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Hanna N, Neubauer M, Yiannoutsos C, McGarry R, Arseneau J, Ansari R, Reynolds C, Govindan R, Melnyk A, Fisher W, Richards D, Bruetman D, Anderson T, Chowhan N, Nattam S, Mantravadi P, Johnson C, Breen T, White A, Einhorn L. Phase III study of cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel in patients with inoperable stage III non-small-cell lung cancer: the Hoosier Oncology Group and U.S. Oncology. J Clin Oncol 2008; 26:5755-60. [PMID: 19001323 DOI: 10.1200/jco.2008.17.7840] [Citation(s) in RCA: 350] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Concurrent chemoradiotherapy is standard treatment for patients with inoperable stage III non-small-cell lung cancer (NSCLC). A phase II study by the Southwest Oncology Group using consolidation docetaxel after cisplatin (P), etoposide (E), and radiation (XRT) resulted in a median survival time (MST) of 26 months. This randomized phase III trial evaluated whether consolidation docetaxel was responsible for this improved survival. PATIENTS AND METHODS Eligible patients had stage IIIA or IIIB NSCLC, baseline performance status of 0 to 1, forced expiratory volume in 1 second >or= 1 L, and less than 5% weight loss. Patients received P 50 mg/m(2) intravenously (IV) on days 1, 8, 29, and 36 and E 50 mg/m(2) IV on days 1-5 and 29-33 concurrently with chest XRT to 59.40 Gy. Patients who did not experience progression were randomly assigned to docetaxel 75 mg/m(2) IV every 21 days for three cycles versus observation. The primary end point was to compare overall survival (Kaplan-Meier analysis). RESULTS On the basis of evidence of futility, a data and safety monitoring board recommended early termination after an analysis of the initial 203 patients. Patient characteristics (n = 203) were as follows: 34% female; median age, 63 years; 39.4% stage IIIA; and 60.6% stage IIIB. One hundred forty-seven (72.4%) of 203 patients were randomly assigned to docetaxel (n = 73) or observation (n = 74). Grade 3 to 5 toxicities during docetaxel included febrile neutropenia (10.9%) and pneumonitis (9.6%); 28.8% of patients were hospitalized during docetaxel (v 8.1% in observation arm), and 5.5% died as a result of docetaxel. The MST for all patients (n = 203) was 21.7 months; MST was 21.2 months for docetaxel arm compared with 23.2 months for observation arm (P = .883). CONCLUSION Consolidation docetaxel after PE/XRT results in increased toxicities but does not further improve survival compared with PE/XRT alone in patients with stage III inoperable NSCLC.
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Affiliation(s)
- Nasser Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN 46202, USA.
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Chen C, Kane M, Song J, Campana J, Raben A, Hu K, Harrison L, Quon H, Dancey J, Baron A, Said S, Eckhardt SG, Raben D. Phase I Trial of Gefitinib in Combination With Radiation or Chemoradiation for Patients With Locally Advanced Squamous Cell Head and Neck Cancer. J Clin Oncol 2007; 25:4880-6. [DOI: 10.1200/jco.2007.12.9650] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo establish the safety and toxicity profile of daily gefitinib with radiation alone or with concurrent chemoradiotherapy in previously untreated patients with locally advanced squamous cell head and neck cancer (LAHNC).Patients and MethodsPatients with intermediate-stage LAHNC were treated with concomitant boost radiation (RT) alone with escalating doses of daily gefitinib (250 or 500 mg; cohort I). Once a safety profile was determined with RT alone, patients with high-risk disease were then treated with daily gefitinib (250 or 500 mg), weekly cisplatin (CDDP; 30 mg/m2), and once-daily RT (cohort II). Patients also received post-RT gefitinib at 250 mg daily for a period of up to 2 years.ResultsTwenty-three patients were enrolled and assessable for toxicity. No dose-limiting toxicities (DLTs) were observed in patients treated in cohort I at either 250 or 500 mg of gefitinib daily with concomitant boost RT to 72 Gy. In patients receiving chemoradiotherapy and gefitinib (cohort II), DLTs included one grade 4 diarrhea and one grade 4 neutropenic fever. Fifteen patients started maintenance gefitinib, and eight (53%) experienced grade 1 to 2 acne-like skin rash and diarrhea, but no grade 3 or 4 toxicity occurred.ConclusionGefitinib (250 or 500 mg daily) was well tolerated with concomitant boost RT or concurrent chemoradiotherapy with weekly CDDP. Protracted administration of gefitinib for up to 2 years at 250 mg daily was also tolerated well.
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Affiliation(s)
- Changhu Chen
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - Madeleine Kane
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - John Song
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - John Campana
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - Adam Raben
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - Kenneth Hu
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - Louis Harrison
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - Harry Quon
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - Janet Dancey
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - Anna Baron
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - Sherif Said
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - S. Gail Eckhardt
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
| | - David Raben
- From the Departments of Radiation Oncology, Medical Oncology, Otolaryngology, Preventive Medicine and Biometrics, and Pathology, University of Colorado, Aurora, CO; Department of Radiation Oncology, Christiana Hospital Medical Center, Wilmington, DE; Department of Radiation Oncology, Beth Israel Medical Center, New York, NY; Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia, PA; and National Cancer Institute, Bethesda, MD
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