Predictors of Long-Term Survival in Patients with Lung Cancer Included in the Randomized Spanish Lung Cancer Group 0008 Phase II Trial Using Concomitant Chemoradiation with Docetaxel and Carboplatin plus Induction or Consolidation Chemotherapy

Docetaxel and Carboplatin Plus Induction or Consolidation Chemotherapy

Pilar Garrido; Rafael Rosell; Bartomeu Massutí; Felipe Cardenal; Vicente Alberola; Manuel Dómine; Inmaculada Maeztu; Alfredo Ramos; Antonio Arellano

Disclosures

Clin Lung Cancer. 2009;10(3):180-186. 

In This Article

Abstract and Introduction

Abstract

Purpose: The aim of this study was to analyze prognostic variables associated with long-term survival in patients with stage III non-small-cell lung cancer enrolled in a Spanish Lung Cancer Group (SLCG) phase II trial.
Patients and Methods: Between May 2001 and June 2006, 139 patients were enrolled. The initial design included 3 arms: sequential chemotherapy (CT) followed by standard thoracic radiation therapy (TRT; RT), concomitant CT/TRT followed by consolidation CT, or induction CT followed by CT/TRT. Based on the results of the Radiation Therapy Oncology Group 9410 trial, the sequential arm was closed. Induction or consolidation therapy comprised docetaxel plus gemcitabine. Concomitant treatment comprised docetaxel plus carboplatin plus 60 Gy TRT. A univariate and a Cox proportional hazard regression analysis of the following 11 variables were performed: age, sex, Eastern Cooperative Oncology Group performance status (PS), histology, forced expiratory volume in 1 second, disease stage, nodal status, hemoglobin level, completion of RT treatment, completion of induction or consolidation plus concomitant treatment, and RT delay.
Results: With a median follow-up of 23 months for living patients, median survival was 13.07 months for the consolidation arm and 14.65 months for the induction arm. The 4-year survival rates were 25.37% and 32.35%, respectively. Only RT treatment completion (P < .0001) and induction or consolidation plus concomitant treatment completion (P < .0001) were associated with longer survival.
Conclusion: Based on this retrospective analysis of patients enrolled in the SLCG 0008 randomized phase II study, age, sex, PS, and clinical parameters are not good predictors of overall survival; however, completion of treatment is needed to achieve long-term results.

Introduction

Lung cancer is the leading cause of cancer-related death for both men and women worldwide, and its global incidence has been steadily increasing for decades. Non-small-cell lung cancer (NSCLC) accounts for approximately 85% of all cases, and 40% of patients with NSCLC present with locally advanced disease (stage III).[1] This group is the most controversial subset of patients with lung cancer because of the group's great heterogeneity and can be divided into several subgroups based on such characteristics as resectability, performance status (PS), or pleural effusion status.

At present, there is no single widely accepted standard of care for all patients with locally advanced disease. Unresectable but fit patients are usually treated with concurrent platinum-based chemotherapy (CT) and thoracic radiation therapy (TRT), which has achieved a median survival of 15 months but with 20% grade 3/4 acute esophagitis.[2,3,4,5,6] The optimal drugs, schedule sequence, and doses of CT when administered in combination with TRT are not yet well adequately defined, and the 5-year survival rates remain disappointing. Furthermore, although there has been quite extensive research exploring the impact of different prognostic factors on survival in advanced disease, there are limited data concerning their role in stage III disease.

To examine the potential association between patient variables and survival, we undertook a retrospective analysis of 11 potential prognostic variables in 139 patients with locally advanced NSCLC included in the randomized phase II Spanish Lung Cancer Group (SLCG) 0008 study comparing induction versus consolidation CT plus concomitant CT/TRT.

processing....