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Zheng R, Wang B, Liang F, Xu B. Systemic therapy‐based split‐course stereotactic body radiation therapy. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rong Zheng
- Department of Radiation Oncology Fujian Medical University Union Hospital Fuzhou Fujian China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University) Fuzhou Fujian China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies) Fuzhou Fujian China
| | - Bisi Wang
- Department of Radiation Oncology Fujian Medical University Union Hospital Fuzhou Fujian China
| | - Feihong Liang
- Department of Radiation Oncology Fujian Medical University Union Hospital Fuzhou Fujian China
| | - Benhua Xu
- Department of Radiation Oncology Fujian Medical University Union Hospital Fuzhou Fujian China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University) Fuzhou Fujian China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies) Fuzhou Fujian China
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Fukuda M, Okumura M, Iwakiri T, Arimori K, Honda T, Kobayashi K, Senju H, Takemoto S, Ikeda T, Yamaguchi H, Nakatomi K, Matsuo N, Mukae H, Ashizawa K. Relationship between UGT1A1*27 and UGT1A1*7 polymorphisms and irinotecan-related toxicities in patients with lung cancer. Thorac Cancer 2017; 9:51-58. [PMID: 29052349 PMCID: PMC5754284 DOI: 10.1111/1759-7714.12535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/09/2017] [Accepted: 09/09/2017] [Indexed: 11/29/2022] Open
Abstract
Background The objective of this study was to evaluate the effects of gene polymorphisms, including UGT1A1*7, *27, and *29, on the safety of irinotecan therapy. Methods The eligibility criteria were: lung cancer patients scheduled to undergo irinotecan therapy, aged ≥ 20 years, with a performance status of 0–2. Thirty‐one patients were enrolled and their blood was collected and used to examine the frequency of UGT1A1*6, *7, *27, *28, and *29 polymorphisms and the concentrations of irinotecan, SN‐38, and SN‐38G after irinotecan therapy. Results The patients’ characteristics were as follows: male/female 25/6, median age 71 years (range 55–84), stage IIB/IIIA/IIIB/IV 2/6/11/12, and adenocarcinoma/squamous cell carcinoma/small cell carcinoma/other 14/10/3/4, respectively. The −/−, *6/−, *7/−, *27/−, *28/−, and *29/− UGT1A1 gene polymorphisms were observed in 10 (32%), 10 (32%), 2 (6%), 2 (6%), 7 (23%), and 0 (0%) cases, respectively. The UGT1A1*27 polymorphism occurred separately from the UGT1A1*28 polymorphism. The lowest leukocyte counts of the patients with the UGT1A1*27 and UGT1A1*6 gene polymorphisms were lower than those observed in the wild‐type patients. SN‐38 tended to remain in the blood for a prolonged period after the infusion of irinotecan in patients with UGT1A1*27 or UGT1A1*28 polymorphisms. No severe myelotoxicity was seen in the patients with UGT1A1*7. Conclusion UGT1A1*27 can occur separately from UGT1A1*28 and is related to leukopenia during irinotecan treatment. UGT1A1*7 is less relevant to irinotecan‐induced toxicities, and UGT1A1*29 seems to have little clinical impact.
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Affiliation(s)
- Minoru Fukuda
- Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Manabu Okumura
- Department of Pharmacy, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Tomomi Iwakiri
- Department of Pharmacy, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Kazuhiko Arimori
- Department of Pharmacy, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Takuya Honda
- Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan.,Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuma Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroaki Senju
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinnosuke Takemoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takaya Ikeda
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroyuki Yamaguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsumi Nakatomi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nobuko Matsuo
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuto Ashizawa
- Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan.,Department of Clinical Oncology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kleinberg LR, Catalano PJ, Forastiere AA, Keller SM, Mitchel EP, Anne PR, Benson AB. Eastern Cooperative Oncology Group and American College of Radiology Imaging Network Randomized Phase 2 Trial of Neoadjuvant Preoperative Paclitaxel/Cisplatin/Radiation Therapy (RT) or Irinotecan/Cisplatin/RT in Esophageal Adenocarcinoma: Long-Term Outcome and Implications for Trial Design. Int J Radiat Oncol Biol Phys 2015; 94:738-46. [PMID: 26972646 DOI: 10.1016/j.ijrobp.2015.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/22/2015] [Accepted: 12/09/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Toxicity, pathologic complete response, and long-term outcomes are reported for the neoadjuvant therapies assessed in a randomized phase 2 Eastern Cooperative Oncology Group and American College of Radiology Imaging Network trial for operable esophageal adenocarcinoma, staged as II-IVa by endoscopy/ultrasonography (EUS). METHODS AND MATERIALS A total of 86 eligible patients began treatment. For arm A, preoperative chemotherapy was cisplatin, 30 mg/m(2), and irinotecan, 50 mg/m(2), on day 1, 8, 22, 29 during 45 Gy radiation therapy (RT), 1.8 Gy per day over 5 weeks. Adjuvant therapy was cisplatin, 30 mg/m(2), and irinotecan, 65 mg/m(2) day 1, 8 every 21 days for 3 cycles. Arm B therapy was cisplatin, 30 mg/m(2), and paclitaxel, 50 mg/m(2), day 1, 8, 15, 22, 29 with RT, followed by adjuvant cisplatin, 75 mg/m(2), and paclitaxel, 175 mg/m(2), day 1 every 21 days for 3 cycles. Stratification included EUS stage and performance status. RESULTS In arm A, median overall survival was 35 months, and 5-, 6-, and 7-year survival rates were 46%, 39%, and 35%, respectively, whereas for arm B, they were 21 months and 27%, 27%, and 23%, respectively. Median progression- or recurrence-free survival (PFS) was 39.8 months with a 3-year PFS of 50% for arm A and 12.4 months (P=.046) with 3-year PFS of 28% for arm B. Eighty percent of the observed incidents of progression occurred within 19 months. Survival did not differ significantly by EUS and performance status strata. CONCLUSIONS Long-term survival was similar for both arms and did not appear superior to results achieved with other standard regimens.
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Affiliation(s)
- Lawrence R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Steven M Keller
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY
| | - Edith P Mitchel
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pramila Rani Anne
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Al B Benson
- Department of Medicine-Hematology/Oncology, Lurie Cancer Center, Northwestern University, Chicago, Illinois
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Phase II study of induction cisplatin and irinotecan followed by concurrent carboplatin, etoposide, and thoracic radiotherapy for limited-stage small-cell lung cancer, CALGB 30206. J Thorac Oncol 2013. [PMID: 23196276 DOI: 10.1097/jto.0b013e31827628e1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION We sought to determine the efficacy of using both irinotecan- and etoposide-containing regimens sequentially for patients with untreated limited-stage small-cell lung cancer. METHODS Patients with untreated, measurable, limited-stage small-cell lung cancer with performance status 0 to 2, and adequate organ function were eligible. Treatment consisted of induction with cisplatin 30 mg/m and irinotecan 65 mg/m intravenously on day 1 and 8, every 21 days for two cycles. Beginning day 43, daily chest irradiation to 70 Gy was administered concurrently with carboplatin area under curve 5 on day 1, and etoposide 100 mg/m on days 1 to 3, every 21 days for three cycles. The primary objective was to differentiate between 45% and 60% 2-year survival. RESULTS Two induction cycles were delivered to 72 of 75 eligible patients (96%) and all planned treatment was delivered to 59 patients (79%). Cisplatin and irinotecan induction chemotherapy resulted in complete responses in 7% and partial responses in 64% (response rate 71%, 95% confidence interval [CI], 59%-81%). The best response to all therapy included 88% complete or partial responses (95% CI, 78%-94%). With median follow-up of 57 months, the median progression-free survival and overall survival are 12.6 (95% CI, 9.4-14.7) and 18.1 months (15.8-22.9), respectively. The 1- and 2-year survival was 69% and 31%, respectively. Frequent (>20%) grade 3 and 4 toxicities were neutropenia in 84%, hemoglobin in 36%, platelets in 51%, esophagitis in 22%, and dehydration in 24%. There were no fatal toxicities. CONCLUSIONS This treatment regimen of irinotecan-cisplatin induction chemotherapy followed by 70 Gy concurrent radiation and etoposide-carboplatin had tolerable toxicity but did not meet the preplanned 2-year survival target for further development.
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Chen AY, Chen PMT, Chen YJ. DNA topoisomerase I drugs and radiotherapy for lung cancer. J Thorac Dis 2012; 4:390-7. [PMID: 22934142 DOI: 10.3978/j.issn.2072-1439.2012.07.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/12/2012] [Indexed: 01/18/2023]
Abstract
Lung cancer represents the most common cause of cancer-related mortality in the United States and around the world. DNA topoisomerase I (TOP1) drugs such as irinotecan and topotecan represent a unique class of chemotherapeutic agents that exhibit not only potent cytotoxic effect, but also tumor-selective radiation-sensitizing effect. The mechanism of cytotoxicity and radiation sensitization by TOP1 drugs has been intensely investigated. Modern radiotherapy, aided by improved imaging and treatment delivery technology, is capable of targeting tumors more precisely, while sparing surrounding critical structures. Clinical trials with camptothecin derivatives and radiotherapy have been conducted in lung cancers. Combined modality therapy with TOP1 drugs and radiotherapy offers a new frontier for lung cancer therapy. We review the present state of TOP1-targeted chemotherapy and modern radiotherapy for lung cancer.
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Phase II study of irinotecan and cisplatin with concurrent split-course radiotherapy in limited-disease small cell lung cancer. Cancer Chemother Pharmacol 2012; 70:645-51. [PMID: 23010852 DOI: 10.1007/s00280-012-1952-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 08/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Irinotecan and cisplatin are one of active regimens for patients with extensive-stage small cell lung cancer (SCLC). To determine the efficacy and toxicity of irinotecan and cisplatin with concurrent split-course thoracic radiotherapy in limited-disease (LD) SCLC, we conducted a phase II study. PATIENTS AND METHODS Thirty-four patients fulfilling the following eligibility criteria were enrolled: chemotherapy-naïve, good performance status (PS 0-1), age ≤75, LD-SCLC, and adequate organ function. The patients received irinotecan 40 mg/m(2) i.v. on days 1, 8, and 15, and cisplatin 60 mg/m(2) i.v. on day 1. Four cycles of chemotherapy were repeated every 4 weeks. Split-course thoracic radiotherapy of once-daily 2 Gy/day commenced on day 2 of each chemotherapy cycle, with 26 and 24 Gy administered in the first and second cycles, respectively. RESULTS Thirty-four patients were eligible and assessable for response, toxicity, and survival. Patients' characteristics were as follows: male/female = 29/5; PS 0/1 = 18/16; median age (range) = 67 (50-73); and stage IB/IIA/IIB/IIIA/IIIB = 2/2/3/16/11. The overall response was 100 % (CR 8, PR 26). Grade 4 leukopenia, neutropenia, grade 3-5 pneumonitis, diarrhea, and esophagitis occurred in 24, 38, 6, 3, and 0 %, respectively. There were 2 treatment-related deaths from pneumonitis. The median time to tumor progression was 14.3 months. The median overall survival time and the 2- and 5-year survival rates were 44.5 months, 66.7 and 46.1 %, respectively. No tumor progression was observed in patients with CR. CONCLUSION Irinotecan plus cisplatin with concurrent split-course thoracic radiotherapy was effective and tolerable in untreated LD-SCLC.
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Wahba HA, Halim AA, El-Hadaad HA. Irinotecan plus cisplatin chemotherapy followed by concurrent thoracic irradiation with low-dose weekly cisplatin for limited-disease small-cell lung cancer. Med Oncol 2010; 29:199-204. [PMID: 21140241 DOI: 10.1007/s12032-010-9772-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
A phase II trial of irinotecan and cisplatin (IP) as induction chemotherapy followed by conventional thoracic irradiation concurrent with low-dose weekly cisplatin for limited-disease small-cell lung cancer (LDS-SCLC). Between February 2005 and December 2008, 34 chemotherapy-naïve patients with LD-SCLC were enrolled. Treatment consisted of two 21-day cycles of cisplatin 40 mg/m(2) and irinotecan 80 mg/m(2) intravenously (IV) on days 1 and 8 followed by conventional thoracic irradiation at a dose of 54 Gy concurrent with cisplatin at dose of 20 mg/m(2) weekly then prophylactic cranial irradiation at dose of 30 Gy in 10 fractions for those achieved complete or partial response. Only 33 patients received the treatment protocol, and they were assessed for response and toxicity. After induction chemotherapy, overall response rate was (72.73%). After median follow-up of 27 months, the median survival was 25 months (95% CI, 21.249-28.751) with 1 and 2-year overall survival rates of 83 and 55%, respectively. Median progression-free survival (PFS) was 15 months (95% CI, 10.311-19.689) with a 1- and 2-year PFS of 59 and 38%, respectively. The most common toxicities during induction chemotherapy were neutropenia (81%), thrombocytopenia (69%), and diarrhea (63%) while esophagitis (84%) and pneumonitis (30%) were the most common toxicities during concurrent chemo-radiation. Relapse rate was 61% with distant metastasis in 42% and local recurrence in 26%. This protocol of induction irinotecon-based regimen followed by delayed concurrent thoracic irradiation with low-dose weekly cisplatin is effective with acceptable toxicities. Based on the favorable outcome in this trial, this regimen should be evaluated in a large phase III trial.
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Affiliation(s)
- Hanan A Wahba
- Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Fabbro M, Gladieff L, Guichard F, El Demery M, Dalenc F, Kerr C, Delannes M, Paraiso D, Pujade-Lauraine E, Kurtz JE. Phase I study of irinotecan and cisplatin in combination with pelvic radiotherapy in the treatment of locally advanced cervical cancer: A GINECO trial. Gynecol Oncol 2010; 117:276-80. [PMID: 20226502 DOI: 10.1016/j.ygyno.2009.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/16/2009] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To define the recommended dose of the association of weekly irinotecan (Iri) and cisplatin (CP) with pelvic radiotherapy in Locally Advanced Cervical Cancer. PATIENTS AND METHODS Stage IB2-IV cervix cancer patients were treated with escalating doses of Iri starting from 30 mg/m(2) and a fixed dose of CP at 20 mg/m(2), both weekly concomitantly with a 45-Gy pelvic irradiation. RESULTS Fifteen patients entered the study, 6 at level 1 (Iri 30 mg/m(2)), 3 at level 2 (Iri 40 mg/m(2)) and 6 at intermediate dose (Iri 35 mg/m(2)). Median age was 47 years (34-72), FIGO stage IB (n=1), IIB (n=7), III (n=6), IVA (n=1). The recommended dose was weekly Iri 35 mg/m(2) and CP 20 mg/m(2). Dose limiting toxicities (grades 3-4) were diarrhea, abdominal pain, febrile neutropenia and fatigue. CONCLUSION In cervix cancer patients, radiosensitization with weekly cisplatin and irinotecan is feasible, and the recommended doses are cisplatin 20 mg/m(2)/week and irinotecan 35 mg/m(2)/week for future phase II studies.
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Affiliation(s)
- M Fabbro
- Centre de Lutte contre le Cancer Val d'Aurelle, Montpellier, France
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Integration of irinotecan and cisplatin with early concurrent conventional radiotherapy for limited-disease SCLC (LD-SCLC). Int J Clin Oncol 2009; 14:230-6. [PMID: 19593615 DOI: 10.1007/s10147-008-0842-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 09/27/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study was conducted using irinotecan and cisplatin (IP) concurrently with thoracic radiation therapy to evaluate the response and toxicity of this protocol in the treatment of patients with limited-disease small cell lung cancer (LD-SCLC). METHODS Twenty-seven chemotherapy-naive patients with LD-SCLC received two cycles of weekly irinotecan 60 mg/m(2) and cisplatin 60 mg/m(2) before the initiation of the thoracic radiation therapy. RESULTS Of the 29 patients with LD-SCLC enrolled in the study, 27 were eligible for evaluation of response and toxicity. The median age was 62 years; 26 patients (90%) were men. Eastern Cooperative Oncology Group (ECOG) performance status was 0 in 5 patients (17%) and 1 in 18 patients (62%). Ten patients (37%) achieved a complete response (CR), 14 patients (52%) achieved a partial response (PR), while 3 patients (11%) had progressive disease (PD); one of the 3 nonresponders achieved a PR after commencing concurrent chemoradiotherapy; therefore, the overall response rate was 93%. The median survival time was 20.2 months and 1- and 2-year survival rates were 69% and 53.2%, respectively. The median progression-free survival (PFS) was 11.8 months, and 1- and 2-year PFS times were 52% and 34.1%, respectively. Neutropenia was the most prevalent hematological toxicity and it was evident as grade 3 in 14 patients (52%). Asthenia was the most prevalent nonhematological toxicity, in 18 patients (67%); esophagitis occurred in 15 patients (56%). No treatment-related deaths (due to sepsis or bleeding) were reported in the study. CONCLUSION Irinotecan and cisplatin is considered to be an effective and safe chemotherapeutic regimen when used concurrently with thoracic radiation therapy for the treatment of patients with LD-SCLC.
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de Jong W, de Jonge M, van der Leest A, van Meerbeeck J, Groen H. Irinotecan and cisplatin with concurrent thoracic radiotherapy in a once-every-three-weeks schedule in patients with limited-disease small-cell lung cancer: A phase I study. Lung Cancer 2008; 61:123-8. [DOI: 10.1016/j.lungcan.2007.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/12/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
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Fukuda M, Soda H, Fukuda M, Kinoshita A, Nakamura Y, Nagashima S, Takatani H, Tsukamoto K, Kohno S, Oka M. Irinotecan and cisplatin with concurrent split-course radiotherapy in locally advanced nonsmall-cell lung cancer: a multiinstitutional phase 2 study. Cancer 2007; 110:606-13. [PMID: 17577234 DOI: 10.1002/cncr.22817] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The purpose was to determine the efficacy and toxicity of irinotecan and cisplatin with concurrent split-course thoracic radiotherapy (TRT) in locally advanced nonsmall-cell lung cancer. METHODS Fifty patients fulfilling the following eligibility criteria were enrolled: chemotherapy-naive, good performance status (PS, 0-2), age <75, stage III, and adequate organ function. The patients received irinotecan 60 mg/m(2) intravenously on Days 1, 8, and 15, and cisplatin 80 mg/m(2) intravenously on Day 1 in the first group. The doses were reduced to 50 and 60 mg/m(2), respectively, in the second group. Two cycles of chemotherapy were repeated every 4 weeks. Split-course thoracic radiotherapy of 2 Gy/day commenced on Day 2 of each chemotherapy cycle, with 28 and 32 Gy administered in the first and second cycles, respectively. RESULTS Fifty patients were eligible and 48 (16 in the first, 32 in the second group) patients were assessable for response, toxicity, and survival. The overall response was 83% (95% confidence interval [CI], 70%-93%). Grade 4 leukopenia, neutropenia, grade 3 or 4 diarrhea, pneumonitis, esophagitis, and fatigue occurred in 21%, 48%, 19%, 10%, and 19%, respectively. The median time to progression was 8.2 months. The median overall survival time and the 2- and 5-year survival rates were 20.1 months, 47.1%, and 17.1%, respectively. In subgroup analysis, grade 4 neutropenia, grade 3 or 4 diarrhea, the overall response, and the median survival times of the first/second groups were 63%/41%, 19%/19%, 75%/88%, and 13.1/33.4 months, respectively. CONCLUSIONS This combined modality of irinotecan and cisplatin with concurrent TRT is active and further investigations are warranted at the second group dose level.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/pathology
- Adenocarcinoma/radiotherapy
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Camptothecin/administration & dosage
- Camptothecin/analogs & derivatives
- Carcinoma, Large Cell/drug therapy
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/radiotherapy
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Cisplatin/administration & dosage
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Humans
- Irinotecan
- Japan
- Lung Neoplasms/drug therapy
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Radiotherapy Dosage
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Minoru Fukuda
- Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
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Sohn JH, Moon YW, Lee CG, Kim GE, Chung KY, Chang J, Kim SK, Kim YS, Choi BW, Choi HJ, Kim JH. Phase II trial of irinotecan and cisplatin with early concurrent radiotherapy in limited-disease small-cell lung cancer. Cancer 2007; 109:1845-950. [PMID: 17366589 DOI: 10.1002/cncr.22621] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND A Phase II trial of irinotecan and cisplatin (IP) with early concurrent radiotherapy was performed in limited-disease small-cell lung cancer (LD-SCLC) to evaluate the efficacy and toxicity. METHODS For untreated LD-SCLC patients, irinotecan (60 mg/m2, Days 1, 8, and 15) and cisplatin (40 mg/m2, Days 1 and 8) were repeated every 4 weeks for a maximum of 6 cycles. Thoracic radiotherapy of 1.8 Gy/day was begun on Day 1 of the second chemotherapy cycle, up to a total of 45 to 54 Gy. Prophylactic cranial irradiation (30 Gy in 10 fractions) was performed on patients with a complete response (CR). RESULTS Thirty-three LD-SCLC patients were enrolled. The median age was 60 years and 31 patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1. Twelve (36.4%) patients had N3 disease. The response rate was 87.9%, with a CR rate of 45.5%. At a median follow-up period of 27 months the median progression-free survival (PFS) and overall survival (OS) were 14.4 and 26.1 months, respectively, with 2-year PFS and OS rates of 26.8% and 54.9%. The dominating toxicity was neutropenia, with grade 3-5 of 81.8%. The most common grade 3-5 nonhematologic toxicities were diarrhea (21.2%), anorexia (21.2%), and fatigue (21.2%). Grade 3-5 radiation esophagitis and pneumonitis occurred in 18.2% and 9.1% of patients, respectively. There were 2 treatment-related deaths from sepsis and radiation pneumonitis. CONCLUSIONS IP with early concurrent radiotherapy was effective and tolerable in untreated LD-SCLC.
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Affiliation(s)
- Joo Hyuk Sohn
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Saito H, Takada Y, Ichinose Y, Eguchi K, Kudoh S, Matsui K, Nakagawa K, Takada M, Negoro S, Tamura K, Ando M, Tada T, Fukuoka M. Phase II Study of Etoposide and Cisplatin With Concurrent Twice-Daily Thoracic Radiotherapy Followed by Irinotecan and Cisplatin in Patients With Limited-Disease Small-Cell Lung Cancer: West Japan Thoracic Oncology Group 9902. J Clin Oncol 2006; 24:5247-52. [PMID: 17114657 DOI: 10.1200/jco.2006.07.1605] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose We initially conducted a randomized phase II study to compare irinotecan and cisplatin (IP) versus irinotecan, cisplatin, and etoposide (IPE) after etoposide and cisplatin (EP) with concurrent twice-daily thoracic radiotherapy (TRT) in limited-disease small-cell lung cancer (LD-SCLC). We amended the protocol to evaluate IP after EP with concurrent twice-daily TRT in a single-arm phase II study because of an unacceptable toxicity in IPE. Patients and Methods Previously untreated patients with LD-SCLC were treated intravenously with etoposide 100 mg/m2 on days 1 through 3 and cisplatin 80 mg/m2 on day 1 with concurrent twice-daily TRT (1.5 Gy per fraction, a total dose of 45 Gy) beginning on day 2 followed by three cycles of irinotecan 60 mg/m2 on days 1, 8, and 15 and cisplatin 60 mg/m2 on day 1 of a 4-week cycle. Results Of the 51 patients enrolled, 49 patients were assessable for response and toxicity. The overall response rate and complete response rate were 88% and 41%, respectively. The median survival time for all patients was 23 months. The 2-year and 3-year survival rates were 49% and 29.7%, respectively. The median progression-free survival was 11.8 months. The major toxicities observed were neutropenia (grade 4, 84%), febrile neutropenia (grade 3, 31%), infection (grade 3 to 4, 33%), electrolytes imbalance (grade 3 to 4, 20%), and diarrhea (grade 3 to 4, 14%). Conclusion EP with concurrent twice-daily TRT followed by the consolidation of IP appears to be an active regimen which deserves further phase III testing in patients with LD-SCLC.
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Affiliation(s)
- Hiroshi Saito
- Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki Aichi, Japan.
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Klautke G, Fähndrich S, Semrau S, Büscher C, Virchow C, Fietkau R. Simultaneous chemoradiotherapy with irinotecan and cisplatin in limited disease small cell lung cancer: A phase I study. Lung Cancer 2006; 53:183-8. [PMID: 16757061 DOI: 10.1016/j.lungcan.2006.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 04/21/2006] [Accepted: 04/24/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Early radiotherapy concurrent with chemotherapy appears to have prognostic benefits in patients with limited disease SCLC. Irinotecan/cisplatin have been shown to be superior to a standard treatment with etoposide/cisplatin in extensive disease SCLC. The present phase I study aims to assess the feasibility of irinotecan/cisplatin administered concurrently with radiotherapy. PATIENTS AND METHODS Twelve patients were treated concurrently with conventional fractionated radiotherapy (1.8-45 Gy + 9 Gy (RP)) and two cycles of irinotecan (40/50/60 mg/m2, Day 1/8/15, 29/36/43) and cisplatin (20 mg/m2, Days 1-3, 29-31), and four cycles of consolidation chemotherapy (CT). In addition, patients in complete remission (CR) received prophylactic cranial irradiation (PCI). Dose-limiting toxicity (DLT) was defined as any case grade III/IV non-hematological toxicity (esophagitis grade IV), grade IV leukopenia or grades III/IV thrombopenia (CTC) during RCT. RESULTS No DLT was observed; an irinotecan dose of 60 mg/m2 is recommended. 3/12 patients developed grade III leukopenia, one grade II pneumonitis. The predominant toxicity was esophagitis, grade II in 7/12 patients, grade III in 5/12. After RCT 7/12 patients were in CR, systemic progression was not observed during RCT. CONCLUSION Concurrent RCT with irinotecan (60 mg/m2) and cisplatin followed by four cycles of CT can be safely administered.
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Affiliation(s)
- Gunther Klautke
- Department of Radiotherapy, University Hospital, University of Rostock, Südring 75, 18059 Rostock, Germany.
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Jeong HC, Lee SY, Lee SY, Kim JH, Shin C, Shim JJ, In KH, Kang KH, Yoo SH. Phase II study of irinotecan plus cisplatin with concurrent radiotherapy for the patients with limited-disease small-cell lung cancer. Lung Cancer 2006; 53:361-6. [PMID: 16846662 DOI: 10.1016/j.lungcan.2006.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 06/02/2006] [Accepted: 06/08/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND A recently conducted randomized, phase III study that compared irinotecan plus cisplatin (IP) with etoposide plus cisplatin for the patients with extensive disease SCLC revealed a superior median survival rate and a superior 2-year survival rate for the IP combination therapy. Yet there have been few such reports on the patients suffering with limited disease SCLC (LD-SCLC). We conducted a phase II trial to evaluate the efficacy and toxicity of administering IP with concurrent radiotherapy for the patients with LD-SCLC. PATIENTS AND METHODS Twenty chemotherapy-naïve patients with LD-SCLC were enrolled in our study. The patients were treated with 40 mg/m(2) irinotecan on days 1, 8 and 15 and with 60 mg/m(2) cisplatin on day 1 every 4 weeks until a maximum of six cycles was delivered. Once-daily radiotherapy included the administration of 50.4 Gy in 28 fractions. After completion of the radiation therapy, the dose of irinotecan was increased to 60 mg/m(2). RESULTS The response rate was 85% (CR: 6; partial response, PR: 11). The median survival was 20.0 months (95% CI: 15.6-24.4 months) with 1-year and 2-year overall survival rates of 85 and 35%, respectively. The median progression free survival (PFS) was 12 months (95% CI: 6.2-18.1 months) with a 1-year PFS of 36%. The major hematologic toxicities of this regimen were neutropenia (60%), leukopenia (55%), anemia (20%) and thrombocytopenia (10%). The non-hematologic toxicities were nausea/vomiting (55%), diarrhea (35%) and dysphagia (15%). CONCLUSIONS Our data show that IP with concurrent radiotherapy is an effective and tolerable regimen for the treatment of LD-SCLC and these findings warrant further investigation.
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Affiliation(s)
- Hye Cheol Jeong
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Pochon CHA University, Seongnam, Republic of Korea
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16
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Kinoshita A, Fukuda M, Soda H, Nagashima S, Fukuda M, Takatani H, Kuba M, Nakamura Y, Tsurutani J, Kohno S, Oka M. Phase II study of irinotecan combined with carboplatin in previously untreated small-cell lung cancer. Br J Cancer 2006; 94:1267-71. [PMID: 16622467 PMCID: PMC2361403 DOI: 10.1038/sj.bjc.6603079] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 03/09/2006] [Accepted: 03/09/2006] [Indexed: 12/03/2022] Open
Abstract
To determine the efficacy and toxicity of irinotecan combined with carboplatin, we conducted a phase II trial. Eligibility criteria were: chemotherapy-naïve, small-cell lung cancer (SCLC), good performance status (PS: 0-2), age
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Affiliation(s)
- A Kinoshita
- National Nagasaki Medical Center, Nagasaki, Japan
| | - M Fukuda
- Kawasaki Medical School, Division of Respiratory Diseases, Department of Medicine, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - H Soda
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | | | - M Fukuda
- Japanese Red-Cross Nagasaki Atomic Bomb Hospital, Nagasaki, Japan
| | - H Takatani
- Nagasaki Municipal Hospital, Nagasaki, Japan
| | - M Kuba
- National Okinawa Hospital, Okinawa, Japan
| | - Y Nakamura
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - J Tsurutani
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - S Kohno
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - M Oka
- Kawasaki Medical School, Division of Respiratory Diseases, Department of Medicine, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
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Jeong HC, Lee SY, Kim JH, Ha ES, Jung JY, Lee KJ, Lee SH, Kim SJ, Lee EJ, Hur GY, Lee SY, Kim JH, Shin C, Shim JJ, In KH, Kang KH, Yoo SH. Phase II Trial of Irinotecan plus Cisplatin Combination as First Line Therapy for Patients with Small cell Lung Cancer. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.60.1.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye Cheol Jeong
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jung Ha Kim
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Eun Sil Ha
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jin Yong Jung
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Kyung Ju Lee
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Seung Hyeun Lee
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Se Joong Kim
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Eun Joo Lee
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sung Yong Lee
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Je Hyeong Kim
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Chol Shin
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jae Jeong Shim
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Kwang Ho In
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Kyung Ho Kang
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Se Hwa Yoo
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Affiliation(s)
- Giuseppe Giaccone
- Division of Medical Oncology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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Sandler A. Irinotecan in small-cell lung cancer: current data and the status of ongoing trials. Clin Lung Cancer 2002; 4 Suppl 1:S30-4. [PMID: 14659039 DOI: 10.3816/clc.2002.s.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Small-cell lung cancer (SCLC) is a particularly aggressive form of lung cancer and is associated with a poor prognosis, rapid tumor growth, and early metastasis. Currently, the cornerstone of treatment in SCLC consists of combination therapy, with platinum/etoposide being the regimen of choice. Unfortunately, even with these advances in treatment, the median survival for patients with limited-stage disease is 10-15 months and 7-11 months for patients with extensive-stage disease. New treatment mechanisms need to be explored in order to extend the survival of SCLC patients. One such new treatment is the topoisomerase I inhibitor, irinotecan. This drug represents a promising advancement in the treatment of SCLC.
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Affiliation(s)
- Alan Sandler
- Vanderbilt University Medical Center, Nashville, TN; e-mail:
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