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Tafenzi HA, Choulli F, Haag EK, Baladi A, Essaadi I, Belbaraka R. Real world results of locally advanced and metastatic lung cancer patients treated with platinum doublet chemotherapy in first line: Moroccan cohort. Transl Oncol 2024; 47:102015. [PMID: 38981247 PMCID: PMC11292509 DOI: 10.1016/j.tranon.2024.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/26/2024] [Accepted: 05/27/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Doublet platin-chemotherapy was the old standard treatment for different histology types of advanced and metastatic lung cancer (LC) and is still an option for patients who are not eligible for immune checkpoint inhibitors. However, in low- and middle-income countries, chemotherapy, either in monotherapy or in combination with platinum, is still the only accessible option in public institutions. The efficacy of different platin-based chemotherapy in patients with LC who are treatment-naïve is unknown. METHODS In this retrospective study, we selected patients with advanced and metastatic (IIIB-IVB) non-squamous non-small cell LC (NSCLC), squamous NSCLC, and lung neuroendocrine tumours (small cell LC (SCLC), large cell neuroendocrine, and atypical carcinoid) aged beyond 18 years who received first-line chemotherapy (docetaxel, gemcitabine, etoposide, paclitaxel, pemetrexed, and vinorelbine) combined with platinum between January 1, 2013, and December 31, 2022. Within the population with non-squamous NSCLC, squamous NSCLC, and neuroendocrine tumours, progression-free survival (PFS) and overall survival (OS) were the primary assessed endpoints. Hematologic safety was the secondary endpoint. RESULTS Overall, 611 patients were included. In the group of patients with non-squamous NSCLC (n = 390), there was no statistical difference between subgroups of patients who received first-line platin-chemotherapy. The median PFS was 182 (95 % confidence interval [CI], 167-208) days (hazard ratio for progression: NR [Not Reached]; p = 0.37), and the median OS was 446 (95 % CI, 405-559) days (hazard ratio for death: 1.31; 95 % CI, 0.94 - 1.82; p = 0.1). In the group of patients with squamous NSCLC (n = 149), we note the absence of statistical significance between subgroups of patients who received platin-based chemotherapy. The median PFS was 195 (95 % CI, 142-238; hazard ratio for progression: 1.21, 95 % CI, 0.29-5.02; p = 0.27), while the median OS was 428 (95 % CI, 324-940) days (hazard ratio for death: 1.76; 95 % CI, 0.93 to 3.3; p = 0.32). The absence of significance has been noticed in the neuroendocrine subgroup of patients who received first etoposide-platinum, vinorelbine-platinum, or paclitaxel-platinum (n = 72). The median PFS was 216 (95 % CI, 193-277) days; hazard ratio for progression: 1.74, 95 % CI, 0.41-7.27; p = 0.69, while the median OS was 273 (95 % CI, 241-459) days (hazard ratio for death: 2.95; 95 % CI, 0.4-21.7; p = 0.51). Grade 3-4 neutropenia grade was the predominant adverse event associated with chemotherapy in almost 11 % of patients. CONCLUSION Moving forward, treatment strategies must be refined for patients, with an emphasis on increasing the number of patients who can benefit from emergent approaches in order to guarantee a wider, deeper, and longer-lasting outcome.
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Affiliation(s)
- Hassan Abdelilah Tafenzi
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Morocco; Biosciences and Health Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.
| | - Farah Choulli
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Morocco; Biosciences and Health Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Edwin Kelly Haag
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Morocco
| | - Anass Baladi
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Morocco
| | - Ismail Essaadi
- Biosciences and Health Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco; Medical Oncology Department, Avicenna Military Hospital of Marrakech, Morocco
| | - Rhizlane Belbaraka
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Morocco; Biosciences and Health Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
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Zhao M, Shao T, Chi Z, Tang W. Effectiveness and cost-effectiveness analysis of 11 treatment paths, seven first-line and three second-line treatments for Chinese patients with advanced wild-type squamous non-small cell lung cancer: A sequential model. Front Public Health 2023; 11:1051484. [PMID: 36908446 PMCID: PMC9999022 DOI: 10.3389/fpubh.2023.1051484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
Background A total of 11 treatment sequences for advanced wild-type squamous non-small cell lung cancer are recommended by Chinese Society of Clinical Oncology Guidelines, consisting of seven first-line and three second-line treatments. Five of these treatments were newly approved in China between 2021 and 2022. We evaluated the effectiveness and cost-effectiveness of these strategies from the Chinese healthcare system perspective. Methods Network meta-analysis with non-proportional hazards was used to calculate the relative efficacy between interventions. A sequential model was developed to estimate costs and quality-adjusted life years (QALY) for treatment sequences with first-line platinum- and paclitaxel-based chemotherapy (SC) with or without nedaplatin, tislelizumab, camrelizumab, sintilimab, sugemalimab or pembrolizumab, followed by second-line docetaxel, tislelizumab or nivolumab. SC and docetaxel were used as comparators for first-line and second-line treatments, respectively. QALY and incremental cost-effectiveness ratio (ICER) were used to evaluate effectiveness and cost-effectiveness, respectively. Cost-effective threshold was set as USD 19,091. Subgroup analysis was conducted to determine the best first-line and second-line therapy. Results Pembrolizumab + SC, followed by docetaxel (PED) was the most effective treatment sequence. QALYs for patients received SC, nedaplatin + SC, tislelizumab + SC, sintilimab + SC, camrelizumab + SC, sugemalimab + SC, pembrolizumab + SC followed by docetaxel were 0.866, 0.906, 1.179, 1.266, 1.179, 1.266, 1.603, 1.721, 1.807; QALYs for SC, nedaplatin + SC followed by tislelizumab were 1.283, 1.301; QALYs for SC, nedaplatin + SC followed by nivolumab were 1.353, 1.389. Camrelizumab + SC, followed by docetaxel (CAD) was the most cost-effective. Compared to SC with or without nedaplatin, tislelizumab, or sintilimab followed by docetaxel, ICERs of CAD were USD 12,276, 13,210, 6,974, 9,421/QALY, respectively. Compared with nedaplatin or SC followed by tislelizumab, the ICERs of CAD were USD 4,183, 2,804/QALY; CAD was dominant compared with nedaplatin or SC followed by nivolumab; The ICER of sugemalimab + SC followed by docetaxel and PED were USD 522,023, 481,639/QALY compared with CAD. Pembrolizumab + SC and camrelizumab + SC were the most effective and cost-effective first-line options, respectively; tislelizumab was the most effective and cost-effective second-line therapy. Tislelizumab used in second-line was more effective than first-line, no significant differences between their cost-effectiveness. Sensitivity and scenario analysis confirmed robustness of the results. Conclusions PED and CAD are the most effective and cost-effective treatment sequence, respectively; pembrolizumab + SC and camrelizumab + SC are the most effective and cost-effective first-line choice, respectively; tislelizumab is the most effective and cost-effective second-line choice.
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Affiliation(s)
- Mingye Zhao
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Taihang Shao
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Zhuoyuan Chi
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Wenxi Tang
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu, China
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Goring S, Varol N, Waser N, Popoff E, Lozano-Ortega G, Lee A, Yuan Y, Eccles L, Tran P, Penrod JR. Correlations between objective response rate and survival-based endpoints in first-line advanced non-small cell lung Cancer: A systematic review and meta-analysis. Lung Cancer 2022; 170:122-132. [PMID: 35767923 DOI: 10.1016/j.lungcan.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The study objective was to estimate the relationship between objective response and survival-based endpoints by drug class, in first-line advanced non-small cell lung cancer (aNSCLC). MATERIALS AND METHODS A systematic literature review identified randomized controlled trials (RCTs) of first-line aNSCLC therapies reporting overall survival (OS), progression-free survival (PFS), and/or objective response rate (ORR). Trial-level and arm-level linear regression models were fit, accounting for inclusion of immunotherapy (IO)-based or chemotherapy-only RCT arms. Weighted least squares-based R2 were calculated along with 95% confidence intervals (CIs). For the main trial-level analysis of OS vs. ORR, the surrogate threshold effect was estimated. Exploratory analyses involved further stratification by: IO monotherapy vs. chemotherapy, dual-IO therapy vs. chemotherapy, and IO + chemotherapy vs. chemotherapy. RESULTS From 17,040 records, 57 RCTs were included. In the main analysis, trial-level associations between OS and ORR were statistically significant in both the IO-based and chemotherapy-only strata, with R2 estimates of 0.54 (95% CI: 0.26-0.81) and 0.34 (0.05-0.63), respectively. OS gains associated with a given ORR benefit were statistically significantly larger within IO vs. chemotherapy comparisons compared to chemotherapy vs. chemotherapy comparisons (p < 0.001). Exploratory analysis suggested a trend by IO type: for a given change in ORR, 'pure' IO (IO monotherapy and dual-IO) vs. chemotherapy RCTs tended to have a larger OS benefit than IO + chemotherapy vs. chemotherapy RCTs. For ORR vs. PFS, trial-level correlations were strong in the IO-based vs. chemotherapy (R2 = 0.84; 0.72-0.95), and chemotherapy vs. chemotherapy strata (R2 = 0.69; 0.49-0.88). For OS vs. PFS, correlations were moderate in both strata (R2 = 0.49; 0.20-0.78 and R2 = 0.49; 0.23-0.76). CONCLUSION The larger OS benefit per unit of ORR benefit in IO-based RCTs compared to chemotherapy-only RCTs provides an important addition to the established knowledge regarding the durability and depth of response in IO-based treatments.
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Affiliation(s)
- Sarah Goring
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, Canada.
| | - Nebibe Varol
- Bristol Myers Squibb Pharmaceuticals Ltd, Sanderson Rd, Denham, Uxbridge, England, UK.
| | | | - Evan Popoff
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, Canada.
| | | | - Adam Lee
- Bristol Myers Squibb Pharmaceuticals Ltd, Sanderson Rd, Denham, Uxbridge, England, UK.
| | - Yong Yuan
- Bristol Myers Squibb Pharmaceuticals Ltd, 3401 Princeton Pike, Lawrenceville, NJ, USA.
| | - Laura Eccles
- Bristol Myers Squibb Pharmaceuticals Ltd, 3401 Princeton Pike, Lawrenceville, NJ, USA.
| | - Phuong Tran
- Bristol Myers Squibb Pharmaceuticals Ltd, 3401 Princeton Pike, Lawrenceville, NJ, USA.
| | - John R Penrod
- Bristol Myers Squibb Pharmaceuticals Ltd, 3401 Princeton Pike, Lawrenceville, NJ, USA.
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Akcali Z, Calikusu Z, Sakalli H, Ozyilkan O. Gemcitabine and Cisplatin Treatment of Advanced-Stage Non-Small-Cell Lung Cancer in Patients Given Cisplatin on Day 8. TUMORI JOURNAL 2018; 94:474-80. [DOI: 10.1177/030089160809400406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Gemcitabine and cisplatin treatment were administered to patients with advanced-stage, non-small-cell lung cancer. During phase II studies, the treatment is performed using a 28-day cycle, with gemcitabine administered on days 1, 8, and 15. Although it is advised that cisplatin not be administered on the first day, gemcitabine and cisplatin treatment is usually performed using a 21-day cycle, with gemcitabine administered on days 1 and 8, and cisplatin is given on the first day in most phase III studies. In contrast with previous phase III studies, cisplatin was administered on day 8 in our study. Dose density, drug toxicity, and efficacy were analyzed. Methods and Study Design Chemonaive patients with stage IIIB or stage IV non-small-cell lung cancer received gemcitabine (1250 mg/m2) on days 1 and 8 plus cisplatin (75 mg/m2) on day 8 every 3 weeks (1 cycle contained 2 applications). Results Sixty-seven patients received a total of 293 applications. Dose densities were 92.3% for gemcitabine and 93.9% for cisplatin. The types and rates of grade 3 and grade 4 hematologic toxicities were anemia (6%), granulocytopenia (46%), and thrombocytopenia (6%). Complete remission was seen in 2 patients (3%); partial remission was 40%, stable disease was 39%, and progression of disease, 10%. The median overall survival time was 13 months. The median progression-free survival time was 9.5 months. One-year survival rate was 54% and 2-year survival, 10.4%. Conclusions In this 21-day treatment regimen, overall survival was longer than 1 year and the 1-year survival rate was more than 50%. Both the severity and rate of observed thrombocytopenia in the study were very low. Other adverse effects in the current study were comparable to those reported in the literature.
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Affiliation(s)
- Zafer Akcali
- Department of Medical Oncology, Baskent University Faculty of Medicine, 06490, Ankara, Turkey
| | - Zuleyha Calikusu
- Department of Medical Oncology, Baskent University Faculty of Medicine, 06490, Ankara, Turkey
| | - Hakan Sakalli
- Department of Medical Oncology, Baskent University Faculty of Medicine, 06490, Ankara, Turkey
| | - Ozgur Ozyilkan
- Department of Medical Oncology, Baskent University Faculty of Medicine, 06490, Ankara, Turkey
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Yu J, Xiao J, Yang Y, Cao B. Oxaliplatin-Based Doublets Versus Cisplatin or Carboplatin-Based Doublets in the First-Line Treatment of Advanced Nonsmall Cell Lung Cancer. Medicine (Baltimore) 2015; 94:e1072. [PMID: 26166081 PMCID: PMC4504603 DOI: 10.1097/md.0000000000001072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The efficacy and toxicity of oxaliplatin-based versus carboplatin/cisplatin-based doublets in patients with previously untreated nonsmall cell lung cancer (NSCLC) have been compared.We searched published randomized controlled trials of oxaliplatin-based or carboplatin/cisplatin-based medications for NSCLC. A fixed effect model was used to analyze outcomes which were expressed as the hazard ratio for overall survival (OS) and time-to-progression (TTP), relative risk, overall response rate (ORR), disease control rate (DCR), 1-year survival, and the odds ratios for toxicity were pooled.Eight studies involving 1047 patients were included. ORR tended to favor carboplatin/cisplatin but the effect was not significantly different compared with oxaliplatin doublets (P = 0.05). The effects of OS, TTP, DCR, and 1-year survival between the 2 regimens were comparable. Oxaliplatin doublets caused less grade 3/4 leukocytopenia and neutropenia. Grades 3 to 4 nonhematological toxicities and grades 3 to 4 hematological toxicities showed little difference between oxaliplatin doublets and carboplatin/cisplatin doublets.Meta-analysis shows that the efficacy of oxaliplatin doublets is similar to that of other currently used platinum doublets. The lack of significant differences in the statistic analysis does not preclude genuine differences in clinical efficacy, because higher diversities between the studies covered differences between the 2 groups in each study. Oxaliplatin combined with a third-generation agent should be considered for use as alternative chemotherapy in patients who cannot tolerate conventional platinum-based regimens because the toxicity profile is much more favorable.
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Affiliation(s)
- Jing Yu
- From the Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, China
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Kubota K, Ichinose Y, Scagliotti G, Spigel D, Kim JH, Shinkai T, Takeda K, Kim SW, Hsia TC, Li RK, Tiangco BJ, Yau S, Lim WT, Yao B, Hei YJ, Park K. Phase III study (MONET1) of motesanib plus carboplatin/paclitaxel in patients with advanced nonsquamous nonsmall-cell lung cancer (NSCLC): Asian subgroup analysis. Ann Oncol 2014; 25:529-36. [PMID: 24419239 DOI: 10.1093/annonc/mdt552] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This preplanned subset analysis of the phase III MONET1 study aimed to determine whether motesanib combined with carboplatin/paclitaxel (C/P) would result in improved overall survival (OS) versus chemotherapy alone, in a subset of Asian patients with nonsquamous nonsmall-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with nonsquamous NSCLC (stage IIIB/IV or recurrent) and no prior systemic therapy for advanced disease were randomized to IV carboplatin (AUC, 6 mg/ml min) and paclitaxel (200 mg/m2) for up to six 3-week cycles, plus either oral motesanib 125 mg q.d. or placebo. Primary end point was OS; secondary end points included progression-free survival (PFS), objective response rate (ORR), and safety. RESULTS Two hundred twenty-seven Asian patients from MONET1 were included in this descriptive analysis. Median OS was 20.9 months in the motesanib plus C/P arm and 14.5 months in the placebo plus C/P arm (P=0.0223); median PFS was 7.0 and 5.3 months, respectively, (P=0.0004); and ORR was 62% and 27%, respectively, (P<0.0001). Grade≥3 adverse events were more common in the motesanib plus C/P arm versus placebo plus C/P (79% versus 61%). CONCLUSION In this preplanned subset analysis of Asian patients with nonsquamous NSCLC, motesanib plus C/P significantly improved OS, PFS, and ORR versus placebo plus C/P. CLINICAL TRIAL NUMBER NCT00460317.
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Affiliation(s)
- K Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo
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First-line systemic chemotherapy in the treatment of advanced non-small cell lung cancer: a systematic review. J Thorac Oncol 2010; 5:260-74. [PMID: 20101151 DOI: 10.1097/jto.0b013e3181c6f035] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) frequently presents at an incurable stage, and a majority of patients will be considered for palliative chemotherapy at some point in their disease. This article reviews the growing evidence for first-line treatment in NSCLC. METHODS Studies of first-line chemotherapy regimens including new agents (docetaxel, gemcitabine, irinotecan, paclitaxel, pemetrexed, and vinorelbine) and targeted agents (bevacizumab, erlotinib, and gefitinib) were identified through Medline, Embase, the Cochrane databases, and web sites of guideline organizations. RESULTS Two evidence-based guidelines, 10 systematic reviews, and forty-six randomized trials were eligible for inclusion. Randomized studies suggest that platinum-based doublets (platinum plus new agent) are the standard of care for first-line systemic therapy. No one new agent is clearly superior for use in combination with a platinum agent. The survival advantage of platinum-based doublets over nonplatinum combinations or older combinations is modest. The addition of bevacizumab to carboplatin and paclitaxel has shown improved survival, although multiple exclusion criteria limit the applicability of these data to a subset of patients. In patients at least 70 years of age or with Eastern Collaborative Oncology Group performance status 2, a new single agent is an alternative. Treatment beyond four to six cycles impedes quality of life without prolonging life. Emerging data suggest that the choice of chemotherapy agent may be influenced by histologic subtype. CONCLUSION In NSCLC, a combination of a platinum agent plus a new agent continues to be the standard of care. As differences between regimens are small, toxicity and patient preference should help guide regimen choice.
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Gemcitabine plus cisplatin chemotherapy with concurrent para-toluenesulfonamide local injection therapy for peripherally advanced nonsmall cell lung cancer larger than 3 cm in the greatest dimension. Anticancer Drugs 2009; 20:838-44. [PMID: 19668080 DOI: 10.1097/cad.0b013e32832fe48f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Para-toluenesulfonamide (PTS), active ingredient being PTS, is a new anticancer drug applied through local intratumoral injection. The aim of this phase II clinical trial was to investigate the response and toxicity of standard gemcitabine (GEM) plus cisplatin (CIS) chemotherapy with concurrent intratumoral injection of PTS in peripherally advanced nonsmall cell lung cancer. Patients received 1250 mg/m of GEM on day 1, 8, and 75 mg/m of CIS on day 1, every 21 days for four cycles. PTS was injected intratumorally through percutaneous injection under computed tomography guidance on days 5, 12, 15, and 18 of cycle 1, and repeated on days 5 and 12 of cycle 2 if a less than 50% necrotic area was achieved after the first cycle according to the computed tomography scan. Twelve (46.2%) patients had metastatic disease, whereas 14 (53.8%) patients had stage IIIB disease. All 26 patients were assessable for response. Overall response rate by intention-to-treat was 53.8% (95% confidence interval: 34.6-73.0%). Median progression-free survival and overall survival were 6.5 months (95% confidence interval: 3.8-10.2 months) and 14.5 months (10.0-18.0 months), respectively. One-year and 2-year survivals were 57.7 and 22.4%, respectively. The grade 3-4 hematologic adverse events were neutropenia in six patients (23.1%), anemia in three (11.5%), and thrombocytopenia in four patients (15.4%). Nonhematologic toxicities were generally mild and usually not dose-limiting. Although grade 1-2 emesis occurred in nine patients (34.6%), only one had grade 3 vomiting. Grade 1-2 cough, local pain, and peripheral neurotoxocity developed in 12 (46.2%), three (11.5%), and five (19.2%) patients, respectively. There were no treatment-related deaths. GEM/CIS chemotherapy with concurrent PTS local injection therapy is a well-tolerated modality with potential activity in previously untreated peripheral advanced nonsmall cell lung cancer patients.
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Chang CH, Chen KY, Young-Xu Y, Kurth T, Orav EJ, Yang PC, Chan KA. The safety and efficacy of gefitinib versus platinum-based doublets chemotherapy as the first-line treatment for advanced non-small-cell lung cancer patients in East Asia: A meta-analysis. Lung Cancer 2008; 62:242-52. [DOI: 10.1016/j.lungcan.2008.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 02/18/2008] [Accepted: 03/01/2008] [Indexed: 10/22/2022]
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Park JO, Kim SW, Ahn JS, Suh C, Lee JS, Jang JS, Cho EK, Yang SH, Choi JH, Heo DS, Park SY, Shin SW, Ahn MJ, Lee JS, Yun YH, Lee JW, Park K. Phase III Trial of Two Versus Four Additional Cycles in Patients Who Are Nonprogressive After Two Cycles of Platinum-Based Chemotherapy in Non–Small-Cell Lung Cancer. J Clin Oncol 2007; 25:5233-9. [PMID: 18024869 DOI: 10.1200/jco.2007.10.8134] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeThis trial was conducted to determine the optimal duration of chemotherapy in Korean patients with advanced non–small-cell lung cancer (NSCLC).Patients and MethodsPatients with stages IIIB to IV NSCLC who had not progressed after two cycles of chemotherapy were randomly assigned to receive either four (arm A) or two (arm B) more cycles of third-generation, platinum-doublet treatment.ResultsOf the 452 enrolled patients, 314 were randomly assigned to the groups. One-year survival rates were 59.0% in arm A and 62.4% in arm B, and the difference of 3.4% (95% CI, −8.0 to 4.8) met the predefined criteria for noninferiority. The median time to progression (TTP), however, was 6.2 months (95% CI, 5.7 to 6.7 months) in arm A and 4.6 months (95% CI, 4.4 to 4.8 months) in arm B, the difference of which is statistically significant (P = .001). The frequencies of hematologic and nonhematologic toxicities were similar in the two arms.ConclusionThis study confirms the noninferiority of overall survival with four cycles compared with six cycles of chemotherapy for the first-line treatment of advanced NSCLC and supports the current American Society of Clinical Oncology guidelines. Notably, patients receiving six cycles of chemotherapy compared with four cycles showed a favorable TTP, suggesting that further investigation of the new strategies of maintenance therapy with less toxic agents after three to four cycles of induction chemotherapy might be warranted to improve survival, with consideration of both ethnicity and pharmacogenomic signatures.
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Affiliation(s)
- Joon Oh Park
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Sang-We Kim
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jin Seok Ahn
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Cheolwon Suh
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jung Shin Lee
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Joung Soon Jang
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Eun Kyung Cho
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Sung Hyun Yang
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jin-Hyuk Choi
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Dae Seog Heo
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Suk Young Park
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Sang Won Shin
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Myung Ju Ahn
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jong Seok Lee
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Young Ho Yun
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jae-Won Lee
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Keunchil Park
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
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