The Lynx Group

Concurrent Chemotherapy and Radiation Therapy Extends Survival in NSCLC

October 2011, Vol 2, No 6

The concurrent use of chemotherapy and thoracic radiotherapy (TRT) confers a greater survival benefit in patients with stage III non–small-cell lung cancer (NSCLC) than a sequential use of these therapies, based on results from a phase 3 clinical study (Curran WJ, et al. J Natl Cancer Inst. 2011;103: 1452-1460).

This study compared standard therapy (ie, chemotherapy followed by radiation) with 2 regimens of concurrent chemoradiation in 610 patients with inoperable stage II or III NSCLC enrolled from 153 centers in the United States and Canada.

Patients were randomized to 1 of 3 treatment groups. Groups 1 (N = 203) and 2 (N = 204) received vincristine (Oncovin) administered once weekly for 5 weeks and cisplatin (Platinol) administered on days 1 and 29. Group 1 also received TRT once daily for 7 weeks, beginning on day 50, at the end of the vincristine/cisplatin regimen; group 2 received TRT once daily concurrently with the vincris tine/cisplatin regimen for 7 weeks. Group 3 (N = 203) received 10 weeks of chemotherapy with cisplatin/etoposide (Toposar) concurrent with 6 weeks of TRT twice daily beginning on day 1.

At a median follow-up of 11 years, the primary end point of 5-year overall survival was 16% in those receiving the concurrent regimen once daily (median survival, 17 months), 13% among those who received TRT twice daily concurrently (median survival, 15.6 months), and 10% among those who received TRT sequentially after chemotherapy (median survival, 14.6 months)—a significant difference favoring the oncedaily concurrent regimen.

Patients receiving concurrent chemotherapy plus TRT once daily and twice daily had a higher rate of acute esophagitis (22% and 45%, respectively) than those receiving sequential therapy (4%), but the long-term rates (ranging from 1%-4%), along with the rates of other, late-occurring grade 3-5 toxic effects, did not differ significantly between any of the groups. The investigators acknowledge that unlike the patients included in their study, most patients with stage III NSCLC will have a poorer functional status and suffer from comorbid conditions that would limit their tolerability to adverse effects such as severe esophagitis.

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