Induction Chemotherapy and Chemoradiation Therapy for Inoperable Locally Advanced Non-small-cell Lung Cancer: A Single-institution Review of Two Different Regimens

Mihriban Kocak; Alper Ozkan; Alpaslan Mayadagli; Cem Parlak; Ahmet Bilici; Mesut Seker; Bala Basak Oven Ustaalioglu; Mahmut Gumus; Makbule Eren; Sule Gul Karabulut; Fatih Oruc

Disclosures

Clin Lung Cancer. 2009;10(2):124-129. 

In This Article

Abstract and Introduction

Abstract

Purpose: We compared 2 different chemotherapeutic agents in combination with cisplatin as induction chemotherapy (ICT) followed by chemoradiation therapy (CHRT) in patients with inoperable locally advanced non–small-cell lung cancer (NSCLC).
Patients and Methods: A total of 90 patients with inoperable locally advanced NSCLC received 3 courses of ICT consisting of gemcitabine 1200 mg/m2 on day 1 and day 8 every 3 weeks and cisplatin 75 mg/m2 on day 1 every 3 weeks (group 1; n = 39) or docetaxel 75 mg/m2 on day 1 every 3 weeks and cisplatin 75 mg/m2 on day 1 every 3 weeks (group 2; n = 51) followed by CHRT (docetaxel 30 mg/m2 every week and cisplatin 20 mg/m2 every week with 6600 cGy radiation therapy).
Results: After the ICT, the response rate for group 2 (88.2%) was significantly higher than that of the gemcitabine-cisplatin arm (64.1%; P = .017). The response assessment performed on first month after CHRT revealed statistical difference for objective response rate in group 2 when compared with group 1 (P = .04). At the median follow-up of 15.7 months (range, 5-36 months), median overall survival (OS) was 12 months in group 1 (95% CI, 9.1-14.8) and 29.9 months in group 2 (95% CI, 16-43). Median progression-free survival (PFS) was 8 months in group 1 and 15 months in group 2. There was statistically significant difference between the 2 groups regarding OS and PFS (P = .043).
Conclusion: Our results suggest that OS, PFS, and local control rate are significantly improved with ICT consisting of docetaxel and cisplatin when compared with gemcitabine-cisplatin in inoperable locally advanced NSCLC.

Introduction

Lung cancer is still the most common cause of cancer-related death for men and women in the world.[1] In addition, only 15% of all patients with lung cancer are alive 5 years or more after diagnosis. The combination of radiation therapy (RT) and chemotherapy (CT) using cisplatin-based regimens has been comprehensively investigated, and today, chemoradiation therapy (CHRT) has been accepted as the standard treatment modality in patients with inoperable locally advanced (stage IIIA and stage IIIB) non–small-cell lung cancer (NSCLC).[2,3,4,5] Previous studies suggested a benefit in the sequential approach.[6]

The Cancer and Leukemia Group B (CALGB) 8433 trial and others trials have shown that 2 cycles of induction chemotherapy (ICT) with either vindesine, cyclophosphamide, and lomustine,[4] or vinblastine and cisplatin,[7,8,9] followed by RT, led to 4-month median survival time compared with RT alone. On the other hand, a recently published CALGB 39801 study by Vokes et al showed that the addition of 2 cycles of ICT with paclitaxel and carboplatin to concurrent CHRT increased toxicity and provided no survival benefit compared with concurrent CHRT alone.[10] Moreover, survival advantage of concomitant CHRT has also been demonstrated when compared with RT.[11,12] However, it is not possible to rule out the current theoretical advantages of CT; its optimal use is still being investigated.

In studies using ICT followed by CHRT, median survival times have been detected as 11.4 and 17 months.[9,13] ICT has had the possible effect of primarily reducing systemic failure rates without affecting local control in this setting.[4] In the present study, 2 different regimens of ICT were used, and all the patients were administered CHRT on follow-up. The effects of ICT and CHRT on overall survival (OS) and progression-free survival (PFS) were studied. Toxicity related to treatment was also investigated.

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