of cost should not be biased