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Pignon JP, Tribodet H, Scagliotti GV, Douillard JY, Shepherd FA, Stephens RJ, Dunant A, Torri V, Rosell R, Seymour L, Spiro SG, Rolland E, Fossati R, Aubert D, Ding K, Waller D, Le Chevalier T. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 2008; 26:3552-9. [PMID: 18506026 DOI: 10.1200/jco.2007.13.9030] [Citation(s) in RCA: 1761] [Impact Index Per Article: 110.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Several recent trials have shown a significant overall survival (OS) benefit from postoperative cisplatin-based chemotherapy in patients with non-small-cell lung cancer (NSCLC). The aim of the Lung Adjuvant Cisplatin Evaluation was to identify treatment options associated with a higher benefit or groups of patients who particularly benefit from postoperative chemotherapy. PATIENTS AND METHODS Individual patient data were collected and pooled from the five largest trials (4,584 patients) of cisplatin-based chemotherapy in completely resected patients that were conducted after the 1995 NSCLC meta-analysis. The interactions between patient subgroups or treatment types and chemotherapy effect on OS were analyzed using hazard ratios (HRs) and log-rank tests stratified by trial. RESULTS With a median follow-up time of 5.2 years, the overall HR of death was 0.89 (95% CI, 0.82 to 0.96; P = .005), corresponding to a 5-year absolute benefit of 5.4% from chemotherapy. There was no heterogeneity of chemotherapy effect among trials. The benefit varied with stage (test for trend, P = .04; HR for stage IA = 1.40; 95% CI, 0.95 to 2.06; HR for stage IB = 0.93; 95% CI, 0.78 to 1.10; HR for stage II = 0.83; 95% CI, 0.73 to 0.95; and HR for stage III = 0.83; 95% CI, 0.72 to 0.94). The effect of chemotherapy did not vary significantly (test for interaction, P = .11) with the associated drugs, including vinorelbine (HR = 0.80; 95% CI, 0.70 to 0.91), etoposide or vinca alkaloid (HR = 0.92; 95% CI, 0.80 to 1.07), or other (HR = 0.97; 95% CI, 0.84 to 1.13). Chemotherapy effect was higher in patients with better performance status. There was no interaction between chemotherapy effect and sex, age, histology, type of surgery, planned radiotherapy, or planned total dose of cisplatin. CONCLUSION Postoperative cisplatin-based chemotherapy significantly improves survival in patients with NSCLC.
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Affiliation(s)
- Jean-Pierre Pignon
- Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
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Laurie SA, Gauthier I, Arnold A, Shepherd FA, Ellis PM, Chen E, Goss G, Powers J, Walsh W, Tu D, Robertson J, Puchalski TA, Seymour L. Phase I and Pharmacokinetic Study of Daily Oral AZD2171, an Inhibitor of Vascular Endothelial Growth Factor Tyrosine Kinases, in Combination With Carboplatin and Paclitaxel in Patients With Advanced Non–Small-Cell Lung Cancer: The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 2008; 26:1871-8. [DOI: 10.1200/jco.2007.14.4741] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PurposeAZD2171 is a potent inhibitor of vascular endothelial growth factor receptors that showed broad antitumor activity in preclinical models. Doses of up to 45 mg/d of AZD2171 are tolerable when administered alone. This study evaluated escalating doses of AZD2171 in combination with standard chemotherapy in patients with advanced non–small-cell lung cancer.Patients and MethodsEligible patients received carboplatin targeted to an area under the concentration time curve of 6 mg · min/mL and paclitaxel 200 mg/m2, both on day 1 of a 3-week cycle; daily oral AZD2171 at either 30 mg or 45 mg commenced day 2 of cycle 1. Pharmacokinetics of all drugs were performed, and tumor response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST).ResultsTwenty patients were enrolled. No dose-limiting toxicities were observed during cycle 1 at either dose. Fatigue, diarrhea, anorexia, and granulocytopenia were common; hypertension was manageable with a treatment algorithm designed for this protocol. No clinically significant drug-related bleeding was observed. At 45 mg/d, fatigue and diarrhea were increased, and headache and hoarseness were observed. Paclitaxel clearance decreased during cycle 2, but no other significant pharmacokinetic interactions were observed. After radiology review, confirmed responses were observed in nine patients (response rate, 45%; 95% CI, 23% to 68%); all but one enrolled patient showed evidence of tumor shrinkage, some with cavitation.ConclusionAZD2171 can be combined with standard doses of carboplatin/paclitaxel with encouraging antitumor activity. Toxicity is increased, but predictable and manageable.
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Affiliation(s)
- Scott A. Laurie
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Isabelle Gauthier
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Andrew Arnold
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Frances A. Shepherd
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Peter M. Ellis
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Eric Chen
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Glenwood Goss
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Jean Powers
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Wendy Walsh
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Dongsheng Tu
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Jane Robertson
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Thomas A. Puchalski
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
| | - Lesley Seymour
- From the From the Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa; Juravinski Cancer Centre, McMaster University, Hamilton; Princess Margaret Hospital, University of Toronto, Toronto; National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston, Ontario, Canada; and AstraZeneca, Macclesfield, United Kingdom
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