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Liu T, Li S, Ding S, Qiu J, Ren C, Chen J, Wang H, Wang X, Li G, He Z, Dang J. Comparison of post-chemoradiotherapy pneumonitis between Asian and non-Asian patients with locally advanced non-small cell lung cancer: a systematic review and meta-analysis. EClinicalMedicine 2023; 64:102246. [PMID: 37781162 PMCID: PMC10539643 DOI: 10.1016/j.eclinm.2023.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Background Pneumonitis is a common complication for patients with locally advanced non-small cell lung cancer undergoing definitive chemoradiotherapy (CRT). It remains unclear whether there is ethnic difference in the incidence of post-CRT pneumonitis. Methods PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible studies from January 1, 2000 to April 30, 2023. The outcomes of interest were incidence rates of pneumonitis. The random-effect model was used for statistical analysis. This meta-analysis was registered with PROSPERO (CRD42023416490). Findings A total of 248 studies involving 28,267 patients were included. Among studies of CRT without immunotherapy, the pooled rates of pneumonitis for Asian patients were significantly higher than that for non-Asian patients (all grade: 66.8%, 95% CI: 59.2%-73.9% vs. 28.1%, 95% CI: 20.4%-36.4%; P < 0.0001; grade ≥2: 25.1%, 95% CI: 22.9%-27.3% vs. 14.9%, 95% CI: 12.0%-18.0%; P < 0.0001; grade ≥3: 6.5%, 95% CI: 5.6%-7.3% vs. 4.6%, 95% CI: 3.4%-5.9%; P = 0.015; grade 5: 0.6%, 95% CI: 0.3%-0.9% vs. 0.1%, 95% CI: 0.0%-0.2%; P < 0.0001). Regarding studies of CRT plus immunotherapy, Asian patients had higher rates of all-grade (74.8%, 95% CI: 63.7%-84.5% vs. 34.3%, 95% CI: 28.7%-40.2%; P < 0.0001) and grade ≥2 (34.0%, 95% CI: 30.7%-37.3% vs. 24.6%, 95% CI: 19.9%-29.3%; P = 0.001) pneumonitis than non-Asian patients, but with no significant differences in the rates of grade ≥3 and grade 5 pneumonitis. Results from subgroup analyses were generally similar to that from the all studies. In addition, the pooled median/mean of lung volume receiving ≥20 Gy and mean lung dose were relatively low in Asian studies compared to that in non-Asian studies. Interpretation Asian patients are likely to have a higher incidence of pneumonitis than non-Asian patients, which appears to be due to the poor tolerance of lung to radiation. Nevertheless, these findings are based on observational studies and with significant heterogeneity, and need to be validated in future large prospective studies focusing on the subject. Funding None.
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Affiliation(s)
- Tingting Liu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
- Department of Radiation Oncology, Anshan Cancer Hospital, Anshan, China
| | - Sihan Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Silu Ding
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jingping Qiu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Chengbo Ren
- Department of Radiation Oncology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
| | - Jun Chen
- Department of Radiation Oncology, Shenyang Tenth People's Hospital, Shenyang, China
| | - He Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoling Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Zheng He
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jun Dang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
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Mikami E, Nakamichi S, Nagano A, Misawa K, Hayashi A, Tozuka T, Takano N, Noro R, Maebayashi K, Kubokura H, Terasaki Y, Kubota K, Seike M. Successful Treatment with Definitive Concurrent Chemoradiotherapy Followed by Durvalumab Maintenance Therapy in a Patient with Tracheal Adenoid Cystic Carcinoma. Intern Med 2023; 62:2731-2735. [PMID: 36642523 PMCID: PMC10569923 DOI: 10.2169/internalmedicine.1142-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/04/2022] [Indexed: 01/15/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare type of malignant tracheal tumor originating from the secretory glands. Complete surgical resection is the current standard of care for tracheal ACC. However, there have been few case reports of chemoradiotherapy for unresectable tracheal ACC. We herein report a 28-year-old man with unresectable tracheal ACC who received concurrent chemoradiotherapy (CCRT) followed by maintenance therapy with durvalumab. CCRT was completed with a good response and safety, and the patient is currently receiving durvalumab as maintenance therapy. Durvalumab after CCRT can be a treatment option for patients with unresectable tracheal ACC.
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Affiliation(s)
- Erika Mikami
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Atsuhiro Nagano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazuhito Misawa
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Anna Hayashi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takehiro Tozuka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Natsuki Takano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Katsuya Maebayashi
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Hirotoshi Kubokura
- Department of Thoracic Surgery, Graduate School of Medicine, Nippon Medical School Musashikosugi Hospital, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
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Tanaka H, Tanzawa S, Misumi T, Makiguchi T, Inaba M, Honda T, Nakamura J, Inoue K, Kishikawa T, Nakashima M, Fujiwara K, Kohyama T, Ishida H, Kuyama S, Miyazawa N, Nakamura T, Miyawaki H, Oda N, Ishikawa N, Morinaga R, Kusaka K, Fujimoto N, Fukuda Y, Yasugi M, Tsuda T, Ushijima S, Shibata K, Shibayama T, Bessho A, Kaira K, Shiraishi K, Matsutani N, Seki N. A phase II study of S-1 and cisplatin with concurrent thoracic radiotherapy followed by durvalumab for unresectable, locally advanced non-small-cell lung cancer in Japan (SAMURAI study): primary analysis. Ther Adv Med Oncol 2022; 14:17588359221142786. [PMID: 36570411 PMCID: PMC9772940 DOI: 10.1177/17588359221142786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background The standard of care for unresectable, locally advanced non-small-cell lung cancer (LA-NSCLC) is chemoradiotherapy (CRT) followed by durvalumab, based on the PACIFIC study. Although multiple Japanese phase II studies have shown high efficacy and tolerability of CRT with cisplatin plus S-1 (SP), no prospective study using durvalumab after SP-based CRT has been reported. Objectives We conducted a multicenter phase II study of this approach, the interim analysis of which showed a high transition rate to durvalumab consolidation therapy. Here, we report the primary analysis results. Design In treatment-naïve LA-NSCLC, cisplatin (60 mg/m2, day 1) and S-1 (80-120 mg/body, days 1-14) were administered with two 4-week cycles with concurrent thoracic radiotherapy (60 Gy) followed by durvalumab (10 mg/kg) every 2 weeks for up to 1 year. Methods The primary endpoint was 1-year progression-free survival (PFS). The expected 1-year PFS and its lower limit of the 80% confidence interval (CI) were set as 63% and 47%, respectively, based on the results of TORG1018 study. Results In all, 59 patients were enrolled, with 51 (86.4%) proceeding to durvalumab. The objective response rate throughout the study was 72.9% (95% CI: 59.7-83.6%). After median follow-up of 21.9 months, neither median PFS nor OS was reached. The 1-year PFS was 72.5% (80% CI: 64.2-79.2%, 95% CI: 59.1-82.2%), while the 1-year overall survival was 91.5% (95% CI: 80.8-96.4%). No grade 5 adverse events were observed throughout the study. The most common adverse event during the consolidation phase was pneumonitis (any grade, 78.4%; grade ⩾3, 2.0%). Eventually, 52.5% of patients completed 1-year durvalumab consolidation therapy from CRT initiation. Conclusion This study of durvalumab after SP-based CRT met its primary endpoint and found a 1-year PFS of 73% from CRT initiation. This study provides the first prospective data on the prognosis and tolerability of durvalumab consolidation from the initiation of CRT. Trial registration Japan Registry of Clinical Trials, jRCTs031190127, registered 1 November, 2019, https://jrct.niph.go.jp/latest-detail/jRCTs031190127.
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Affiliation(s)
| | | | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Tomonori Makiguchi
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Megumi Inaba
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Kumamoto, Kumamoto, Japan
| | - Takeshi Honda
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Junya Nakamura
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Koji Inoue
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Takayuki Kishikawa
- Department of Respiratory Medicine, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Masanao Nakashima
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama, Okayama, Japan
| | - Tadashi Kohyama
- Department of Internal Medicine, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Hiroo Ishida
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Naoki Miyazawa
- Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Kanagawa, Japan
| | - Tomomi Nakamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Hiroshi Miyawaki
- Department of Respiratory Medicine, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Naohiro Oda
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Hiroshima, Japan
| | - Ryotaro Morinaga
- Department of Thoracic Medical Oncology, Oita Prefectural Hospital, Oita, Oita, Japan
| | - Kei Kusaka
- The Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, Japan
| | - Nobukazu Fujimoto
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama, Okayama, Japan
| | - Yasushi Fukuda
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masayuki Yasugi
- Department of Respiratory Medicine, Chugoku Central Hospital, Fukuyama, Hiroshima, Japan
| | - Takeshi Tsuda
- Department of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Sunao Ushijima
- Department of Medical Oncology, Kumamoto Kenhoku Hospital, Tamana, Kumamoto, Japan
| | - Kazuhiko Shibata
- Department of Medical Oncology, Kouseiren Takaoka Hospital, Takaoka, Toyama, Japan
| | - Takuo Shibayama
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama, Okayama, Japan
| | - Akihiro Bessho
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Okayama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kenshiro Shiraishi
- Department of Radiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Noriyuki Matsutani
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, Japan
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Consolidation Systemic Therapy in Locally Advanced, Inoperable Nonsmall Cell Lung Cancer-How to Identify Patients Which Can Benefit from It? Curr Oncol 2022; 29:8316-8329. [PMID: 36354716 PMCID: PMC9689287 DOI: 10.3390/curroncol29110656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Consolidation systemic therapy (ST) given after concurrent radiotherapy (RT) and ST (RT-ST) is frequently practiced in locally advanced inoperable nonsmall cell lung cancer (NSCLC). Little is known, however, about the fate of patients achieving different responses after concurrent phases of the treatment. METHODS we searched the English-language literature to identify full-length articles on phase II and Phase III clinical studies employing consolidation ST after initial concurrent RT-ST. We sought information about response evaluation after the concurrent phase and the outcome of these patient subgroups, the patterns of failure per response achieved after the concurrent phase as well as the outcome of these subgroups after the consolidation phase. RESULTS Eighty-seven articles have been initially identified, of which 20 studies were excluded for various reasons, leaving, therefore, a total of 67 studies for our analysis. Response evaluation after the concurrent phase was performed in 36 (54%) studies but in only 14 (21%) response data were provided, while in 34 (51%) studies patients underwent a consolidation phase regardless of the response. No study provided any outcome (survivals, patterns of failure) as per response achieved after the concurrent phase. CONCLUSIONS Information regarding the outcome of subgroups of patients achieving different responses after the concurrent phase and before the administration of the consolidation phase is still lacking. This may negatively affect the decision-making process as it remains unknown which patients may preferentially benefit from the consolidation of ST.
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Takamochi K, Tsuboi M, Okada M, Niho S, Ishikura S, Oyamada S, Yamaguchi T, Suzuki K. S-1 + Cisplatin with Concurrent Radiotherapy Followed by Surgery for Stage IIIA (N2) Lung Squamous Cell Carcinoma: Results of a Phase II Trial. Ann Surg Oncol 2022; 29:8198-8206. [PMID: 36097299 DOI: 10.1245/s10434-022-12490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND To date, no clinical trials on the use of induction therapy before surgery have focused solely on lung squamous cell carcinoma (LSCC). We report the results of the Personalized Induction Therapy-2 (PIT-2) trial, a multicenter phase II study, performed to investigate the efficacy and safety of S-1 + cisplatin with concurrent thoracic radiotherapy (TRT) followed by surgery in patients with stage IIIA (N2) LSCC. METHODS Patients with pathologically proven stage IIIA (N2) LSCC received induction therapy comprising three cycles of S-1 + cisplatin with concurrent TRT (45 Gy in 25 fractions) followed by surgery. S-1 was administered orally at a dose of 40 mg/m2 twice daily on days 1-14, in addition to intravenous infusion of cisplatin (60 mg/m2) on day 1. The primary endpoint was 2-year progression-free survival (PFS) rate. RESULTS Of 45 registered patients, 43 underwent induction therapy. Of the 43 patients, 39 (91%) underwent surgery (35 lobectomies, 3 pneumonectomies, and 1 wedge resection). The 2-year PFS, 2-year overall survival, objective response rate, and pathological complete response rates were 67% (90% confidence interval [CI] 54-78%), 70% (95% CI 53-81%), 86% (95% CI 76-96%), and 39% (95% CI 23-54%), respectively. No new treatment-related adverse events occurred during the induction therapy. One case of 90-day postoperative mortality involving a patient who underwent right pneumonectomy and developed pneumonia after discharge occurred. CONCLUSIONS Induction therapy using S-1 + cisplatin with concurrent TRT followed by surgery is a feasible and promising treatment approach for stage IIIA (N2) LSCC.
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Affiliation(s)
- Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Masahiro Tsuboi
- Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Seiji Niho
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Multi-institutional feasibility study of intensity-modulated radiotherapy with chemotherapy for locally advanced non-small cell lung cancer. Int J Clin Oncol 2022; 27:1025-1033. [PMID: 35305192 DOI: 10.1007/s10147-022-02151-7] [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: 11/01/2021] [Accepted: 02/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND This multi-institutional clinical trial evaluated the feasibility of intensity-modulated radiotherapy (IMRT) for patients with locally advanced non-small cell lung cancer (NSCLC). METHODS The major inclusion criteria were clinical stage III NSCLC, age 20-74 years, and Eastern Cooperative Oncology Group performance status 0-1. Patients were treated with either cisplatin + S-1 (CS; four cycles every 4 weeks) or carboplatin + paclitaxel (CP; administered weekly with thoracic radiotherapy [RT], plus two consolidation cycles) concurrently with IMRT (60 Gy in 30 fractions). The primary endpoint was a treatment completion rate, defined as at least two cycles of CS or five cycles of CP during IMRT and completing 60 Gy IMRT within 56 days after the start of treatment, assumed its 90% confidence interval exceeds 60%. RT quality assurance was mandatory for all the patients. RESULTS Twenty-two patients were registered. One patient withdrew due to pulmonary infection before starting treatment. RT plans were reviewed and none was judged as a protocol violation. Grade 2 and 3 pneumonitis occurred in four (19%) and one (5%) patients, respectively. Seventeen patients met the primary endpoint, with a treatment completion rate of 77.3% (90% confidence interval [CI] 58.0%-90.6%). Four patients failed to complete chemotherapy due to chemotherapy-related adverse events, but 20 patients completed IMRT. There were no treatment-related deaths. The 2-year progression-free and overall survival rates were 31.8% (95% CI 17.3%-58.7%) and 77.3% (95% CI 61.6%-96.9%), respectively. CONCLUSION The treatment completion rate did not meet the primary endpoint, but 20 of 22 patients completed IMRT.
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Taniguchi Y, Okamoto H, Shimokawa T, Sasaki T, Seto T, Niho S, Ohe Y, Saigusa Y. Concurrent chemoradiotherapy with cisplatin + S-1 versus cisplatin + other third-generation agents for locally advanced non-small-cell lung cancer: a meta-analysis of individual participant data. BMC Pulm Med 2022; 22:31. [PMID: 35000608 PMCID: PMC8744285 DOI: 10.1186/s12890-022-01828-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For decades, concurrent chemo-radiotherapy with cisplatin-based regimen has been a standard therapy for locally advanced stage III non-small-cell lung cancer (NSCLC). We conducted individual-participant-data (IPD) meta-analyses to compare S-1/cisplatin versus other third-generation anti-cancer medications plus cisplatin regimens with the goal of determining whether or not S-1/cisplatin was the ideal choice for treatment accompanied by radiotherapy (RT). METHODS A thorough search was performed using multiple electronic databases. We integrated the IPD of each trial and analyzed the resulting meta-database. The primary endpoint was the overall survival (OS), and the secondary endpoints included the progression-free survival (PFS), objective response rate (ORR), toxicities, and treatment delivery. Subgroup analyses were conducted based on baseline characteristics. Statistical analyses were stratified by trials. RESULTS Three randomized control trials (WJOG5008L study, SPECTRA study, and TORG1018 study) were found. Of the 316 patients enrolled in those studies, 159 received S-1/cisplatin (SP), and 157 were assigned to other combination chemotherapy. The median OS for the SP arm was 48.2 months, and that of the non-SP arm was 42.4 months. The combined hazard ratio (HR) for the OS was 0.895 (95% confidence interval [CI] 0.638-1.256), and no heterogeneity was noted among the trials (test for heterogeneity, p = 0.87; I2 = 0). The median PFS for the SP and non-SP arms was 12.8 and 14.0 months, respectively. The corresponding HR for the PFS was 1.022 (95% CI 0.776-1.347), and there was evidence of moderate heterogeneity among the trials (test for heterogeneity, p = 0.16; I2 = 0.46). The ORRs were 69.7% (95% CI 62.1-76.7%) and 70.9% (95% CI 63.7-78.1%) in the SP and non-SP arms, respectively. The toxicity profile showed that SP caused significantly fewer instances of grade 3-4 leukopenia and neutropenia than non-SP regimens. CONCLUSION No marked differences were detected in the OS, PFS, or ORR between the SP and non-SP arms. SP had significantly less myelosuppression and better treatment compliance as a chemotherapy regimen for concurrent chemoradiation in locally advanced NSCLC than non-SP regimens.
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Affiliation(s)
- Yuri Taniguchi
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa-nishimachi, Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan.
| | - Hiroaki Okamoto
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa-nishimachi, Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan
| | - Tsuneo Shimokawa
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa-nishimachi, Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan
| | - Tomonari Sasaki
- Department of Clinical Radiology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Seiji Niho
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center, Tokyo, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
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Tanzawa S, Makiguchi T, Tasaka S, Inaba M, Ochiai R, Nakamura J, Inoue K, Kishikawa T, Nakashima M, Fujiwara K, Kohyama T, Ishida H, Kuyama S, Miyazawa N, Nakamura T, Miyawaki H, Oda N, Ishikawa N, Morinaga R, Kusaka K, Miyamoto Y, Yokoyama T, Matsumoto C, Tsuda T, Ushijima S, Shibata K, Shibayama T, Bessho A, Kaira K, Misumi T, Shiraishi K, Matsutani N, Seki N. Prospective analysis of factors precluding the initiation of durvalumab from an interim analysis of a phase II trial of S-1 and cisplatin with concurrent thoracic radiotherapy followed by durvalumab for unresectable, locally advanced non-small cell lung cancer in Japan (SAMURAI study). Ther Adv Med Oncol 2022; 14:17588359221116603. [PMID: 35923924 PMCID: PMC9340896 DOI: 10.1177/17588359221116603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background: The standard of care for unresectable, locally advanced non-small cell lung cancer (LA-NSCLC) is chemoradiotherapy (CRT) followed by durvalumab, based on the PACIFIC trial. Disease progression and pneumonitis were reported as the main reasons to preclude the initiation of durvalumab in multiple retrospective studies. However, the transition rate and the reasons for failure to proceed to consolidation therapy with durvalumab after CRT were not evaluated prospectively. Although phase II studies in Japan have shown high efficacy and tolerability of CRT with cisplatin + S-1 (SP), no prospective study using durvalumab after SP-based CRT has yet been reported. We therefore conducted a phase II study to verify the efficacy and safety of durvalumab following SP-based CRT. In this interim analysis, we report the transition rate and the reasons for its failure. Methods: In treatment-naïve LA-NSCLC, cisplatin (60 mg/m2, day 1) and S-1 (80–120 mg/body, days 1–14) were administered with two 4-week cycles with concurrent thoracic radiotherapy (60 Gy) followed by durvalumab every 2 weeks for up to 12 months. The primary endpoint was 12 month progression-free survival rate. Results: Fifty-nine patients were enrolled, of whom 86.4% (51/59) proceeded to durvalumab. All of them initiated durvalumab within 42 days after CRT [median 18 days (range: 3–38)], including 27.5% (14/51) in <14 days. Common reasons for failure to proceed to durvalumab were disease progression (2/59, 3.4%) and adverse events (6/59, 10.2%). Among the latter cases, four resumed treatment and proceeded to durvalumab within 42 days on off-protocol. The objective response rate and the disease control rate were 62.7% and 93.2%, respectively. The incidences of ⩾grade 3 pneumonitis, febrile neutropenia, and esophagitis were 0%, 8.5%, and 3.4%, respectively. Conclusion: Regarding durvalumab after CRT, this interim analysis of the SAMURAI study clarified the high transition rate, early introduction, and reasons for failure to proceed to consolidation therapy, which were not determined in the PACIFIC trial. Trial registration: Japan Registry of Clinical Trials, jRCTs031190127, registered 1 November, 2019, https://jrct.niph.go.jp/latest-detail/jRCTs031190127.
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Affiliation(s)
- Shigeru Tanzawa
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tomonori Makiguchi
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Megumi Inaba
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Kumamoto, Kumamoto, Japan
| | - Ryosuke Ochiai
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Junya Nakamura
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Koji Inoue
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Takayuki Kishikawa
- Department of Respiratory Medicine, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Masanao Nakashima
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama, Okayama, Japan
| | - Tadashi Kohyama
- Department of Internal medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Hiroo Ishida
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Naoki Miyazawa
- Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Kanagawa, Japan
| | - Tomomi Nakamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Hiroshi Miyawaki
- Department of Respiratory Medicine, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Naohiro Oda
- Department of Internal medicine, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Hiroshima, Japan
| | - Ryotaro Morinaga
- Department of Thoracic Medical Oncology, Oita Prefectural Hospital, Oita, Oita, Japan
| | - Kei Kusaka
- The Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, Japan
| | - Yosuke Miyamoto
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama, Okayama, Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Chiaki Matsumoto
- Department of Respiratory Medicine, Chugoku Central Hospital, Fukuyama, Hiroshima, Japan
| | - Takeshi Tsuda
- Department of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Sunao Ushijima
- Department of Medical Oncology, Kumamoto Kenhoku Hospital, Tamana, Kumamoto, Japan
| | - Kazuhiko Shibata
- Department of Medical Oncology, Kouseiren Takaoka Hospital, Takaoka, Toyama, Japan
| | - Takuo Shibayama
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama, Okayama, Japan
| | - Akihiro Bessho
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Okayama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Kenshiro Shiraishi
- Department of Radiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Noriyuki Matsutani
- Department of Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Nobuhiko Seki
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan
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9
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Tanzawa S, Ushijima S, Shibata K, Shibayama T, Bessho A, Kaira K, Misumi T, Shiraishi K, Matsutani N, Tanaka H, Inaba M, Haruyama T, Nakamura J, Kishikawa T, Nakashima M, Iwasa K, Fujiwara K, Kohyama T, Kuyama S, Miyazawa N, Nakamura T, Miyawaki H, Ishida H, Oda N, Ishikawa N, Morinaga R, Kusaka K, Fujimoto N, Yokoyama T, Gemba K, Tsuda T, Nakagawa H, Ono H, Shimizu T, Nakamura M, Kusumoto S, Hayashi R, Shirasaki H, Ochi N, Aoe K, Kanaji N, Kashiwabara K, Inoue H, Seki N. A phase II study of S-1 and cisplatin with concurrent thoracic radiotherapy followed by durvalumab for unresectable, locally advanced non-small-cell lung cancer in Japan (SAMURAI study). Ther Adv Med Oncol 2021; 13:1758835921998588. [PMID: 33717228 PMCID: PMC7917867 DOI: 10.1177/1758835921998588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Based on the results of the PACIFIC study, chemoradiotherapy followed by
1-year consolidation therapy with durvalumab was established as the standard
of care for unresectable, locally advanced non-small-cell lung cancer
(LA-NSCLC). However, some topics not foreseen in that design can be
explored, including progression-free survival (PFS) and overall survival
(OS) after the start of chemoradiotherapy, the proportion of patients who
proceeded to consolidation therapy with durvalumab, and the optimal
chemotherapeutic regimens. In Japan, the combination regimen of
S-1 + cisplatin (SP), for which the results of multiple clinical studies
have suggested a good balance of efficacy and tolerability, is frequently
selected in clinical settings. However, the efficacy and safety of
consolidation therapy with durvalumab following this SP regimen have not
been evaluated. We therefore planned a multicenter, prospective, single-arm,
phase II study. Methods: In treatment-naïve LA-NSCLC, two cycles of combination chemotherapy with S-1
(80–120 mg/body, Days 1–14) + cisplatin (60 mg/m2, Day 1) will be
administered at an interval of 4 weeks, with concurrent thoracic
radiotherapy (60 Gy). Responders will then receive durvalumab every 2 weeks
for up to 1 year. The primary endpoint is 1-year PFS rate. Discussion: Compared with the conventional standard regimen in Japan, the SP regimen is
expected to be associated with lower incidences of pneumonitis, esophagitis,
and febrile neutropenia, which complicate the initiation of consolidation
therapy with durvalumab, and have higher antitumor efficacy during
chemoradiotherapy. Therefore, SP-based chemoradiotherapy is expected to be
successfully followed by consolidation therapy with durvalumab in more
patients, resulting in prolonged PFS and OS. Toxicity and efficacy results
of the SP regimen in this study will also provide information important to
the future establishment of the concurrent combination of chemoradiotherapy
and durvalumab. Trial registration: Japan Registry of Clinical Trials, jRCTs031190127, registered 1 November
2019, https://jrct.niph.go.jp/latest-detail/jRCTs031190127
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Affiliation(s)
- Shigeru Tanzawa
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-City, Tokyo, Japan
| | - Sunao Ushijima
- Department of Medical Oncology, Kumamoto Chuo Hospital, Kumamoto-City, Kumamoto, Japan
| | - Kazuhiko Shibata
- Department of Medical Oncology, Kouseiren Takaoka Hospital, Takaoka-City, Toyama, Japan
| | - Takuo Shibayama
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama-City, Okayama, Japan
| | - Akihiro Bessho
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama-City, Okayama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka-City, Saitama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama-City, Kanagawa, Japan
| | - Kenshiro Shiraishi
- Department of Radiology, Teikyo University School of Medicine, Itabashi-City, Tokyo, Japan
| | - Noriyuki Matsutani
- Department of Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki-City, Kanagawa, Japan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki-City, Aomori, Japan
| | - Megumi Inaba
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Kumamoto-City, Kumamoto, Japan
| | - Terunobu Haruyama
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-City, Tokyo, Japan
| | - Junya Nakamura
- Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Matsuyama-City, Ehime, Japan
| | - Takayuki Kishikawa
- Division of Thoracic Oncology, Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya-City, Tochigi, Japan
| | - Masanao Nakashima
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kawasaki-City, Kanagawa, Japan
| | - Keiichi Iwasa
- Department of Medical Oncology, Kouseiren Takaoka Hospital, Takaoka-City, Toyama, Japan
| | - Keiichi Fujiwara
- Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama-City, Okayama, Japan
| | - Tadashi Kohyama
- Department of Internal medicine, Teikyo University Mizonokuchi Hospital, Kawasaki-City, Kanagawa, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni-City, Yamaguchi, Japan
| | - Naoki Miyazawa
- Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Yokohama-City, Kanagawa, Japan
| | - Tomomi Nakamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga-City, Saga, Japan
| | - Hiroshi Miyawaki
- Department of Respiratory Medicine, Kagawa Prefectural Central Hospital, Takamatsu-City, Kagawa, Japan
| | - Hiroo Ishida
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama-City, Kanagawa, Japan
| | - Naohiro Oda
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama-City, Hiroshima, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima-City, Hiroshima, Japan
| | - Ryotaro Morinaga
- Department of Thoracic Medical Oncology, Oita Prefectural Hospital, Oita-City, Oita, Japan
| | - Kei Kusaka
- The Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Kiyose-City, Tokyo, Japan
| | - Nobukazu Fujimoto
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama-City, Okayama, Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki-City, Okayama, Japan
| | - Kenichi Gemba
- Department of Respiratory Medicine, Chugoku Central Hospital, Fukuyama-City, Hiroshima, Japan
| | - Takeshi Tsuda
- Department of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama-City, Toyama, Japan
| | - Hideyuki Nakagawa
- Department of Respiratory Medicine, National Hospital Organization, Hirosaki Hospital, Hirosaki-City, Aomori, Japan
| | - Hirotaka Ono
- Department of Respiratory Medicine, Tsuboi Hospital, Koriyama-City, Fukushima, Japan
| | - Tetsuo Shimizu
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-City, Tokyo, Japan
| | - Morio Nakamura
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, Minato-City, Tokyo, Japan
| | - Sojiro Kusumoto
- Division of Allergology and Respiratory Medicine, Showa University School of Medicine, Shinagawa-City, Tokyo, Japan
| | - Ryuji Hayashi
- Clinical Oncology, Toyama University Hospital, Toyama-City, Toyama, Japan
| | - Hiroki Shirasaki
- Department of Respiratory Medicine, Fukui-ken Saiseikai Hospital, Fukui-City, Fukui, Japan
| | - Nobuaki Ochi
- General Internal Medicine 4, Kawasaki Medical School, Okayama-City, Okayama, Japan
| | - Keisuke Aoe
- Department of Medical Oncology, National Hospital Organization Yamaguchi-Ube Medical Center, Ube-City, Yamaguchi, Japan
| | - Nobuhiro Kanaji
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kida-gun, Kagawa, Japan
| | - Kosuke Kashiwabara
- Department of Respiratory Medicine, Kumamoto Regional Medical Center, Kumamoto-City, Kumamoto, Japan
| | - Hiroshi Inoue
- Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu-City, Saga, Japan
| | - Nobuhiko Seki
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8606, Japan
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10
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Shimokawa T, Yamada K, Tanaka H, Kubota K, Takiguchi Y, Kishi K, Saito H, Hosomi Y, Kato T, Harada D, Otani S, Kasai T, Nakamura Y, Misumi T, Yamanaka T, Okamoto H. Randomized phase II trial of S-1 plus cisplatin or docetaxel plus cisplatin with concurrent thoracic radiotherapy for inoperable stage III non-small cell lung cancer. Cancer Med 2020; 10:626-633. [PMID: 33319495 PMCID: PMC7877366 DOI: 10.1002/cam4.3641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/22/2020] [Accepted: 11/10/2020] [Indexed: 12/25/2022] Open
Abstract
Cisplatin‐based chemoradiotherapy is considered standard treatment for unresectable locally advanced non‐small‐cell lung cancer (LA‐NSCLC). This study examined two regimens of chemotherapy in concurrent chemoradiation. Eligible patients with unresectable, radically irradible LA‐NSCLC were randomized to either the SP (S‐1 and cisplatin) or DP (docetaxel and cisplatin) arms with concurrent thoracic radiotherapy of 60 Gy, comprising 2 Gy per daily fraction. The primary endpoint was the overall survival (OS) rate at 2 years (the 2‐year OS rate). From May 2011 to August 2014, 110 patients were enrolled. Of 106 eligible patients, the 2‐year OS rates were 79% (95% CI: 66%–88%) and 69% (95% CI: 55%–80%) the SP and DP arms, respectively. The median progression‐free survival was 11.6 months for the SP arm and 19.9 months for the DP arm, while the median survival time was 55.2 months for the SP arm and 50.8 months for the DP arm. Grade 3/4 leukopenia were more frequent in DP arm. The incidences of febrile neutropenia and pneumonitis tended to be higher in DP arm. There were no treatment‐related deaths in either arm. The primary endpoint was met in both arms. The SP arm as a future reference regimen will be chosen due to fewer toxicities and better OS.
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Affiliation(s)
- Tsuneo Shimokawa
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Kazuhiko Yamada
- Department of Respiratory Medicine, Shin Koga Hospital, Fukuoka, Japan
| | - Hiroshi Tanaka
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine, Infection and Oncology, Nippon Medical School, Tokyo, Japan
| | | | - Kazuma Kishi
- Department of Respiratory Medicine, Toho University, Tokyo, Japan
| | - Haruhiro Saito
- Department of Thoracic Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Yukio Hosomi
- Department of Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Daijiro Harada
- Department of Thoracic Oncology, Shikoku Cancer Center, Ehime, Japan
| | - Sakiko Otani
- Division of Medical Oncology, Kanazawa University Cancer Research Institute, Ishikawa, Japan
| | - Takashi Kasai
- Department of Respiratory Medicine, Tochigi Cancer Center, Tochigi, Japan
| | - Yoichi Nakamura
- Department of Respiratory Medicine, Tochigi Cancer Center, Tochigi, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University, Kanagawa, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University, Kanagawa, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
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11
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Iwata H, Akita K, Yamaba Y, Kunii E, Takakuwa O, Yoshihara M, Hattori Y, Nakajima K, Hayashi K, Toshito T, Ogino H, Shibamoto Y. Concurrent Chemo-Proton Therapy Using Adaptive Planning for Unresectable Stage 3 Non-Small Cell Lung Cancer: A Phase 2 Study. Int J Radiat Oncol Biol Phys 2020; 109:1359-1367. [PMID: 33227444 DOI: 10.1016/j.ijrobp.2020.11.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study prospectively evaluated the efficacy and safety of concurrent chemo-proton therapy (CCPT) using adaptive planning for unresectable stage III non-small cell lung cancer (NSCLC). METHODS AND MATERIALS The primary endpoint was overall survival (OS). Secondary endpoints were local control rate (LCR), progression-free survival (PFS), incidence of grade 3 or higher adverse events, and changes in quality of life (QOL). Patients received cisplatin (60 mg/m2) on day 1 and S-1 (∼40 mg/m2 twice daily) on days 1 to 14, q4w, for up to 4 cycles, plus concurrent proton therapy at a total dose of 70 GyRBE for the primary lesion and 66 GyRBE for lymph node metastasis with 2 GyRBE per day. Proton therapy was performed using respiratory-gated and image guided techniques, and adaptive plans were implemented. RESULTS Forty-seven patients were enrolled between August 2013 and August 2018. Four cycles of cisplatin plus S-1 were completed in 34 patients. The mean number of cycles was 4 (range, 1-4). The median follow-up of all and surviving patients was 37 (range, 4-84) and 52 months (range, 26-84), respectively. The mean number of replanning sessions was 2.5 (range, 1-4). The 2- and 5-year OS, LCR, and PFS were 77% (95% confidence interval 64%-89%) and 59% (43%-76%), 84% (73%-95%) and 61% (44%-78%), and 43% (28%-57%) and 37% (22%-51%), respectively. The median OS was not reached. No grade 3 or higher radiation pneumonitis was observed. There was no significant deterioration in the QOL scores after 24 months except for alopecia. CONCLUSIONS CCPT with adaptive planning was well tolerated and yielded remarkable OS for unresectable stage III NSCLC.
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Affiliation(s)
- Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Kenji Akita
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Yusuke Yamaba
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Eiji Kunii
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Osamu Takakuwa
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Misuzu Yoshihara
- Department of Respiratory Tract Oncology Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kensuke Hayashi
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Toshiyuki Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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12
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Randomized phase II study of chemoradiotherapy with cisplatin + S-1 versus cisplatin + pemetrexed for locally advanced non-squamous non-small cell lung cancer: SPECTRA study. Lung Cancer 2020; 141:64-71. [PMID: 31955002 DOI: 10.1016/j.lungcan.2020.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/10/2019] [Accepted: 01/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES SPECTRA is a multicenter, randomized phase II study of chemotherapy with cisplatin (CDDP) plus S-1 versus CDDP plus pemetrexed (PEM) in combination with thoracic radiotherapy (TRT) for locally advanced non-squamous non-small cell lung cancer, in order to determine which of these two regimens might be preferable for comparison with standard therapies in a future phase III study. MATERIALS AND METHODS Patients were randomly assigned to receive CDDP + S-1 (CDDP 60 mg/m2 on day 1 and S-1 80 mg/m2 on days 1-14, every 4 weeks, up to 4 cycles) or CDDP + PEM (CDDP 75 mg/m2 + PEM 500 mg/m2 on day 1, every 3 weeks, up to 4 cycles) combined with TRT (60 Gy in 30 fractions). The primary endpoint was the 2-year progression-free survival (PFS) rate. The sample size had been set at 100 patients. RESULTS A total of 102 patients were randomized to receive CDDP + S-1 or CDDP + PEM (CDDP + S-1, n = 52; CDDP + PEM, n = 50) between January 2013 and October 2016. The results in the CDDP + S1 group and CDDP + PEM group were as follows: completion rates of TRT (60 Gy)/chemotherapy (4 cycles) was 92 %/73 % and 98 %/86 %, respectively; the response rates were 60 % and 64 %, respectively; median PFS after a median follow-up of 32.1 months, 12.7/13.8 months (hazard ratio [HR] = 1.16; 95 % confidence interval [CI], 0.73-1.84); 2-year PFS rate, 36.5 % (95 % CI, 23.5-49.6)/32.1 % (95 %CI, 18.9-45.4); median OS, 48.3/59.1 months (HR = 1.05; 95 %CI, 0.58-1.90); 2-year OS rate, 69.2 % (95 %CI, 56.7-81.8)/66.4 % (95 %CI, 53.0-79.9); Grade 3 toxicities: febrile neutropenia (12 %/2 %), anorexia (8 %/16 %), diarrhea (8 %/0 %), esophagitis (6 %/8 %), and neutropenia (35 %/50 %); Grade 2 or worse radiation pneumonitis, 15 % (8 patients)/4 % (2 patients). CONCLUSION The 2-year PFS rate in the CDDP + S-1 arm was higher than that in the CDDP + PEM arm. Both treatments were safe, with manageable toxicities.
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13
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Niho S, Hosomi Y, Okamoto H, Nihei K, Tanaka H, Hida T, Umemura S, Goto K, Akimoto T, Ohe Y. Carboplatin, S-1 and concurrent thoracic radiotherapy for elderly patients with locally advanced non-small cell lung cancer: a multicenter Phase I/II study. Jpn J Clin Oncol 2019; 49:614-619. [PMID: 30916304 DOI: 10.1093/jjco/hyz039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES We conducted a Phase I/II study of carboplatin, S-1 and concurrent thoracic radiotherapy (TRT) for elderly patients (71 years or older) with unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients received carboplatin (AUC 3-5) on Day 1 and S-1 (30-40 mg/m2 two times daily) on Days 1-14, every 2 weeks, for up to four cycles, plus concurrent TRT at a total dose of 60 Gy. The primary endpoint for the Phase II study was the 1-year progression-free survival (PFS) rate. RESULTS Eighteen patients were enrolled in the Phase I study. Febrile neutropenia, a decreased platelet count and esophagitis were dose-limiting toxicities. The recommended doses for the Phase II study were determined to be an AUC of 3 for carboplatin, 40 mg/m2 twice daily for S-1. Twenty-eight patients were evaluated in the Phase II study. The 1-year PFS rate was 57.1% (90% CI 41.6-71.4%), and the median PFS was 16.8 months (95% CI 7.8-not assessable [NA]). The lower limit of the 90% CI for 1-year PFS exceeded the prespecified threshold value of 30%; therefore, the primary endpoint was met. Grades 3-4 toxicities included thrombocytopenia (21%) and hyponatremia (11%). Grade 3 radiation pneumonitis was observed in 18% of patients. No treatment-related deaths were observed. CONCLUSION Combination chemotherapy consisting of carboplatin plus S-1 and concurrent TRT had a promising efficacy in elderly patients with locally advanced NSCLC; however, radiation pneumonitis was frequently observed.
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Affiliation(s)
- Seiji Niho
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Keiji Nihei
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Respiratory Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Toyoaki Hida
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shigeki Umemura
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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14
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Liu T, He Z, Dang J, Li G. Comparative efficacy and safety for different chemotherapy regimens used concurrently with thoracic radiation for locally advanced non-small cell lung cancer: a systematic review and network meta-analysis. Radiat Oncol 2019; 14:55. [PMID: 30925881 PMCID: PMC6441209 DOI: 10.1186/s13014-019-1239-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background It remains unknown which is the most preferable regimen used concurrently with thoracic radiation for locally advanced non-small cell lung cancer (NSCLC). We performed a network meta-analysis to address this important issue. Methods PubMed, Embase, Cochrane Library, Web of Science and major international scientific meetings were searched for relevant randomized controlled trials (RCTs). Overall survival (OS) data was the primary outcome of interest, and progression-free survival (PFS), and serious adverse events (SAEs) were the secondary outcomes of interests, reported as hazard ratio (HR) or odds ratio (OR) and 95% confidence intervals (CIs). Results 14 RCTs with a total of 2975 patients randomized to receive twelve categories of treatments were included in the meta-analysis. Direct comparison meta-analysis showed that etoposide-cisplatin (EP) was more effective than paclitaxel-cisplatin/carboplatin (PC) in terms of OS (HR = 0.85, 95% CI: 0.77–0.94) and PFS (HR = 0.66, 95% CI: 0.47–0.95). In network meta-analysis, all regimen comparisons did not produce statistically significant differences in survival. Based on treatment ranking of OS and the benefit-risk ratio, S-1-cisplatin (SP) was likely to be the most preferable regimen for its best efficacy and low risk of causing SAEs. Uracil/tegafur-cisplatin (UP) and pemetrexed-cisplatin/carboplatin (PP) were ranked the second and third respectively. Gemcitabine-cisplatin (GP) and PC + Cetuximab (PC-Cet) appeared to be the worst and second-worst regimens for their poor efficacy and poor tolerability. Conclusions Based on efficacy and tolerability, SP is likely to be the most preferable regimen used concurrently with thoracic radiation for locally advanced NSCLC, followed by UP and PP. Further direct head-to-head studies are needed to confirm these findings. Electronic supplementary material The online version of this article (10.1186/s13014-019-1239-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tingting Liu
- Department of Radiation Oncology, The First Hospital of China Medical University, 155 Nanjing Road, Heping District, Shenyang, 110001, China
| | - Zheng He
- Department of Radiation Oncology, The First Hospital of China Medical University, 155 Nanjing Road, Heping District, Shenyang, 110001, China
| | - Jun Dang
- Department of Radiation Oncology, The First Hospital of China Medical University, 155 Nanjing Road, Heping District, Shenyang, 110001, China.
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, 155 Nanjing Road, Heping District, Shenyang, 110001, China
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Pneumonectomy after induction chemoradiotherapy for locally advanced non-small cell lung cancer: should curative intent pulmonary resection be avoided? Surg Today 2019; 49:197-205. [PMID: 30610361 DOI: 10.1007/s00595-018-1751-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/27/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE We conducted a retrospective analysis to assess the practicality of pneumonectomy, especially after concurrent induction chemoradiotherapy (i-CRT), for locally advanced non-small cell lung cancer (LA-NSCLC). The operative risks vs. the survival benefit of this procedure for such patients is a subject of controversy. METHODS The subjects of this retrospective study were 71 consecutive LA-NSCLC patients with cStage IIIA-C NSCLC, who underwent i-CRT followed by curative intent pulmonary resection between February, 2001 and March, 2013. RESULTS Thirty-two patients underwent pneumonectomy (group P) and 39 patients underwent lobectomy (group L). In group P, 17 (54.8%) patients underwent right pneumonectomy. There was no 30-day postoperative mortality in either group and no significant difference in 90-day postoperative mortality between the groups (3.1% vs. 2.6% in groups P and L, respectively). The 5-year overall survival (OS) rate was 58.7% (95% CI: 41.5-75.9%) in group P and 57.3% (95% CI 41.2-73.4%) in group L, without a significant difference between the groups. CONCLUSION Our findings suggest that i-CRT followed by pneumonectomy is feasible, with a similar survival benefit to lobectomy. Thus, pneumonectomy after i-CRT should not be avoided as it is a potentially curative intent strategy for carefully selected patients.
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Ogawa H, Tanaka Y, Tachihara M, Uehara K, Shimizu N, Doi T, Hokka D, Maniwa Y. ROS1-rearranged high-PD-L1-expressing lung adenocarcinoma manifesting as mediastinal tumor: A case report. Oncol Lett 2018; 17:488-491. [PMID: 30655791 DOI: 10.3892/ol.2018.9622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/07/2018] [Indexed: 12/26/2022] Open
Abstract
ROS proto-oncogene 1 receptor tyrosine kinase (ROS1)-rearranged lung cancer is rare and comprises only 1% of lung adenocarcinoma cases. It has recently been reported to have good response to crizotinib, a tyrosine kinase inhibitor of anaplastic lymphoma kinase. Driver oncogene mutations with approved therapies seldom coexist with a high expression of Programmed death-ligand 1 (PD-L1). The present case report describes a rare case of ROS1 rearrangement with high-PD-L1-expressing occult lung adenocarcinoma. A 32-year-old woman presented with chest pain and a prolonged cough. Chest computed tomography (CT) revealed a 57×36-mm tumor in the mediastinum, with no tumors detected in other regions. Positron emission tomography (PET)-CT showed a strong fluorodeoxyglucose accumulation in the tumor (SUVmax 13.2). Mediastinal tumor resection was completely resected using a video-assisted thoracic surgery approach. Pathological examination showed the tumor cells were positive for thyroid transcription factor 1, Napsin-A, ROS1, and PD-L1 (tumor proportion score >99%). ROS1 rearrangement was confirmed by fluorescence in situ hybridization. The mediastinal tumor was diagnosed as mediastinal lymph node metastasis of ROS1-rearranged PD-L1 high-expression undifferentiated lung adenocarcinoma (pathological stage 3, TxN2M0). Two months after the operation, the CT scan showed multiple mediastinum lymph nodes metastases with rapid tumor growth. The patient achieved a complete response after three cycles of S-1 plus cisplatin with concurrent radiotherapy 60 Gy/30 Fr.
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Affiliation(s)
- Hiroyuki Ogawa
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
| | - Motoko Tachihara
- Department of Respiratory Medicine, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
| | - Keiichiro Uehara
- Department of Diagnostic Pathology, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
| | - Nahoko Shimizu
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
| | - Takefumi Doi
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo 650-0017, Japan
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Sasaki T, Seto T, Yamanaka T, Kunitake N, Shimizu J, Kodaira T, Nishio M, Kozuka T, Takahashi T, Harada H, Yoshimura N, Tsutsumi S, Kitajima H, Kataoka M, Ichinose Y, Nakagawa K, Nishimura Y, Yamamoto N, Nakanishi Y. A randomised phase II trial of S-1 plus cisplatin versus vinorelbine plus cisplatin with concurrent thoracic radiotherapy for unresectable, locally advanced non-small cell lung cancer: WJOG5008L. Br J Cancer 2018; 119:675-682. [PMID: 30206369 PMCID: PMC6173687 DOI: 10.1038/s41416-018-0243-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/18/2018] [Accepted: 08/02/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cisplatin-based chemoradiotherapy is the standard treatment for unresectable, locally advanced non-small-cell lung cancer (NSCLC). This trial evaluated two experimental regimens that combine chemotherapy with concurrent radiotherapy. METHODS Eligible patients with unresectable stage III NSCLC were randomised to either the SP arm (S-1 and cisplatin) or VP arm (vinorelbine and cisplatin), with early concurrent thoracic radiotherapy of 60 Gy, comprising 2 Gy per daily fraction. The primary endpoint was the overall survival rate at 2 years (2-year overall survival (OS)) (Study ID: UMIN000002420). RESULTS From September 2009 to September 2012, 112 patients were enroled. Of the 108 eligible patients, the 2-year OS was 75.6% (80% confidence interval (CI), 67-82%) in the SP arm and 68.5% (80% CI: 60-76%) in the VP arm. The hazard ratio (HR) for death between the two arms was 0.85 (0.48-1.49). The median progression-free survival was 14.8 months for the SP arm and 12.3 months for the VP arm with an HR of 0.92 (0.58-1.44). There were four treatment-related deaths in the SP arm and five in the VP arm. CONCLUSIONS The null hypotheses for 2-year OS were rejected in both arms. The West Japan Oncology Group will employ the SP arm as the investigational arm in a future phase III study.
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Affiliation(s)
- Tomonari Sasaki
- National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
| | - Takashi Seto
- National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
| | - Takeharu Yamanaka
- Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Naonobu Kunitake
- National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
| | - Junichi Shimizu
- Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Takeshi Kodaira
- Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Makoto Nishio
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takuyo Kozuka
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiaki Takahashi
- Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hideyuki Harada
- Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Naruo Yoshimura
- Osaka City University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan
| | - Shinichi Tsutsumi
- Osaka City University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan
| | - Hiromoto Kitajima
- Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama City, Ehime, 791-0280, Japan
| | - Masaaki Kataoka
- Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama City, Ehime, 791-0280, Japan
| | - Yukito Ichinose
- National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
| | - Kazuhiko Nakagawa
- Kindai University Hospital, 377-2 Ohnohigashi, Osaka-Sayama, 589-8511, Japan
| | - Yasumasa Nishimura
- Kindai University Hospital, 377-2 Ohnohigashi, Osaka-Sayama, 589-8511, Japan
| | - Nobuyuki Yamamoto
- Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yoichi Nakanishi
- Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Taira T, Yoh K, Nagase S, Kubota K, Ohmatsu H, Niho S, Onozawa M, Akimoto T, Ohe Y, Goto K. Long-term results of S-1 plus cisplatin with concurrent thoracic radiotherapy for locally advanced non-small-cell lung cancer. Cancer Chemother Pharmacol 2018; 81:565-572. [DOI: 10.1007/s00280-018-3530-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
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19
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Takase N, Hattori Y, Kiriu T, Itoh S, Kawa Y, Yamamoto M, Urata Y, Shimada T, Tsujino K, Soejima T, Negoro S, Satouchi M. Concurrent chemoradiotherapy with cisplatin and S-1 or vinorelbine for patients with stage III unresectable non-small cell lung cancer: A retrospective study. Respir Investig 2016; 54:334-40. [PMID: 27566381 DOI: 10.1016/j.resinv.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/24/2015] [Accepted: 02/22/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) is the preferred treatment for stage III unresectable non-small cell lung cancer (NSCLC). However, there have been few reports on combination chemotherapy with radiation for second- and third-generation antitumor drugs, although clinical guidelines have recommended the use of these drugs along with platinum agents. METHODS We retrospectively analyzed the efficacy and toxicity of cisplatin and either S-1 or vinorelbine for treating stage III unresectable NSCLC patients who were treated with CCRT. RESULTS Between September 2006 and May 2014, 56 patients with unresectable stage III NSCLC were treated with CCRT with S-1 and cisplatin (median age: 63 years) and 58 patients were treated with CCRT with vinorelbine and cisplatin (median age: 61 years). The median follow-up time was 14.6 months in the S-1 arm and 28.0 months in the vinorelbine arm. We found no significant difference in progression-free survival (15.8 months vs. 10.1 months; p=0.15) and overall survival (33.7 months vs. 31.1 months; p=0.63) between the S-1 and vinorelbine arms, respectively. Severe (more than grade 3) leukopenia (35.7% vs. 98.2%; p<0.01), neutropenia (44.6% vs. 98.2%; p<0.01), and febrile neutropenia (1.8% vs. 46.6%, p<0.01) were significantly less frequent in the S-1 arm than in the vinorelbine arm. Treatment-related deaths were not observed in either arm. CONCLUSIONS CCRT with both S-1 or vinorelbine with cisplatin appears feasible based on their efficacy and toxicity profiles. Both treatments may be recommended as treatment options for patients with stage III unresectable NSCLC.
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Affiliation(s)
- Naoto Takase
- Department of Medical Oncology, Hyogo Cancer Center, Akashi-City, Hyogo 673-8558, Japan.
| | - Yoshihiro Hattori
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Tatsunori Kiriu
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Shouichi Itoh
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Yoshitaka Kawa
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Masatsugu Yamamoto
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Yoshiko Urata
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Temiko Shimada
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
| | - Kayoko Tsujino
- Department of Therapeutic Radiology, Hyogo Cancer Center, Akashi-City, Hyogo 673-8558, Japan.
| | - Toshinori Soejima
- Department of Therapeutic Radiology, Hyogo Cancer Center, Akashi-City, Hyogo 673-8558, Japan.
| | - Shunichi Negoro
- Department of Medical Oncology, Hyogo Cancer Center, Akashi-City, Hyogo 673-8558, Japan.
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi-City, Hyogo 673-8558, Japan.
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Inagaki M, Shinohara Y, Kaburagi T, Endo T, Homma S, Hizawa N, Kishi K, Nakamura H, Hayashihara K, Saito T, Kurishima K, Ishikawa H, Ichimura H, Nawa T, Kikuchi N, Miyazaki K, Kodama T, Satoh H, Furukawa K. S-1-containing chemotherapy for patients with non-small-cell lung cancer: A population-based observational study by the Ibaraki thoracic integrative (POSITIVE) research group. Mol Clin Oncol 2016; 4:1025-1030. [PMID: 27284438 DOI: 10.3892/mco.2016.826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 03/02/2016] [Indexed: 11/06/2022] Open
Abstract
To evaluate the efficacy and safety of S-1 monotherapy, S-1-containing combined chemotherapy and S-1 containing chemoradiotherapy for non-small cell lung cancer (NSCLC), a population-based observational study was performed. The efficacy and safety of the chemotherapies were evaluated at 13 institutes in a prefecture of Japan between April 2011 and March 2015. Datasets were obtained from 282 patients with NSCLC. For either wild-type or mutated epidermal growth factor receptor (EGFR), these three therapy groups generated almost identical response results and toxicity profiles as those in previously reported clinical trials, although the present study appeared to have slightly lower survival rates compared with those in the previous clinical trials. This may be due to the inclusion of patients in poor condition, and S-1 therapy being administered in the second, or later, line of therapy. In conclusion, the present study has confirmed that S-1-containing chemotherapy is effective against wild- and mutated-type EGFR NSCLC, and it is also tolerable in clinical practice.
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Affiliation(s)
- Masaharu Inagaki
- Tsuchiura Kyodo General Hospital and Regional Cancer Center, Tsuchiura, Ibaraki 300-0053, Japan
| | - Yoko Shinohara
- Tsuchiura Kyodo General Hospital and Regional Cancer Center, Tsuchiura, Ibaraki 300-0053, Japan
| | - Takayuki Kaburagi
- Ibaraki Prefectural Central Hospital and Regional Cancer Center, Kasama, Ibaraki 309-1793, Japan
| | - Takeo Endo
- Mito Medical Center Hospital, Mito, Ibaraki 311-3193, Japan
| | - Shinsuke Homma
- Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Nobuyuki Hizawa
- Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Koji Kishi
- Tokyo Medical University, Ibaraki Medical Center Hospital, Ami, Ibaraki 300-0395, Japan
| | - Hiroyuki Nakamura
- Tokyo Medical University, Ibaraki Medical Center Hospital, Ami, Ibaraki 300-0395, Japan
| | | | - Takefumi Saito
- Ibaraki Higashi National Hospital, Tokai, Ibaraki 319-1113, Japan
| | - Koichi Kurishima
- Tsukuba Medical Center Hospital and Regional Cancer Center, Tsukuba, Ibaraki 305-8558, Japan
| | - Hiroichi Ishikawa
- Tsukuba Medical Center Hospital and Regional Cancer Center, Tsukuba, Ibaraki 305-8558, Japan
| | - Hideo Ichimura
- Hitachi General Hospital, Hitachi, Ibaraki 317-0077, Japan
| | - Takeshi Nawa
- Hitachi General Hospital, Hitachi, Ibaraki 317-0077, Japan
| | | | - Kunihiko Miyazaki
- Ryugasaki Saiseikai General Hospital, Ryugasaki, Ibaraki 301-0854, Japan
| | - Takahide Kodama
- Ryugasaki Saiseikai General Hospital, Ryugasaki, Ibaraki 301-0854, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Μito Medical Center, Institute of Clinical Medicine, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Kinya Furukawa
- Tokyo Medical University, Ibaraki Medical Center Hospital, Ami, Ibaraki 300-0395, Japan
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Nakanishi Y. Implementation of modern therapy approaches and research for non-small cell lung cancer in Japan. Respirology 2016; 20:199-208. [PMID: 25594902 DOI: 10.1111/resp.12460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/28/2014] [Accepted: 11/25/2014] [Indexed: 12/14/2022]
Abstract
The genetic backgrounds of the Japanese (or Asians) are, at least in part, different from those of Caucasians. It is necessary to recognize this difference to develop medicine that is both optimized and individualized. In particular, the consideration of ethnic differences is becoming increasingly important for lung cancer medicine. Japanese clinical practice guidelines indicate that some clinical biomarkers, such as epidermal growth factor receptor gene mutations, echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene and uridine diphosphate glucuronosyltransferase genotypes should be determined in appropriate lung cancer patients. At the present time, tests for these biomarkers are covered by the Japanese national health-care programme, as is treatment with certain targeted drugs and cytotoxic agents. Therefore, most patients with lung cancer in Japan receive these tests as part of daily practice if their performance status and organ function are judged to be eligible. In addition, ethnic differences in bone marrow toxicity caused by cytotoxic drugs are reflected in treatment choice, and the requirements for the development of treatment modalities suitable for rare targeted populations are also increasing. To meet these requirements, many collaborative groups in Japan that have improved their infrastructure for investigator-initiated trials and conducted important activities need to provide further optimal treatment modalities for Japanese and Asian patients with lung cancer. Here, the characteristics of lung cancer in Japanese patients, general aspects of medical treatment and the care system in Japan, and representative studies on lung cancer in Japan are reviewed.
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Affiliation(s)
- Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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22
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Nogami N, Takigawa N, Hotta K, Segawa Y, Kato Y, Kozuki T, Oze I, Kishino D, Aoe K, Ueoka H, Kuyama S, Harita S, Okada T, Hosokawa S, Inoue K, Gemba K, Shibayama T, Tabata M, Takemoto M, Kanazawa S, Tanimoto M, Kiura K. A phase II study of cisplatin plus S-1 with concurrent thoracic radiotherapy for locally advanced non-small-cell lung cancer: The Okayama Lung Cancer Study Group Trial 0501. Lung Cancer 2015; 87:141-7. [DOI: 10.1016/j.lungcan.2014.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/01/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
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Takenaka T, Takenoyama M, Toyozawa R, Inamasu E, Yoshida T, Toyokawa G, Shiraishi Y, Hirai F, Yamaguchi M, Seto T, Ichinose Y. Concurrent Chemoradiotherapy for Patients With Postoperative Recurrence of Surgically Resected Non–Small-Cell Lung Cancer. Clin Lung Cancer 2015; 16:51-6. [DOI: 10.1016/j.cllc.2014.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/02/2014] [Accepted: 06/17/2014] [Indexed: 12/28/2022]
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Phase II clinical trial of S-1 plus oral leucovorin in previously treated patients with non-small-cell lung cancer. Lung Cancer 2014; 86:339-43. [PMID: 25453619 DOI: 10.1016/j.lungcan.2014.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/15/2014] [Accepted: 10/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND S-1, a novel oral fluoropyrimidine, has potent antitumor activity against non-small-cell lung cancer (NSCLC). Meanwhile, leucovorin enhances the efficacy of 5-fluorouracil by inhibiting thymidylate synthase. Therefore, this phase II clinical trial evaluated the safety and efficacy of S-1 plus leucovorin combination therapy for previously treated patients with NSCLC. PATIENTS AND METHODS Patients with stage IIIB or IV NSCLC were prospectively enrolled if they received 1 or 2 prior chemotherapy regimens. S-1 (40-60 mg) and leucovorin (25mg) were administered together orally twice per day for 7 consecutive days followed by 7 days of rest. This 2-week cycle was repeated for a maximum of 25 cycles until the onset of disease progression or unacceptable adverse events. Endpoints included objective tumor response, progression-free survival, overall survival, and safety. RESULTS Among 33 patients, 6 (18.2%), 14 (42.4%), and 11 (33.3%) had partial response, stable disease, and progressive disease, respectively. Median progression-free and overall survival times were 3.5 and 11.7 months, respectively. The common grade 3 toxicities included stomatitis (18.2%), anorexia (12.1%), and neutropenia (9.1%). One patient had pneumatosis cystoides intestinalis, and another experienced paralytic ileus. There were no treatment-related deaths. CONCLUSIONS S-1 plus leucovorin combination therapy demonstrated promising efficacy and an acceptable toxicity profile in previously treated patients with NSCLC.
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A phase II study of S-1 chemotherapy with concurrent thoracic radiotherapy in elderly patients with locally advanced non-small-cell lung cancer: the Okayama Lung Cancer Study Group Trial 0801. Eur J Cancer 2014; 50:2783-90. [PMID: 25172295 DOI: 10.1016/j.ejca.2014.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 07/31/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although thoracic irradiation (TRT) is a standard treatment for elderly patients with locally advanced non-small-cell lung cancer (LA-NSCLC), treatment outcomes are poor. We previously reported a phase I trial combining S-1, an oral 5-fluorouracil derivative, and thoracic radiation, which yielded safe and effective outcomes. METHODS In this phase II trial, 30 patients aged 76 years or older with LA-NSCLC received S-1 (80 mg/m(2) on days 1-14 and 29-42) and TRT (60Gy). The primary end-point was the response rate. RESULTS The median age and pre-treatment Charlson score were 79 years and 1, respectively. The mean proportions of the actual doses of S-1 and TRT delivered relative to the planned doses were 95% and 98%, respectively. Partial responses were observed in 19 patients (63%; 95% confidence interval: 45-82%), which did not attain the end-point. At a median follow-up time of 23.7 months, the median progression-free survival and median survival times were 13.0 months and 27.9 months, respectively. No difference in efficacy was observed upon stratification by tumour histology. Toxicities were generally mild, except for grade 3 or greater febrile neutropenia and pneumonitis in 7% and 10% of patients, respectively. No patient developed severe oesophagitis. CONCLUSIONS Although the primary end-point was not met, concurrent S-1 chemotherapy and radiotherapy yielded favourable survival data. Also, the combined treatment was well-tolerated in elderly patients with LA-NSCLC.
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Toyokawa G, Takenoyama M, Ichinose Y. Multimodality treatment with surgery for locally advanced non-small-cell lung cancer with n2 disease: a review article. Clin Lung Cancer 2014; 16:6-14. [PMID: 25220209 DOI: 10.1016/j.cllc.2014.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/28/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
Abstract
Stage III non-small-cell lung cancer (NSCLC) is composed of a heterogeneous population of lesions (ie, T4N0-3, T3N1-3, and T1a-2aN2-3), which makes it difficult to establish a definitive treatment strategy. Although several retrospective and prospective studies have been conducted to investigate the significance of multimodality treatments with surgery for patients with resectable stage III NSCLC, the role of surgery still remains controversial. In this article, we review the results of retrospective and prospective studies that have investigated the significance of multimodality treatment with surgery for patients with stage III NSCLC, particularly those with mediastinal lymph node metastasis, and the implications for the treatment of this controversial subset of patients.
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Affiliation(s)
- Gouji Toyokawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan.
| | | | - Yukito Ichinose
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
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Novel chemoradiotherapy with concomitant boost thoracic radiation and concurrent cisplatin and vinorelbine for stage IIIA and IIIB non-small-cell lung cancer. Clin Lung Cancer 2014; 15:281-6. [PMID: 24656641 DOI: 10.1016/j.cllc.2014.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 01/29/2014] [Accepted: 02/11/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lung cancer is a leading cause of cancer death in the world. The results from concurrent chemoradiotherapy (CRT) are still disappointing, although long-term survival can be observed in certain populations of patients. Local control is a critical problem in CRT; dose escalation of thoracic radiation (TRT) in CRT has not been effective. PATIENTS AND METHODS The authors developed a novel TRT scheme of accelerated hyperfractionation using concomitant boost TRT (ccbRT). Total doses of 64 Gy and 40 Gy were given to the gross tumor volume and elective clinical target volume, respectively, for 20 working days, combined with systemic chemotherapy with cisplatin (day 1) and vinorelbine (days 1, 8) with a 3-week interval (NP regimen). The purpose of this phase II study was to evaluate the efficacy and toxicity of this novel treatment. RESULTS From July 2002 to July 2010, 56 patients were enrolled in this study. One patient was excluded from the analysis. All 55 patients completed ccbRT, and 52 patients (94.5%) underwent at least 2 cycles of NP. Grade 3 esophagitis and grade 3 radiation pneumonitis were observed in 18.2% and 3.6% of the patients. Complete response and partial response were achieved in 24.5% and 69.1% of the patients, resulting in a response rate of 93.6%. The median progression-free survival (PFS) and overall survival (OS) times were 16.7 months and 58.2 months. CONCLUSION CRT using ccbRT with concurrent NP is safe and effective for locally advanced non-small-cell lung cancer, with good PFS and excellent OS.
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Akamatsu H, Mori K, Naito T, Imai H, Ono A, Shukuya T, Taira T, Kenmotsu H, Murakami H, Endo M, Harada H, Takahashi T, Yamamoto N. Progression-free survival at 2 years is a reliable surrogate marker for the 5-year survival rate in patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy. BMC Cancer 2014; 14:18. [PMID: 24422706 PMCID: PMC3901557 DOI: 10.1186/1471-2407-14-18] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/09/2014] [Indexed: 12/04/2022] Open
Abstract
Background In locally advanced Non-Small-Cell Lung Cancer (LA-NSCLC) patients treated with chemoradiotherapy (CRT), optimal surrogate endpoint for cure has not been fully investigated. Methods The clinical records of LA-NSCLC patients treated with concurrent CRT at Shizuoka Cancer Center between Sep. 2002 and Dec. 2009 were reviewed. The primary outcome of this study was to evaluate the surrogacy of overall response rate (ORR) and progression-free survival (PFS) rate at 3-month intervals (from 9 to 30 months after the initiation of treatment) for the 5-year survival rate. Landmark analyses were performed to assess the association of these outcomes with the 5-year survival rate. Results One hundred and fifty-nine patients were eligible for this study. The median follow-up time for censored patients was 57 months. The ORR was 72%, median PFS was 12 months, and median survival time was 39 months. Kaplan-Meier curve of progression-free survival and hazard ratio of landmark analysis at each time point suggest that most progression occurred within 2 years. With regard to 5-year survival rate, patients with complete response, or partial response had a rate of 45%. Five-year survival rates of patients who were progression free at each time point (3-months intervals from 9 to 30 months) were 53%, 69%, 75%, 82%, 84%, 89%, 90%, and 90%, respectively. The rate gradually increased in accordance with progression-free interval extended, and finally reached a plateau at 24 months. Conclusions Progression-free survival at 2 years could be a reliable surrogate marker for the 5-year survival rate in LA-NSCLC patients treated with concurrent CRT.
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Affiliation(s)
- Hiroaki Akamatsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shimonagakubo, 1007 Shimonagakubo, Nagaizumi-cho Sunto-gun, Shizuoka 411-8777, Japan.
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Takayama K, Inoue K, Tokunaga S, Matsumoto T, Oshima T, Kawasaki M, Imanaga T, Kuba M, Takeshita M, Harada T, Shioyama Y, Nakanishi Y. Phase II study of concurrent thoracic radiotherapy in combination with weekly paclitaxel plus carboplatin in locally advanced non-small cell lung cancer: LOGIK0401. Cancer Chemother Pharmacol 2013; 72:1353-9. [PMID: 24166107 DOI: 10.1007/s00280-013-2335-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/06/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Concurrent chemoradiotherapy for regionally advanced stage III non-small cell lung cancer is the standard treatment method. However, the clinical implications of consolidation chemotherapy following chemoradiation have been unclear. Therefore, we conducted a phase II study of concurrent weekly carboplatin plus paclitaxel treatment in combination with radiotherapy followed by vinorelbine monotherapy. The primary endpoint was the 1-year survival rate. PATIENTS AND METHODS Chemonaive PS 0-1 patients with stage IIIA/B NSCLC were enrolled. During the concurrent chemoradiation phase, patients were treated with weekly paclitaxel 40 mg/m(2) plus carboplatin AUC 2. The primary tumor and involved nodes received 60 Gy in 2-Gy fractions over 6 weeks. During the consolidation phase, vinorelbine 25 mg/m(2) on days 1 and 8 was repeated for three cycles. RESULTS A total of 40 eligible patients (72.5 % male; median age, 63 years; range 29-74 years) were analyzed for efficacy. Squamous cell carcinoma was the most common histology (47.5 %), and more patients had clinical stage IIIB (55 %) cancer. The average radiation dose was 56.5 Gy, and the average number of carboplatin plus paclitaxel cycles was 4.93. Seventeen patients proceeded to the consolidation chemotherapy phase, and 14 completed three cycles of vinorelbine monotherapy. The objective response rate was 75.0 %, including 1 patient who achieved a complete response. Progression-free survival and overall survival (OS) were 46 weeks [95 % confidence interval (CI) 31-64 weeks] and 110 weeks (95 % CI 90-184 weeks), respectively. The OS rate at 1 and 2 years was 85.0 % (95 % CI 69.6-93.0 %) and 53.9 % (95 % CI 37.1-68.0 %), respectively. CONCLUSION Concurrent chemoradiation with weekly carboplatin and paclitaxel followed by vinorelbine consolidation is effective for stage III non-small cell lung cancer and shows a generally mild toxicity profile.
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Affiliation(s)
- Koichi Takayama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan,
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Kaira K, Tomizawa Y, Yoshino R, Yoshii A, Matsuura M, Iwasaki Y, Koga Y, Ono A, Nishioka M, Kamide Y, Hisada T, Ishizuka T, Shirai K, Ebara T, Saitoh JI, Nakano T, Sunaga N. Phase II study of oral S-1 and cisplatin with concurrent radiotherapy for locally advanced non-small-cell lung cancer. Lung Cancer 2013; 82:449-54. [PMID: 24099666 DOI: 10.1016/j.lungcan.2013.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 09/06/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the efficacy and safety of oral S-1 in combination with cisplatin and thoracic radiotherapy in patients with unresectable stage III non-small-cell lung cancer (NSCLC). METHODS AND MATERIALS S-1 (50mg/m(2)) was administered orally twice daily for 14 days, with cisplatin (40 mg/m(2)) on days 1 and 8 of each cycle every 3 weeks, for 2-4 cycles. Thoracic radiation therapy was administered in 2 Gy fractions five times weekly for a total dose of 60 Gy. The primary endpoint was the response rate, and secondary endpoints included progression-free survival, overall survival and safety. RESULTS Forty-one patients were enrolled in this study. The objective response rate was 87.8% (98% CI: 77.8-97.8%). The median progression-free survival was 467 days (15.4 months), and the median survival time was 904 days (29.7 months). The overall survival rates at 1- and 2-years were 85.7% and 52.9%, respectively. Hematological toxicities included grade 3/4 neutropenia (17%) and grade 3/4 leukopenia (27%). No grade 3 febrile neutropenia was detected, and grade 3/4 non-hematological toxicities were also mild. A grade 3 gastrointestinal hemorrhage was observed in one patient. CONCLUSIONS The combination of oral S-1 plus cisplatin with concurrent radiotherapy is a promising treatment with a high efficacy and lower toxicity in patients with locally advanced NSCLC.
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Affiliation(s)
- Kyoichi Kaira
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma 371-8511, Japan.
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Takeda K. Clinical development of S-1 for non-small cell lung cancer: a Japanese perspective. Ther Adv Med Oncol 2013; 5:301-11. [PMID: 23997830 DOI: 10.1177/1758834013500702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
For more than a decade, S-1 has been investigated aggressively against non-small cell lung cancer (NSCLC) in Japan. Recently, two randomized phase III trials of S-1 combined with cisplatin (CDDP) or carboplatin (CBDCA) compared with the standard platinum doublet chemotherapy were reported. S-1 and CDDP was noninferior to CDDP and DTX in terms of overall survival (OS) (median survival time [MST] 16.1 versus 17.1 months, respectively; hazard ratio [HR] 1.013; 96.4% confidence interval [CI] 0.837-1.227). Noninferiority of S-1 and CBDCA compared with CBDCA and paclitaxel was also confirmed for OS (MST 15.2 versus 13.3 months, respectively; HR 0.928; 99.2% CI 0.671-1.283). The noninferiority design employed an upper CI limit of HR<1.322 in the former trial and HR<1.33 in the latter. S-1 combined with CDDP or CBDCA was thought to be one of the standard platinum doublet regimens in the first-line setting for patients with advanced NSCLC in Japan. Some additional interesting phase I and II studies have been published in Japan. They include studies of S-1 as first-line chemotherapy when combined with nonplatinum agents; as second-line chemotherapy; within chemoradiotherapy for locally advanced disease; and in the postoperative adjuvant setting. This review will also describe the use of S-1 for the treatment of NSCLC in these settings.
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Affiliation(s)
- Koji Takeda
- Department of Clinical Oncology, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, 534-0021, Japan
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Yamaguchi M, Toyokawa G, Ohba T, Sasaki T, Kometani T, Hamatake M, Hirai F, Taguchi K, Yamanaka T, Seto T, Takenoyama M, Sugio K, Ichinose Y. Preoperative concurrent chemoradiotherapy of S-1/cisplatin for stage III non-small cell lung cancer. Ann Thorac Surg 2013; 96:1783-9. [PMID: 23998404 DOI: 10.1016/j.athoracsur.2013.06.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy using S-1 containing tegafur, an oral 5-FU prodrug, plus cisplatin has been reported to show promising efficacy against locally advanced non-small cell lung cancer with acceptable toxicity. The purpose of this study is to assess the impact of this induction treatment followed by surgery on survival for those patients. METHODS Potentially resectable locally advanced non-small cell lung cancer patients were eligible. The concurrent phase consisted of S-1 (orally at 40 mg/m² twice a day on days 1 to 14 and 22 to 36) and cisplatin (60 mg/m² on days 1 and 22) with radiation of 40 Gy/20 fractions beginning on day 1 followed by surgical resection. RESULTS Forty-two consecutive patients, between June 2005 and February 2011, were retrospectively analyzed. The median age was 59 (42 to 77) years, there were 34 males and 8 females, 26 cStage IIIA and 16 IIIB, each 21 adenocarcinomas and others. There were 26 partial responses and 16 stable disease cases after current induction treatment without uncontrollable toxicity. Of the 42 patients, 39 underwent surgical resection; 27 underwent a lobectomy and 12 pneumonectomies. One patient died due to thoracic empyema 65 days after surgery. The median follow-up time was 32.0 months. Three- and 5-year disease-free survival rates in all 39 resected patients were 52.0% and 44.0%, respectively, and 3- and 5-year overall survival rates were 77.4% and 61.7%, respectively. CONCLUSIONS Concurrent chemoradiotherapy using S-1 plus cisplatin followed by surgery may provide a better prognosis for locally advanced non-small cell lung cancer patients. Further prospective clinical investigation should be required.
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Affiliation(s)
- Masafumi Yamaguchi
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
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Sugawara S, Maemondo M, Tachihara M, Inoue A, Ishimoto O, Sakakibara T, Usui K, Watanabe H, Matsubara N, Watanabe K, Kanazawa K, Ishida T, Saijo Y, Nukiwa T. Randomized phase II trial of uracil/tegafur and cisplatin versus vinorelbine and cisplatin with concurrent thoracic radiotherapy for locally advanced unresectable stage III non-small-cell lung cancer: NJLCG 0601. Lung Cancer 2013; 81:91-6. [DOI: 10.1016/j.lungcan.2013.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/14/2013] [Accepted: 04/08/2013] [Indexed: 11/16/2022]
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Harada H, Nishio M, Murakami H, Ohyanagi F, Kozuka T, Ishikura S, Naito T, Kaira K, Takahashi T, Horiike A, Nishimura T, Yamamoto N. Dose-escalation study of three-dimensional conformal thoracic radiotherapy with concurrent S-1 and cisplatin for inoperable stage III non-small-cell lung cancer. Clin Lung Cancer 2013; 14:440-5. [PMID: 23540866 DOI: 10.1016/j.cllc.2013.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/31/2012] [Accepted: 01/29/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the recommended dose (RD) in concurrent conformal radiotherapy with S-1 and cisplatin chemotherapy for inoperable stage III non-small-cell lung cancer. PATIENTS AND METHODS Eligible patients with inoperable stage III non-small-cell lung cancer, age ≥ 20 years, performance status 0-1 received 4 cycles of intravenous cisplatin (60 mg/m(2), day 1) and oral S-1 (80, 100, or 120 mg based on body surface area, days 1-14) repeated every 4 weeks. Radiation doses were 66, 70, and 74 Gy for arms 1, 2, and 3, respectively. RESULTS A total of 24 patients were enrolled in our study, including 6 in arm 1, 6 in arm 2, and 12 in arm 3. The patients consisted of 14 men and 10 women, with a median age of 63 years (range, 44-73 years). The median follow-up was 27.3 months (range, 8.5-42.6 months) for all patients and 33.9 months (range, 15.2-42.6 months) for those still alive. Grade 3 febrile neutropenia, lung toxicities, and heart toxicities occurred in 2, 2, and 2 patients, respectively. Dose-limiting toxicity occurred in 2, none, and 1 patient in arms 1, 2, and 3, respectively. The median survival was not reached, and the 2-year survival rate was 70% (95% CI, 51%-89%). Two-year local relapse-free survival and distant metastasis-free survival were 74% (95% CI, 56%-92%) and 45% (95% CI, 25%-65%), respectively. CONCLUSIONS High-dose radiotherapy with S-1 and cisplatin is feasible, and 74 Gy was determined as the recommended dose.
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Affiliation(s)
- Hideyuki Harada
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
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Abstract
Over the past decade, concomitant chemotherapy and radiotherapy has become the established treatment for patients with stage III non-small-cell lung cancer (NSCLC). Unfortunately, many patients with NSCLC are too old or have multiple comorbidities to withstand such aggressive treatments. Attempts to improve outcomes have included studies of radiotherapy dose escalation and new chemotherapy combinations, as well as adding biological agents and cancer vaccines to existing regimens. Technical radiotherapy modifications, including intensity-modulated radiotherapy and particle beam therapy, have also been investigated. Given the number of potential advances to current models of treatment development, phase III trials of any single new treatment can take years to complete, which is inadequate. To advance research within shorter timescales to improve patient outcomes, we need methods of improving clinical trial accrual, which might require changes in models of research governance, cooperative group activity, trial design and patient consent.
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A phase I study of S-1 with concurrent radiotherapy in elderly patients with locally advanced non-small cell lung cancer. Invest New Drugs 2012; 31:599-604. [PMID: 22623066 DOI: 10.1007/s10637-012-9833-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A phase I study was performed to evaluate dose-limiting toxicity and the recommended dose for the oral fluoropyrimidine S-1 administered concurrently with thoracic radiotherapy (TRT) in elderly (≥ 70 years of age) patients with locally advanced non-small cell lung cancer. METHODS S-1 was administered on days 1 to 14 and 22 to 35 at oral doses of 65 or 80 mg m(-2) day(-1). TRT was administered in 2-Gy fractions five times weekly for a total dose of 60 Gy. Twelve previously untreated patients were treated with S-1 at 65 (n=6) or 80 (n=6) mg m(-2) day(-1). RESULTS All patients completed the planned 60 Gy of TRT. Dose-limiting toxicity included pneumonitis (n=2), infection (n=1), and stomatitis (n=1), each of grade 3, but each event was reversible. The recommended dose for S-1 was determined to be 80 mg m(-2) day(-1). No patient experienced toxicity of grade 4. The dose intensity of S-1 was well maintained and the combination of S-1 plus TRT was well tolerated overall. The overall response rate was 83.3 %, with a median survival time of 34.0 months. CONCLUSIONS Administration of S-1 at 80 mg m(-2) day(-1) on days 1 to 14 and 22 to 35 can be safely combined with concurrent TRT in elderly patients with locally advanced non-small cell lung cancer.
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