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Sridhar A, Khan H, Yohannan B, Chan KH, Kataria N, Jafri SH. A Review of the Current Approach and Treatment Landscape for Stage III Non-Small Cell Lung Cancer. J Clin Med 2024; 13:2633. [PMID: 38731161 PMCID: PMC11084624 DOI: 10.3390/jcm13092633] [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: 03/16/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
The therapeutic landscape of the management of stage III non-small cell lung cancer (NSCLC) has drastically evolved with the incorporation of immunotherapy and targeted therapy. Stage III NSCLC accounts for one-third of the cases and the treatment strategy of these locally advanced presentations are diverse, ranging from surgical to non-surgical options; with the incorporation of chemo-immunotherapy, radiation, and targeted therapies wherever applicable. The staging of this disease has also changed, and it is essential to have a strong multidisciplinary approach to do justice to patient care. In this article, we aim to navigate the nuanced approaches in the diagnosis and treatment of stage III NSCLC and expand on the evolution of the management of this disease.
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Affiliation(s)
- Arthi Sridhar
- Department of Oncology, Mayo Clinic, Rochester, MN 55901, USA
| | - Hina Khan
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Binoy Yohannan
- Department of Hematology, Mayo Clinic, Rochester, MN 55901, USA
| | - Kok Hoe Chan
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Nilansh Kataria
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA;
| | - Syed Hasan Jafri
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
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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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Zhao Y, Feng H, Tian J, Li B, Wang C, Ge L, Wang JK, Yang K, Yu Q. Consolidation treatments after chemoradiotherapy in patients with locally advanced inoperable non-small cell lung cancer: a systematic review and network meta-analysis protocol. BMJ Open 2022; 12:e060900. [PMID: 35414564 PMCID: PMC9006802 DOI: 10.1136/bmjopen-2022-060900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Concurrent chemoradiotherapy (CCRT) is the standard of care for inoperable locally advanced non-small cell lung cancer. To further improve prognosis, the use of consolidation treatments after CCRT has been explored extensively. Although durvalumab is the only consolidation treatment recommended by national clinical practice guidelines, there have been many studies exploring the effectiveness of other agents. However, until now, no studies have compared all agents systematically, and no studies have provided evidence for the optimal combination of different CCRTs and consolidation treatments regimens. This systematic review will evaluate the comparative clinical efficacy of consolidation therapies after CCRT as well as various combinations of CCRTs and consolidation therapies. METHODS AND ANALYSIS PubMed, the Cochrane Controlled Register of Trials (CENTRAL), EMBASE and ClinicalTrials.gov will be searched for relevant information. The estimated end date for the search will be 3 February 2022. Each stage of the review, including the study section, data extraction and risk of bias and quality of evidence assessments, will be performed in duplicate. We will include randomised controlled trials that included participants who received CCRT and consolidation treatment in at least one treatment arm. The primary endpoints will be overall survival and progression-free survival. Tumour response, health-related quality of life, disease-free survival and treatment-related toxicity will be presented as secondary outcomes. Both traditional meta-analysis and network meta-analysis (NMA) with the Bayesian approach will be conducted. Subgroup analyses and meta-regression will be completed to investigate heterogeneity, and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION Ethical approval and patient consent are not required as this study is a meta-analysis based on published studies. The results of this study will be submitted to a peer-reviewed journal for publication. In case of any changes in the protocol, protocol amendments will be updated in PROSPERO and explanations of these modifications will be described in the final report of this review. The results of this systematic review and NMA will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021239433.
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Affiliation(s)
- Ye Zhao
- First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Haiming Feng
- Department of Thoracic Surgery, The Second Affiliated Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu, China
| | - Jinhui Tian
- Evidence Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Bin Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu, China
| | - Cheng Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Lanzhou University, Lanzhou University, Lanzhou, Gansu, China
| | - Long Ge
- Evidence Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Jian Kai Wang
- Department of Radiotherapy, Gansu Province People's Hospital, Lanzhou, Gansu, China
| | - Kehu Yang
- Evidence Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Qin Yu
- First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
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Wang D, Qiu B, He H, Yin S, Peng K, Hu N, Guo J, Li Q, Chen N, Chu C, Liu F, Xie CM, Liu H. Tumor response evaluation by combined modalities of chest magnetic resonance imaging and computed tomography in locally advanced non-small cell lung cancer after concurrent chemoradiotherapy. Radiother Oncol 2022; 168:211-220. [DOI: 10.1016/j.radonc.2022.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022]
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Clinical outcome and side effects of concomitant chemoradiotherapy in the treatment of locally advanced inoperable non-small cell lung cancer: Our experiences. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp210102038r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background/Aim. About 1.8 million new lung cancer cases are diagnosed worldwide every year, and about 1.6 million cases have a fatal outcome. Despite improvements in treatment in the previous decades, the survival of patients with lung cancer is still poor. The five-year survival rate is about 50% for patients with localized disease, 20% for patients with regionally advanced disease, 2% for patients with metastatic disease, and about 14% for all stages. The median survival of patients with untreated non-small cell lung carcinoma (NSCLC) in the advanced stage is four to five months, and the annual survival rate is only 10%. The aim of the study was to determine the results of treatment with concomitant chemoradiotherapy (CHRT) in terms of efficacy and toxicity in selected patients with advanced inoperable NSCLC. Methods. The study included data analysis of 31 patients of both sexes who were diagnosed and histopathologically verified with NSCLC in inoperable stage III and were referred by the Council for Malignant Lung Diseases to the Radiotherapy Department of the Military Medical Academy in Belgrade, Serbia for concomitant CHRT treatment. Upon expiry of the three months from the performed radiation treatment (RT), the tumor resonance was assessed based on multislice computed tomography (MSCT) examination of the chest and upper abdomen according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. According to the same criteria, progression-free survival (PFS), as well as overall survival (OS), was assessed every three months during the first two years, then every 6 months or until the onset of disease symptoms. Results. The median PFS was 13 months, and the median OS was 20 months. During and immediately after RT, 9 (29%) patients had a grade 2 or higher adverse events. Conclusion. The use of concomitant CHRT in patients in the third stage of locally advanced inoperable NSCLC provides a good opportunity for a favorable therapeutic outcome with an acceptable degree of acute and late toxicity and represents the standard therapeutic approach for selected patients in this stage of the disease.
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Yuan M, Zhai Y, Men Y, Wang J, Deng L, Wang W, Bao Y, Yang X, Sun S, Ma Z, Liu Y, Wang J, Zhu H, Hui Z. Endostar (rh-endostatin) improves efficacy of concurrent chemoradiotherapy for locally advanced non-small cell lung cancer: A systematic review and meta-analysis. Thorac Cancer 2021; 12:3208-3215. [PMID: 34676669 PMCID: PMC8636201 DOI: 10.1111/1759-7714.14188] [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: 09/20/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We aimed to clarify the benefits of the addition of rh-endostatin into concurrent chemoradiotherapy (CCRT) versus CCRT alone for locally advanced non-small cell lung cancer (NSCLC) by a meta-analysis. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials, Wanfang and Chinese National Knowledge Infrastructure (CNKI) were systematically screened from inception to November 2020 using the prespecified terms. Prospective trials (evaluating or) comparing the efficacy of endostar combined with CCRT and CCRT for locally advanced NSCLC were included. The primary endpoints were risk ratios (RRs) for objective response rate (ORR) and disease control rate (DCR). The secondary endpoints were RRs for overall survival (OS) and adverse events (AEs). RESULTS Ten studies with 716 patients were included in this meta-analysis. Endostar combined with CCRT significantly improved ORR and DCR compared with CCRT. The RRs of ORR and DCR for endostar combined with CCRT versus CCRT were 1.263 (95% CI: 1.137-1.403, p < 0.001) and 1.274 (95% CI: 1.124-1.444, p < 0.001), respectively. Endostar combined with CCRT significantly improved one-year survival rate compared with CCRT with pooled RR = 1.113 (95% CI: 1.006-1.231, p = 0.038). Endostar combination treatments had similar incidences of main adverse events compared with CCRT (p > 0.05). CONCLUSION Endostar combined with CCRT is associated with significantly higher ORR, DCR and survival rate than CCRT with similar incidences of main adverse events in NSCLC.
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Affiliation(s)
- Meng Yuan
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Men
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongxing Bao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeliang Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunsong Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kozono DE, Stinchcombe TE, Salama JK, Bogart J, Petty WJ, Guarino MJ, Bazhenova L, Larner JM, Weiss J, DiPetrillo TA, Feigenberg SJ, Chen X, Sun Z, Nuthalapati S, Rosenwinkel L, Johnson EF, Bach BA, Luo Y, Vokes EE. Veliparib in combination with carboplatin/paclitaxel-based chemoradiotherapy in patients with stage III non-small cell lung cancer. Lung Cancer 2021; 159:56-65. [PMID: 34311345 DOI: 10.1016/j.lungcan.2021.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/10/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Veliparib is a potent poly(ADP)-ribose polymerase (PARP) 1 and 2 inhibitor that impedes repair of DNA damage induced by cytotoxic and radiation therapies. This phase 1 study evaluated veliparib in combination with chemoradiotherapy in patients with unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients received veliparib orally twice daily (BID) in escalating doses (60-240 mg, Day -3 to 1 day after last dose of radiation) combined with weekly carboplatin (area under the curve [AUC] 2 mg/mL/min), paclitaxel (45 mg/m2), and daily radiation therapy (60 Gy in 30 fractions), followed by two cycles of veliparib (120-240 mg BID, Days -2 through 5 of each 21-day cycle), carboplatin (AUC 6 mg/mL/min, Day 1 of each cycle), and paclitaxel (200 mg/m2, Day 1 of each cycle) consolidation. Endpoints included veliparib maximum tolerated dose (MTD), recommended phase 2 dose (RP2D), pharmacokinetics, safety, and efficacy. RESULTS Forty-eight patients were enrolled. The MTD/RP2D of veliparib was 240 mg BID with chemoradiotherapy followed by 120 mg BID with consolidation. The most common any-grade adverse events (AEs) in this cohort for the whole treatment period were nausea (83%), esophagitis (75%), neutropenia (75%), and thrombocytopenia (75%). Dose-proportional pharmacokinetics of veliparib were observed. Median progression-free survival (mPFS) was 19.6 months (95% CI: 9.7-32.6). Median overall survival was estimated to be 32.6 months (95% CI: 15.0-not reached). In patients treated with the RP2D, mPFS was 19.6 months (95% CI: 3.0-not reached). CONCLUSIONS When combined with standard concurrent chemoradiotherapy and consolidation chemotherapy in patients with stage III NSCLC, veliparib demonstrated an acceptable safety profile and antitumor activity with an mPFS of 19.6 months.
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Affiliation(s)
- David E Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
| | - Thomas E Stinchcombe
- Duke Cancer Institute, Durham, 2 Seeley Mudd, 10 Bryan Searle Drive, Durham, NC 27710, USA.
| | - Joseph K Salama
- Duke Cancer Institute, Durham, 2 Seeley Mudd, 10 Bryan Searle Drive, Durham, NC 27710, USA.
| | - Jeffrey Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
| | - W Jeffrey Petty
- Department of Hematology and Oncology, Wake Forest School of Medicine, Bowman Gray Center for Medical Education, 475 Vine Street, Winston-Salem, NC 27101, USA.
| | - Michael J Guarino
- Christiana Care Health System, Helen F Graham Cancer Center, 4701 Ogletown Stanton Road, Suite 3400, Newark, DE 19713, USA.
| | - Lyudmila Bazhenova
- Department of Medicine, Moores Cancer Center, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - James M Larner
- University of Virginia, Emily Couric Clinical Cancer Center, 1240 Lee Street, Charlottesville, VA 22903, USA.
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center at the University of North Carolina, Cancer Hospital, 101 Manning Drive, Chapel Hill, NC 27514, USA.
| | - Thomas A DiPetrillo
- Department of Radiation Oncology, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
| | - Steven J Feigenberg
- Greenebaum Comprehensive Cancer Center, University of Maryland, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Xin Chen
- Data and Statistical Sciences, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Zhaowen Sun
- Data and Statistical Sciences, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Silpa Nuthalapati
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Lindsey Rosenwinkel
- Global Pharmaceutical R&D, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Eric F Johnson
- Oncology Early Development, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Bruce A Bach
- Oncology Development, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Yan Luo
- Oncology Development, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Everett E Vokes
- Department of Medicine, University of Chicago, 5801 South Ellis Avenue, Chicago, IL 60637, USA.
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Abstract
Horner syndrome is an uncommon but important clinical entity, representing interruption of the sympathetic pathway to the eye and face. Horner syndrome is almost always diagnosed clinically, though pharmacological testing can be used to confirm the diagnosis. Imaging modalities such as PET, CT and MRI are important components of work-up for patients presenting with acquired Horner syndrome. Our patient's presentation with Horner syndrome unmasked the causative superior sulcus squamous cell carcinoma and a coincidental lower lobe adenocarcinoma. Successful radical treatment of these cancers resulted in complete resolution of the syndrome and disease-free survival at 18 months. We review the anatomy and pathophysiology underlying this and other causes of Horner syndrome.
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Affiliation(s)
- Yu X Kong
- Cardiothoracic Care Centre, Fitzroy, Victoria, Australia
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Zhai Y, Ma H, Hui Z, Zhao L, Li D, Liang J, Wang X, Xu L, Chen B, Tang Y, Wu R, Xu Y, Pang Q, Chen M, Wang L. HELPER study: A phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment of unresectable stage III non-small-cell lung cancer. Radiother Oncol 2018; 131:27-34. [PMID: 30773184 DOI: 10.1016/j.radonc.2018.10.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 09/30/2018] [Accepted: 10/25/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE The prognosis of unresectable stage III non-small cell lung cancer (NSCLC) was poor even after concurrent chemoradiotherapy. There remains a great need to develop novel therapeutic agents in combination with CCRT to improve outcomes. This prospective study sought to evaluate the efficacy and toxicities of the addition of endostar, an anti-angiogenesis agent, to concurrent etoposide, cisplatin (EP) and radiotherapy for treatment of patients with NSCLC. PATIENTS AND METHODS Patients with untreated pathologically confirmed inoperable stage III NSCLC were eligible. Radiation at doses of 60-66 Gy, four cycles of endostar (7.5 mg/m2/24 h × 120 h, 14 days/cycle), and two cycles of EP (etoposide 50 mg/m2 on days 1-5 and cisplatin 50 mg/m2 on days 1 and 8, 28 days/cycle) were delivered. The primary endpoint was progression-free survival (PFS). The secondary endpoints were response rate and overall survival (OS), locoregional relapse-free survival (LRFS) distant metastasis-free survival (DMFS) and adverse events (AE). RESULTS From November 2012 to June 2015, 73 patients were enrolled, and 67 patients were evaluable. The median age was 59 years. Sixty-six percent of the patients had squamous cell carcinoma. Grade ≥3 AEs occurred in 58.2% of the patients. The most common Grade ≥3 AE was leucopenia (44.8%). The response rate was 76.1%. The median times of PFS and OS were 13.3 months and 34.7 months, respectively. The 2-year PFS, OS, LRFS and DMFS rates were 34.8%, 59.9%, 54.7% and 68.5%, respectively. CONCLUSIONS For patients with unresectable stage III NSCLC, continuous intravenous endostar in combination with concurrent EP and radiotherapy did not prolong median PFS, although it got preferable OS, promising 2-year PFS with tolerable toxicities.
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Affiliation(s)
- Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Honglian Ma
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of VIP Medical Services, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Cancer Hospital, China
| | - Dongming Li
- Department of Radiation Oncology, Beijing Cancer Hospital, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaozhen Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liming Xu
- Department of Radiation Oncology, Tianjin Cancer Hospital, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujin Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qingsong Pang
- Department of Radiation Oncology, Tianjin Cancer Hospital, China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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10
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Immune Checkpoint Inhibitors in Early-Stage and Locally Advanced Non-Small Cell Lung Cancer. Curr Treat Options Oncol 2018; 19:39. [PMID: 29931587 DOI: 10.1007/s11864-018-0556-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OPINION STATEMENT Surgical resection ± chemotherapy ± radiation or stereotactic body radiation therapy (SBRT) are established treatment modalities for resectable stage non-small cell lung cancer (NSCLC), and concurrent chemotherapy with radiation is the therapy of choice for unresectable locally advanced disease. Despite treatment with curative intent, most patients subsequently relapse and develop distant disease. Treatment with checkpoint inhibitors represents a major advancement in the treatment of metastatic NSCLC. Therapy against programed cell death-1/programmed cell death ligand 1 (PD-1/PD-L1) is associated with a significant improvement in overall survival in stage IV disease, and these results have led to a great interest in evaluating these agents in earlier-stage NSCLC. The preliminary data from ongoing trials suggest that the integration of checkpoint blockage into the treatment of early-stage and locally advanced NSCLC is safe, tolerable, and has the potential to improve outcomes without adding substantial toxicity. In the current review, we provide an overview of the emerging data on the role of PD-1/PD-L1 and cytotoxic T lymphocyte-associated protein 4 (CTLA-4) inhibitors in the treatment of early-stage and locally advanced NSCLC, with a focus on ongoing clinical trials and combination strategies.
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Shafique MR, Robinson LA, Antonia S. Durvalumab: a potential maintenance therapy in surgery-ineligible non-small-cell lung cancer. Cancer Manag Res 2018; 10:931-940. [PMID: 29760563 PMCID: PMC5937504 DOI: 10.2147/cmar.s148009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is the most common cancer worldwide and the most common cause of cancer-related death. Non-small-cell lung cancer comprises ~87% of newly diagnosed cases of lung cancer, and nearly one-third of these patients have stage III disease. Despite improvements in the treatment of stage IV lung cancer, particularly with the introduction and dissemination of checkpoint inhibitors, very little progress has been made in the treatment of stage III lung cancer. In this article, we discuss the general staging criteria and treatment options for stage III lung cancer. We review how concurrent radiation and chemotherapy can have immunomodulatory effects, supporting the rationale for incorporating immunotherapy into existing treatment paradigms. Finally, we discuss the results of the PACIFIC trial and implications for the treatment of stage III lung cancer. In the PACIFIC trial, adding durvalumab as a maintenance therapy following the completion of chemoradiotherapy improved progression-free survival in patients with locally advanced unresectable stage III lung cancer. On the strength of these results, durvalumab has been approved by the US Food and Drug Administration for use in this setting, representing the first advance in the treatment of stage III lung cancer in nearly a decade.
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Affiliation(s)
- Michael R Shafique
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lary A Robinson
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Scott Antonia
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Skrzypski M, Jassem J. Consolidation systemic treatment after radiochemotherapy for unresectable stage III non-small cell lung cancer. Cancer Treat Rev 2018; 66:114-121. [DOI: 10.1016/j.ctrv.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/02/2018] [Indexed: 12/22/2022]
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13
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Zhang TW, Rodrigues GB, Louie AV, Palma D, Dar AR, Dingle B, Kocha W, Sanatani M, Yaremko B, Yu E, Younus J, Vincent MD. Phase I study of concurrent and consolidation cisplatin and docetaxel chemotherapy with thoracic radiotherapy in non-small cell lung cancer. CURRENT ONCOLOGY (TORONTO, ONT.) 2018; 25:22-31. [PMID: 29507480 DOI: 10.347/co.25.3657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background We designed a phase i study of concurrent chemoradiotherapy (ccrt) with docetaxel (D) and cisplatin (C), followed by consolidation dc, for unresectable stage iii non-small cell lung cancer (nsclc). Methods Patients with histologically proven and unresectable stage iii nsclc were eligible. During ccrt, C was given every 3 weeks (75 mg/m2) and D given weekly. The starting dose of D was 20 mg/m2, escalated in cohorts of 3 to define the maximum tolerated dose (mtd). Radiotherapy was prescribed to a dose of 60 Gy in 30 fractions. This was followed by 2 cycles of consolidation dc, which were dose escalated if ccrt was tolerated. Results Twenty-six patients were enrolled, with 1 excluded following evidence of metastatic disease. Nineteen patients completed both phases of treatment. There were 7 grade 3 events during ccrt (5 esophagitis, 2 nausea), and 8 grade 3 events during consolidation (2 neutropenia, 2 leukopenia, 1 esophagitis, 2 nausea, and 1 pneumonitis). Three patients had grade 4 neutropenia. No patients died due to toxicities. The mtd of concurrent weekly D was 20 mg/m2. Consolidation D and C were each dose escalated to 75 mg/m2 in 8 patients. The median overall survival (os) and progression-free survival (pfs) of all patients were 33.6 months and 17.2 months, respectively, with median follow-up of 26.6 months (range 0.43-110.8). Conclusions The use of docetaxel 20 mg/m2 weekly and cisplatin 75 mg/m2 every 3 weeks concurrent with thoracic radiotherapy, followed by consolidation docetaxel and cisplatin, both given at 75 mg/m2 every 3 weeks, appears to be safe in this phase i trial.
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Affiliation(s)
- T W Zhang
- Department of Oncology, London Regional Cancer Program, London, ON
| | - G B Rodrigues
- Department of Oncology, London Regional Cancer Program, London, ON
| | - A V Louie
- Department of Oncology, London Regional Cancer Program, London, ON
| | - D Palma
- Department of Oncology, London Regional Cancer Program, London, ON
| | - A R Dar
- Department of Oncology, London Regional Cancer Program, London, ON
| | - B Dingle
- Department of Oncology, London Regional Cancer Program, London, ON
| | - W Kocha
- Department of Oncology, London Regional Cancer Program, London, ON
| | - M Sanatani
- Department of Oncology, London Regional Cancer Program, London, ON
| | - B Yaremko
- Department of Oncology, London Regional Cancer Program, London, ON
| | - E Yu
- Department of Oncology, London Regional Cancer Program, London, ON
| | - J Younus
- Department of Oncology, London Regional Cancer Program, London, ON
| | - M D Vincent
- Department of Oncology, London Regional Cancer Program, London, ON
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Hughes BG, Ahern E, Lehman M, Pratt G, Dauth M, Pritchard W, Wockner L, Horwood K. Concurrent chemoradiation with cisplatin and vinorelbine followed by consolidation with oral vinorelbine in locally advanced non-small cell lung cancer (NSCLC): the phase II CONCAVE study. Asia Pac J Clin Oncol 2017; 13:137-144. [PMID: 28181415 DOI: 10.1111/ajco.12649] [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: 04/05/2016] [Revised: 08/19/2016] [Accepted: 09/06/2016] [Indexed: 12/28/2022]
Abstract
AIM Despite recent advances, outcomes for patients with stage III non-small cell lung cancer (NSCLC) with concurrent chemoradiotherapy (CRT) remain poor. We evaluated the combination of ciplatin/vinorelbine and concurrent thoracic radiotherapy followed by consolidation oral vinorelbine in this phase II study. METHODS Eligible patients with unresectable stage III NSCLC received cisplatin intravenous (IV) 40 mg/m2 and vinorelbine IV 20 mg/m2 on days 1, 8, 22 and 29 concurrent with thoracic radiotherapy of 60 Gy in 30 fractions. Four to eight weeks later, oral vinorelbine 60 mg/m2 day 1 and 8 every 3 weeks was given for 3 cycles. The primary end point was overall response rate (ORR). Secondary end points were safety, quality of life, progression-free survival (PFS) and overall survival (OS). RESULTS Twenty-seven eligible patients were enrolled from December 2007 to June 2010 before the trial was prematurely closed due to toxicity concerns. The median age was 63 years (range, 42-71), 56% were male, 52% ECOG 0 and 52% stage IIIa. The ORR was 81% (including 37% complete response rate) and disease control rate of 93%. The median PFS was 11 months and median OS was 26 months. Consolidation vinorelbine was associated with significant grade 3/4 toxicity (68%) including grade 3-5 febrile neutropenia (27%) and respiratory infections (36%) including two deaths in the consolidation phase (9%). CONCLUSIONS Consolidation oral vinorelbine after CRT was associated with significant toxicity. Overall, this regimen achieved a high ORR and survival results comparable to other CRT protocols but the significant toxicity precludes further evaluation of this approach.
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Affiliation(s)
- Brett Gm Hughes
- Cancer Care Services, The Royal Brisbane and Women's Hospital, Queensland, Australia.,School of Medicine, University of Queensland, Queensland, Australia
| | - Elizabeth Ahern
- Cancer Care Services, The Royal Brisbane and Women's Hospital, Queensland, Australia.,School of Medicine, University of Queensland, Queensland, Australia.,Queensland Institute of Medical Research, Queensland, Australia
| | - Margot Lehman
- School of Medicine, University of Queensland, Queensland, Australia.,Cancer Care Services, The Princess Alexandra Hospital, Queensland, Australia
| | - Gary Pratt
- Cancer Care Services, The Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Margaret Dauth
- Respiratory Medicine, The Princess Alexandra Hospital, Queensland, Australia
| | - Wendy Pritchard
- Cancer Care Services, The Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Leesa Wockner
- Queensland Institute of Medical Research, Queensland, Australia
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Wang X, Ding X, Kong D, Zhang L, Guo Y, Ren J, Hu X, Yang J, Gao S. The effect of consolidation chemotherapy after concurrent chemoradiotherapy on the survival of patients with locally advanced non-small cell lung cancer: a meta-analysis. Int J Clin Oncol 2016; 22:229-236. [DOI: 10.1007/s10147-016-1074-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 12/06/2016] [Indexed: 12/28/2022]
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Zhou Q, Wu YL. Developing CSCO Lung Cancer Practice Guidelines Stratified by Resource Availability and Treatment Value. J Glob Oncol 2016; 3:285-288. [PMID: 28831436 PMCID: PMC5560461 DOI: 10.1200/jgo.2016.006734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
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Liu L, Bi N, Ji Z, Li J, Wang J, Wang X, Hui Z, Lv J, Liang J, Zhou Z, Wang Y, Yin W, Wang L. Consolidation chemotherapy may improve survival for patients with locally advanced non-small-cell lung cancer receiving concurrent chemoradiotherapy--retrospective analysis of 203 cases. BMC Cancer 2015; 15:715. [PMID: 26474893 PMCID: PMC4609086 DOI: 10.1186/s12885-015-1710-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 10/08/2015] [Indexed: 12/25/2022] Open
Abstract
Background For patients with locally advanced non-small-cell lung cancer (LA-NSCLC), the role of consolidation chemotherapy (CCT) following concurrent chemoradiotherapy (CRT) is partially defined. The aim of this study was to evaluate the efficacy and toxicity of CCT. Methods The characteristics of LA-NSCLC patients treated with curative concurrent CRT from 2001 to 2010 were retrospectively reviewed. Results Among 203 patients, 113 (55.7 %) patients received CCT. The median number of delivered CCT was 3 and 89.4 % patients completed ≥2 cycles. The OS was significantly better for patients in the CCT group compared with that in the non-CCT group (median OS, 27 months vs. 16 months; 5-year OS, 30.4 % vs. 22.5 %; p = 0.012). The median PFS were 12 months in the CCT group and 9 months in the non-CCT group (p = 0.291). The survival advantages of CCT were significant for males (HR: 0.63; 95 % CI, 0.44 − 0.90), patients with age < 60 years (HR: 0.63; 95 % CI, 0.42 − 0.95), non-squamous histology (HR: 0.44; 95 % CI, 0.25 − 0.76), pretreatment KPS ≥ 80 (HR: 0.67; 95 % CI, 0.48 − 0.93), stage IIIb (HR: 0.64; 95 % CI, 0.43 − 0.95), stable disease (HR: 0.31; 95 % CI, 0.14 − 0.65) and radiotherapy dose ≥ 60 Gy (HR: 0.69; 95 % CI, 0.48 − 1.00). There was no significant difference between the CCT group and the non-CCT group regarding treatment-related toxicities. Conclusions CCT might further prolong survival compared with CRT alone for LA-NSCLC without increasing treatment-related toxicities, especially for males, patients with age < 60 years, non-squamous histology, pretreatment KPS ≥ 80, stage IIIb, stable disease and radiotherapy dose ≥ 60 Gy. Large size prospective investigations that incorporate patient characteristics and treatment response are warranted to validate our findings. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1710-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lipin Liu
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Nan Bi
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Zhe Ji
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Junling Li
- Department of Medical Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Jingbo Wang
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Xiaozhen Wang
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Zhouguang Hui
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Jima Lv
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Jun Liang
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Zongmei Zhou
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Yan Wang
- Department of Medical Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Weibo Yin
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Luhua Wang
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
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Wozniak AJ, Moon J, Thomas CR, Kelly K, Mack PC, Gaspar LE, Raben D, Fitzgerald TJ, Pandya KJ, Gandara DR. A Pilot Trial of Cisplatin/Etoposide/Radiotherapy Followed by Consolidation Docetaxel and the Combination of Bevacizumab (NSC-704865) in Patients With Inoperable Locally Advanced Stage III Non-Small-Cell Lung Cancer: SWOG S0533. Clin Lung Cancer 2015; 16:340-7. [PMID: 25703100 PMCID: PMC4497941 DOI: 10.1016/j.cllc.2014.12.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/31/2014] [Accepted: 12/31/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of this trial was to determine feasibility of incorporating bevacizumab (B) into concurrent chemoradiotherapy (CRT) for locally advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with unresectable stage III NSCLC, performance status of 0 to 1, and adequate organ function were accrued in 2 strata, low- and high-risk (squamous histology, hemoptysis, tumor with cavitation and/or adjacent to a major vessel). Cohort 1 patients received cisplatin 50 mg/m(2) days (d) 1 and 8, etoposide 50 mg/m(2) (d 1-5) for 2 cycles concurrent with radiotherapy (64.8 Gy) followed by docetaxel (D) 75 mg/m(2) and B 15 mg/kg for 3 cycles. If safety was established, then accrual would continue to cohort 2 (B, d 15, 36, 57) and then subsequently to cohort 3 (B, d 1, 22, 43). RESULTS Twenty-nine patients (17 low- and 12 high-risk) registered to cohort 1. Twenty-six patients (including 4 squamous, 1 adenosquamous) were assessable. Twenty-five completed CRT. Grade 3/4 toxicities during CRT included acceptable rates of hematologic toxicity, esophagitis, and pneumonitis. Of 21 assessable for safety with D/B consolidation, major adverse events were pneumonitis (2 Grade 3) and 2 episodes of fatal hemoptysis in the high-risk group, resulting in closure of this stratum. The low-risk stratum subsequently closed because of slow accrual. Median overall survival was 46 months for low-risk and 17 months for high-risk strata. CONCLUSION Bevacizumab was not safely integrated into CRT for stage III NSCLC in patients considered at high risk for hemoptysis. In lower risk patients, data are insufficient to determine safety or efficacy.
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Affiliation(s)
| | | | - Charles R Thomas
- Oregon Health and Sciences University/Knight Cancer Institute, Portland, OR
| | - Karen Kelly
- University of California at Davis, Sacramento, CA
| | | | | | - David Raben
- University of Colorado School of Medicine, Aurora, CO
| | | | - Kishan J Pandya
- University of Rochester/James P. Wilmot Cancer Center, Rochester, NY
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Intratumoral chemotherapy with paclitaxel liposome combined with systemic chemotherapy: a new method of neoadjuvant chemotherapy for stage III unresectable non-small cell lung cancer. Med Oncol 2014; 32:345. [DOI: 10.1007/s12032-014-0345-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/09/2014] [Indexed: 12/19/2022]
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20
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Kerner GSMA, van Dullemen LFA, Wiegman EM, Widder J, Blokzijl E, Driever EM, van Putten JWG, Liesker JJW, Renkema TEJ, Pieterman RM, Mertens MJF, Hiltermann TJN, Groen HJM. Concurrent gemcitabine and 3D radiotherapy in patients with stage III unresectable non-small cell lung cancer. Radiat Oncol 2014; 9:190. [PMID: 25174943 PMCID: PMC4262382 DOI: 10.1186/1748-717x-9-190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 08/16/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stage III unresectable non-small cell lung cancer (NSCLC) is preferably treated with concurrent schedules of chemoradiotherapy, but none is clearly superior Gemcitabine is a radiosensitizing cytotoxic drug that has been studied in phase 1 and 2 studies in this setting. The aim of this study was to describe outcome and toxicity of low-dose weekly gemcitabine combined with concurrent 3-dimensional conformal radiotherapy (3D-CRT). PATIENTS & METHODS Treatment consisted of two cycles of a cisplatin and gemcitabine followed by weekly gemcitabine 300 mg/m2 during 5 weeks of 3D-CRT, 60 Gy in 5 weeks (hypofractionated-accelerated). Overall survival (OS), progression-free survival (PFS), and treatment related toxicity according to Common Toxicity Criteria of Adverse Events (CTCAE) version 3.0 were assessed. RESULTS Between February 2002 and August 2008, 318 patients were treated. Median age was 64 years (range 36-86); 72% were male, WHO PS 0/1/2 was 44/53/3%. Median PFS was 15.5 months (95% confidence interval [CI], 12.9-18.1) and median OS was 24.6 months (95% CI., 21.0-28.1). Main toxicity (CTCAE grade ≥3) was dysphagia (12.6%), esophagitis (9.6%), followed by radiation pneumonitis (3.0%). There were five treatment related deaths (1.6%), two due to esophagitis and three due to radiation pneumonitis. CONCLUSION Concurrent low-dose gemcitabine and 3D-CRT provides a comparable survival and toxicity profile to other available treatment schemes for unresectable stage III.
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Affiliation(s)
- Gerald S M A Kerner
- University of Groningen and Department of Pulmonary Diseases, University Medical Center Groningen, Hanzeplein 1, P,O, Box 30,001, Groningen 9700 RB, The Netherlands.
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Koshy M, Malik R, Sher DJ, Spiotto M, Mahmood U, Aydogan B, Weichselbaum RR. The effect of radiotherapy dose on survival in stage III non-small-cell lung cancer patients undergoing definitive chemoradiotherapy. Clin Lung Cancer 2014; 15:365-71. [PMID: 24984565 DOI: 10.1016/j.cllc.2014.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/07/2014] [Accepted: 05/19/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND In this study, we examined trends in the radiotherapy dose prescribed and the effect of dose escalation on survival in patients with stage III lung cancer. MATERIALS AND METHODS Radiation dose prescription patterns were analyzed for 38,848 patients in the National Cancer Database with clinical stage III disease who underwent concurrent chemoradiation between 2004 and 2011 to a dose between 57 and 80 Gy. Survival information was available for patients diagnosed from 2004 to 2006 (n = 12,024). Overall survival (OS) was estimated using Kaplan-Meier methods. Cox proportional hazard regression was used to estimate hazard ratios (HRs). RESULTS The percentage of patients treated to ≥ 64 Gy increased from 50% in 2004 to 62% in 2011 (P < .001). The 5-year OS was 12% for patients treated between 57 and 59.3 Gy, 14% for patients treated at 59.4 to 62.9 Gy, 16% for patients treated at 63 to 66 Gy and 66.1 to 73.9 Gy, and 13% for patients treated at 74 to 80 Gy (P < .0001). In multivariate analysis, the estimated HR (95% confidence interval) was 1.3 (1.1-1.6) for 57 to 59.3 Gy, 1.0 (0.9-1.2) for 59.4 to 62.9 Gy, 0.9 (0.9-1.2) for 63 to 66 Gy, 0.9 (0.8-1.1) for 66.1 to 73.9 Gy, and 1.0 (referent) for the 74 to 80 Gy cohort. There was no significant difference in the HR for the dose groups > 59.4 Gy compared with the 74 to 80 Gy cohort. CONCLUSION There was no improvement in OS with radiotherapy dose escalation beyond 59.4 Gy for patients with unresectable clinical stage III lung cancer treated with chemoradiation.
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Affiliation(s)
- Matthew Koshy
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL.
| | - Renu Malik
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - David J Sher
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
| | - Michael Spiotto
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Usama Mahmood
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Bulent Aydogan
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Ralph R Weichselbaum
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
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Arslan D, Bozcuk H, Gunduz S, Tural D, Tattli AM, Uysal M, Goksu SS, Bassorgun CI, Koral L, Coskun HS, Ozdogan M, Savas B. Survival Results and Prognostic Factors in T4 N0-3 Non-small Cell Lung Cancer Patients According to the AJCC 7thEdition Staging System. Asian Pac J Cancer Prev 2014; 15:2465-72. [DOI: 10.7314/apjcp.2014.15.6.2465] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Russell K, Healy B, Pantarotto J, Laurie SA, MacRae R, Sabri E, Wheatley-Price P. Prognostic factors in the radical nonsurgical treatment of stage IIIB non-small-cell lung cancer. Clin Lung Cancer 2013; 15:237-43. [PMID: 24461300 DOI: 10.1016/j.cllc.2013.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/21/2013] [Accepted: 12/23/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many patients diagnosed with stage IIIB (AJCC sixth edition; T4, N3, or both; no pleural effusion) non-small-cell lung cancer (NSCLC) are treated with curative intent, despite a low cure rate. Guidelines are required to help select patients for radical therapy so that the patients with little chance of cure may be spared the toxicities of aggressive treatment. A retrospective analysis was performed to investigate factors influencing outcomes in these patients. MATERIALS AND METHODS From 2002 to 2009, all cases of stage IIIB NSCLC from the authors' institution were identified. Patients treated with radical radiotherapy (minimum dose, 50 Gy), with or without chemotherapy, were included. Charts were reviewed for patient demographic data, baseline blood work, tumor factors, treatment factors, and hospitalizations. The primary outcome was overall survival (OS), measured from time of diagnosis. RESULTS Of 238 patients identified, 184 eligible cases were reviewed. The median follow-up for all patients was 17.2 months (range, 1.7-237.1). The median progression-free survival was 10.8 months (95% CI, 9.6-12.4). Median survival was 17.9 months, and OS was 68%, 42%, and 28% at 1, 2, and 3 years, respectively. In multivariate analysis, female gender (hazard ratio [HR], 0.58; 95% CI, 0.37-0.88; P = .0013), ≤ 5% weight loss (HR, 0.64; 95% CI, 0.43-0.93; P = .01), and absence of N3 disease (HR, 0.64; 95% CI, 0.42-0.96; P = .03) were associated with significantly longer survival. CONCLUSION OS was significantly longer in women, in patients with ≤ 5% weight loss, and in those without N3 disease. Good patient selection remains important in the radical treatment of stage IIIB NSCLC.
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Affiliation(s)
- Kent Russell
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Healy
- Division of Medical Oncology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jason Pantarotto
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Scott A Laurie
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert MacRae
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Elham Sabri
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Wheatley-Price
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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Phase II study of low-dose paclitaxel with timed thoracic radiotherapy followed by adjuvant gemcitabine and carboplatin in unresectable stage III non-small cell lung cancer. Lung Cancer 2013; 83:67-72. [PMID: 24246506 DOI: 10.1016/j.lungcan.2013.09.007] [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: 05/16/2013] [Revised: 09/04/2013] [Accepted: 09/13/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The purpose of the proposed study is to evaluate the effectiveness and safety of low-dose paclitaxel with timed thoracic radiotherapy (TTR) for local control by inducing maximum radiosensitization through G2-M phase cell cycle arrest, followed by full dose adjuvant chemotherapy with gemcitabine and carboplatin for eradication of possible micrometastasis in unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This is a single-center, non-randomized prospective phase II study. Patients with unresectable stage III NSCLC were treated with paclitaxel 15 mg/m(2) IV, followed by TTR 6 h later on Monday/Wednesday/Friday, and TTR only on Tuesday/Thursday mornings (total 55 Gy). Full dose adjuvant chemotherapy consisted of intravenous carboplatin (AUC 5) on day 1, gemcitabine 1000 mg/m(2) on days 1 and 8, every 21 days for 4 cycles. The primary endpoint was overall survival (OS). Secondary endpoints were overall response rate (ORR), and toxicities. RESULTS Twenty-seven patients were eligible for the study. Patient characteristics were: 19 males (70%); median age 67 years (range 39-82); 15 (56%) stage IIIB; 89% with ECOG performance status ≥1. Three-year OS was 16.7% in all patients, and 27.3% in patients received three or more cycles of adjuvant chemotherapy, respectively. ORR was 63%. Grade 3 toxicities during paclitaxel plus concurrent TTR phase were radiation esophagitis (11%) and radiation pneumonitis (4%), no grade 4 toxicities occurred. One grade 5 hemoptysis. Grade 3/4 toxicities during adjuvant gemcitabine/carboplatin were pneumonitis (22%), anemia (30%), neutropenia (22%), and thrombocytopenia (33%), one grade 5 neutropenic fever. CONCLUSION Low-dose paclitaxel with concurrent TTR is an effective chemoradiotherapy regimen in unresectable stage III NSCLC. Improved survival benefit was observed in patients who have received three or more cycles of full dose adjuvant chemotherapy, yet, gemcitabine related radiation pneumonitis and hematological toxicities limited adjuvant chemotherapy delivery.
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A phase III concurrent chemoradiotherapy trial with cisplatin and paclitaxel or docetaxel or gemcitabine in unresectable non-small cell lung cancer: KASLC 0401. Cancer Chemother Pharmacol 2013; 72:1247-54. [DOI: 10.1007/s00280-013-2308-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
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Eberhardt WEE, Gauler TC, LePechoux C, Stamatis G, Bildat S, Krbek T, Welter S, Grunenwald D, Fischer B, Rodrigo HDLR, Theegarten D, Le Chevalier T, Seeber S, Stuschke M, Poettgen C. 10-year long-term survival (LTS) of induction chemotherapy with three cycles cisplatin/paclitaxel followed by concurrent chemoradiation cisplatin/etoposide/45Gy (1.5Gy bid) plus surgery in locally advanced non-small-cell lung cancer (NSCLC)—A multicenter phase-II trial (CISTAXOL). Lung Cancer 2013; 82:83-9. [DOI: 10.1016/j.lungcan.2013.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/18/2013] [Accepted: 06/22/2013] [Indexed: 01/17/2023]
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Garrido P, Rosell R, Arellano A, Andreu F, Dómine M, Perez-Casas A, Cardenal F, Arnaiz MDM, Morán T, Morera R, Isla D, Valencia J, Cobo M, Delgado R, García-Gómez R, Calvo F, Zamora J, Ramos A, Massutí B. Randomized phase II trial of non-platinum induction or consolidation chemotherapy plus concomitant chemoradiation in stage III NSCLC patients: Mature results of the Spanish Lung Cancer Group 0008 study. Lung Cancer 2013; 81:84-90. [DOI: 10.1016/j.lungcan.2013.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/11/2013] [Accepted: 03/08/2013] [Indexed: 12/28/2022]
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Eroglu C, Orhan O, Unal D, Dogu GG, Karaca H, Dikilitas M, Oztürk A, Ozkan M, Kaplan B. Concomitant chemoradiotherapy with docetaxel and cisplatin followed by consolidation chemotherapy in locally advanced unresectable non-small cell lung cancer. Ann Thorac Med 2013; 8:109-15. [PMID: 23741274 PMCID: PMC3667439 DOI: 10.4103/1817-1737.109824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/18/2013] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES: To evaluate treatment results and toxicities in patients who received concomitant chemoradiotherapy (CRT) followed by consolidation with docetaxel and cisplatin in locally advanced unresectable non-small cell lung cancer (NSCLC). METHODS: Ninety three patients were included in this retrospective study. The patients received 66 Gy radiotherapy and weekly 20 mg/m2 docetaxel and 20 mg/m2 cisplatin chemotherapy concomitantly. One month later than the end of CRT, consolidation chemotherapy with four cycles of docetaxel 75 mg/m2 and cisplatin 75 mg/m2 were administered at each 21 days. RESULTS: Median age of the patients was 57 (range, 30-74). Following concomitant CRT, 14 patients (15%) showed complete and 50 patients (54%) showed partial response (total response rate was 69%). The median follow-up was 13 months (range: 2-51 months). The median overall survival was 18 months (95% confidential interval [CI]: 13.8-22.1 months); local control was 15 months (95% CI: 9.3-20.6 months); progression-free survival was 9 months (95% CI: 6.5-11.4 months). Esophagitis in eight (9%) patients, neutropenia in seven (8%) patients and pneumonitis in eight (9%) patients developed as grade III-IV toxicity due to concomitant CRT. CONCLUSION: Concomitant CRT with docetaxel and cisplatin followed by docetaxel and cisplatin consolidation chemotherapy might be considered as a feasible, and well tolerated treatment modality with high response rates despite the fact that it has not a survival advantage in patients with locally advanced unresectable NSCLC.
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Affiliation(s)
- Celalettin Eroglu
- Department of Radiation Oncology, Erciyes University, School of Medicine, Kayseri, Turkey
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Garrido P, Olmedo E. State of the art of radiotherapy. Transl Lung Cancer Res 2013; 2:189-99. [PMID: 25806232 DOI: 10.3978/j.issn.2218-6751.2013.03.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 03/06/2013] [Indexed: 11/14/2022]
Abstract
Locally advanced or stage III disease accounts for ~30% of patients with non-small-cell lung cancer (NSCLC), which means only in the United States, more than 50,000 new patients each year. Stage III is a very heterogeneous disease, the management of patients is complex and several conditions (performance status, weight loss, comorbidities, characteristics of nodal involvement or resectability) must be considered before selecting the best treatment, which in most cases is chemotherapy (CT) and radiotherapy (RT). In this article, we will review key changes in the management of unresectable stage III during the last decades. Also we will highlight some challenges and areas of active research.
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Affiliation(s)
- Pilar Garrido
- Medical Oncology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo km 9100, 28034, Madrid, Spain
| | | | - Eugenia Olmedo
- Medical Oncology Department, IRYCIS, Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo km 9100, 28034, Madrid, Spain
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Driesen P, Lambrechts M, Kraaij K, Soldatenkova V, Chouaki N, Colinet B. A phase II single-arm study of induction chemotherapy with cisplatin and gemcitabine followed by concurrent cisplatin and gemcitabine with thoracic radiation for unresectable locally advanced non-small cell lung cancer. Ther Adv Med Oncol 2013; 5:159-68. [PMID: 23634194 DOI: 10.1177/1758834013481021] [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: 11/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy and tolerability of the combination of cisplatin-gemcitabine with concurrent thoracic radiotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). METHODS This was a phase II, multicenter, open-label, single-arm trial in treatment-naïve patients with stage IIIA and IIIB LA-NSCLC. After three induction cycles with gemcitabine 1250 mg/m(2) plus cisplatin 80 mg/m(2), two concurrent chemoradiotherapy cycles with gemcitabine 300 mg/m(2), cisplatin 80 mg/m(2), and radiotherapy (63 Gy) were administered. The primary endpoint was response rate after induction chemotherapy followed by concurrent chemoradiotherapy. Secondary endpoints included time to progressive disease (TtPD), overall survival (OS), and safety. RESULTS Overall, 49 patients (median age 63.4 years; 73.5% male; Karnofsky performance status scores of 80, 85, 90, and 100 [16.3%, 2.0%, 49.0%, and 32.7%, respectively]; disease stage IIIA or IIIB 28.6% and 71.4%, respectively) were enrolled and treated. Response rate was 38.8% (95% confidence interval [CI] 25.2-53.8%). Median TtPD was 11.4 months (95% CI 9.4-12.9). Median OS was 21.8 months (95% CI 17.5-26.0), with 1- and 2-year survival rates of 70.8% and 43.7%, respectively. Overall, six patients discontinued from study treatment due to adverse events (AEs), of which two were serious AEs. The most relevant grade 3/4 AEs were neutropenia and thrombocytopenia in induction chemotherapy and chemoradiotherapy, and grade 3 events related to radiation in acute chemoradiotherapy, e.g. dysphagia, radiation pneumonitis, and radiation esophagitis. CONCLUSIONS Induction chemotherapy followed by concurrent chemoradiotherapy with gemcitabine (300 mg/m(2)) and cisplatin was associated with acceptable toxicity. The observed median OS time was 21.8 months. Response evaluation was difficult as in many cases it was not possible to differentiate tumor progression from local radiofibrosis.
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Affiliation(s)
- Peter Driesen
- AZ Turnhout, Rubensstraat 166, 2300 Turnhout, Belgium
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Phase I study of pemetrexed and cisplatin with concurrent high-dose thoracic radiation after induction chemotherapy in patients with unresectable locally advanced non-small cell lung cancer. Lung Cancer 2013; 80:68-74. [DOI: 10.1016/j.lungcan.2012.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/28/2012] [Accepted: 12/03/2012] [Indexed: 11/21/2022]
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Chida M. Surgery for T4N0-1 non-small cell lung cancer: from research to clinical practice. Ann Thorac Cardiovasc Surg 2012; 18:186-7. [PMID: 22790987 DOI: 10.5761/atcs.ed.12.01916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nieder C, Pawinski A, Dalhaug A, Andratschke N. A review of clinical trials of cetuximab combined with radiotherapy for non-small cell lung cancer. Radiat Oncol 2012; 7:3. [PMID: 22236606 PMCID: PMC3269364 DOI: 10.1186/1748-717x-7-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/11/2012] [Indexed: 12/25/2022] Open
Abstract
Treatment of non-small cell lung cancer (NSCLC) is challenging in many ways. One of the problems is disappointing local control rates in larger volume disease. Moreover, the likelihood of both nodal and distant spread increases with primary tumour (T-) stage. Many patients are elderly and have considerable comorbidity. Therefore, aggressive combined modality treatment might be contraindicated or poorly tolerated. In many cases with larger tumour volume, sufficiently high radiation doses can not be administered because the tolerance of surrounding normal tissues must be respected. Under such circumstances, simultaneous administration of radiosensitizing agents, which increase tumour cell kill, might improve the therapeutic ratio. If such agents have a favourable toxicity profile, even elderly patients might tolerate concomitant treatment. Based on sound preclinical evidence, several relatively small studies have examined radiotherapy (RT) with cetuximab in stage III NSCLC. Three different strategies were pursued: 1) RT plus cetuximab (2 studies), 2) induction chemotherapy followed by RT plus cetuximab (2 studies) and 3) concomitant RT and chemotherapy plus cetuximab (2 studies). Radiation doses were limited to 60-70 Gy. As a result of study design, in particular lack of randomised comparison between cetuximab and no cetuximab, the efficacy results are difficult to interpret. However, strategy 1) and 3) appear more promising than induction chemotherapy followed by RT and cetuximab. Toxicity and adverse events were more common when concomitant chemotherapy was given. Nevertheless, combined treatment appears feasible. The role of consolidation cetuximab after RT is uncertain. A large randomised phase III study of combined RT, chemotherapy and cetuximab has been initiated.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
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The Prognostic Significance of Lymphovascular Invasion on Biopsy Specimens in Lung Cancer Treated With Definitive Chemoradiotherapy. Clin Lung Cancer 2012; 13:59-67. [DOI: 10.1016/j.cllc.2011.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 06/23/2011] [Accepted: 06/27/2011] [Indexed: 11/22/2022]
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Abstract
Nearly one third of non-small cell lung cancer (NSCLC) patients at diagnosis have stage III disease. Concurrent chemoradiation has emerged as the standard of care for patients with unresectable stage III NSCLC. Meta-analyses of studies comparing concurrent with sequential therapy showed that there was a relative improvement of about 20% with concurrent therapy over sequential therapy in these patients and that concurrent chemoradiation is more toxic than the sequential approach, particularly with regard to esophagitis. The incidence of pneumonitis is not significantly higher with concurrent therapy. All the phase 3 trials comparing concurrent with sequential therapy included cisplatin-based therapy. In addition, patients enrolled in these studies were required to have good performance status and some studies mandated limited weight loss. Some patients are also treated with lower doses of chemotherapy, particularly carboplatin and paclitaxel, concurrently with radiation followed by full-dose chemotherapy. Randomized studies have failed to show benefit of induction or consolidation chemotherapy. For patients who have a poor performance status or significant weight loss, a sequential approach of chemotherapy followed by radiation may be appropriate. Ongoing clinical trials are evaluating the utility of integrating some of the newer agents such as pemetrexed and cetuximab into the treatment plan for stage III patients.
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Phase II study of pemetrexed and cisplatin, with chest radiotherapy followed by docetaxel in patients with stage III non-small cell lung cancer. J Thorac Oncol 2011; 6:927-33. [PMID: 21415776 DOI: 10.1097/jto.0b013e3182156109] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pemetrexed has emerged as one of the most active agents for the treatment of patients with advanced non-small cell lung cancer (NSCLC). We conducted a phase II study to assess the efficacy and feasibility of integrating pemetrexed in a concurrent therapy plan for patients with stage III NSCLC. METHODS Patients with stage III NSCLC with performance status 0 to 1, adequate organ function including pulmonary function, and V20 less than 40% were eligible. Patients were treated with cisplatin 75 mg/m² (first five patients 60 mg/m²) and pemetrexed 500 mg/m² every 21 days for three cycles with chest radiotherapy to 66 Gy. Patients then received three cycles of docetaxel 75 mg/m² every 21 days. Tumors were analyzed for Excision Repair Cross Complementation Group 1 and thymidylate synthase. RESULTS Patient characteristics (N = 28) were median age, 60; males, 68%; stage IIIB, 64%; and squamous cell, 43%. Twenty-four patients (86%) completed all three cycles of cisplatin/pemetrexed. Of the 24 patients eligible for docetaxel, 21 (87%) received it. Grade 3/4 toxicities were neutropenia (39%), febrile neutropenia (14%), esophagitis (14%), and pneumonitis (4%). Median survival was 34 months, and 1-year survival was 66%. Survival was not significantly different in squamous and other histology patients. Tumor analysis in 16 patients showed that moderate/strong expression of thymidylate synthase was significantly associated with progression-free survival and overall survival. CONCLUSION Integrating pemetrexed in a concurrent therapy regimen for patients with stage III NSCLC is feasible and was associated with a median survival of 34 months.
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Werner-Wasik M, Paulus R, Curran WJ, Byhardt R. Acute esophagitis and late lung toxicity in concurrent chemoradiotherapy trials in patients with locally advanced non-small-cell lung cancer: analysis of the radiation therapy oncology group (RTOG) database. Clin Lung Cancer 2011; 12:245-51. [PMID: 21726824 DOI: 10.1016/j.cllc.2011.03.026] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/23/2010] [Accepted: 01/28/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND We analyzed time course and factors associated with acute esophagitis (ES) and late lung toxicity (PN), as well as any association between ES and PN in patients (pts) with non-small-cell lung cancer (NSCLC) treated with concurrent chemoradiation (chemo-RT) on the Radiation Therapy Oncology Group (RTOG) trials. MATERIALS AND METHODS Multivariable analysis was used to investigate factors associated with ES or PN. RESULTS Patients (n = 528) received standard fractionated (SFX; 63 Gy) or hyperfractionated (HFX; 69.6 Gy) radiation therapy (RT) with cisplatin-based chemotherapy. Grade > 2 ES developed in 75% of pts; Grade > 3 ES, in 34%. Nineteen percent of pts developed ES by the first, 32% by the second, and 33% by the third month (and for Grade > 3 PN, 9% by 6 months, 15% by year 1, and 18% by year 2). Any PN developed in 59% of pts; Grade > 2, in 39%; Grade > 3, in 18%; and lethal PN, in 2%. Grade > 2 PN was associated with increasing RT dose and Grade > 3 PN, with HFX RT. No association was seen with ES. Grade > 3 ES was less likely to occur in non-whites and more likely, in pts treated with HFX RT. CONCLUSION Most (95%) pts developed ES, and 33% had severe ES, peaking within the first or second month of RT. PN developed in 57% of pts, with 18% experiencing Grade > 3 PN, with most diagnosed by 1 year from RT. No relationship was observed between 1 toxicity (ES or PN) as predictor of the other. HFX RT was associated with more severe PN or ES.
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Affiliation(s)
- Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Mok TS, Zhou Q, Leung L, Loong HH. Personalized medicine for non-small-cell lung cancer. Expert Rev Anticancer Ther 2011; 10:1601-11. [PMID: 20942631 DOI: 10.1586/era.10.76] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Non-small-cell lung cancer (NSCLC) is a heterogeneous illness associated with a high mortality rate. Personalized therapy may improve treatment outcomes by identification of a specific genotypic anomaly and target-specific therapy. The most significant development in recent years was the discovery of activated EGF receptor (EGFR) mutations at exons 19 and 21. Patients with EGFR mutations respond dramatically to EGFR tyrosine kinase inhibitors such as gefitinib or erlotinib, resulting in longer progression-free survival. Multiple randomized studies, including the Iressa Pan-Asia Study and WJTOG3405, have confirmed the role of EGFR tyrosine kinase inhibitors as standard first-line therapy for patients with the EGFR mutation. In this article, we summarize the current nonpersonalized therapies and examine the available and investigational personalized therapies for patients with resectable early-stage, unresectable locally advanced, or metastatic disease.
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Affiliation(s)
- Tony S Mok
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China.
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Shen X, Denittis A, Werner-Wasik M, Axelrod R, Gilman P, Meyer T, Treat J, Curran WJ, Machtay M. Phase i study of 'dose-dense' pemetrexed plus carboplatin/radiotherapy for locally advanced non-small cell lung carcinoma. Radiat Oncol 2011; 6:17. [PMID: 21324160 PMCID: PMC3050732 DOI: 10.1186/1748-717x-6-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 02/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This phase I study investigates the feasibility of carboplatin plus dose-dense (q2-week) pemetrexed given concurrently with radiotherapy (XRT) for locally advanced and oligometastatic non-small cell lung cancer (NSCLC). METHODS Eligible patients had Stage III or IV (oligometastatic) NSCLC. Patients received XRT to 63 Gy in standard fractionation. Patients received concurrent carboplatin (AUC = 6) during weeks 1 and 5 of XRT, and pemetrexed during weeks 1, 3, 5, and 7 of XRT. The starting dose level (level 1) of pemetrexed was 300 mg/m2. Following the finding of dose limiting toxicity (DLT) in dose level 1, an amended dose level (level 1A) continued pemetrexed at 300 mg/m2, but with involved field radiation instead of extended nodal irradiation. Consolidation consisted of carboplatin (AUC = 6) and pemetrexed (500 mg/m2) q3 weeks × 2 -3 cycles. RESULTS Eighteen patients were enrolled. Fourteen patients are evaluable for toxicity analysis. Of the initial 6 patients treated on dose level 1, two experienced DLTs (one grade 4 sepsis, one prolonged grade 3 esophagitis). There was one DLT (grade 5 pneumonitis) in the 8 patients treated on dose level 1A. In 16 patients evaluable for response (4 with oligometastatic stage IV disease and 12 with stage III disease), the median follow-up time is 17.8 months. Thirteen of 16 patients had in field local regional response. The actuarial median survival time was 28.6 months in all patients and 34.7 months (estimated) in stage III patients. CONCLUSIONS Concurrent carboplatin with dose-dense (q2week) pemetrexed at 300 mg/m2 with involved field XRT is feasible and encouraging in patients with locally advanced and oligometastatic NSCLC.
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Affiliation(s)
- Xinglei Shen
- Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, USA
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Machtay M, Bae K, Movsas B, Paulus R, Gore EM, Komaki R, Albain K, Sause WT, Curran WJ. Higher biologically effective dose of radiotherapy is associated with improved outcomes for locally advanced non-small cell lung carcinoma treated with chemoradiation: an analysis of the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 2010; 82:425-34. [PMID: 20980108 DOI: 10.1016/j.ijrobp.2010.09.004] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 08/24/2010] [Accepted: 09/12/2010] [Indexed: 12/13/2022]
Abstract
PURPOSE Patients treated with chemoradiotherapy for locally advanced non-small-cell lung carcinoma (LA-NSCLC) were analyzed for local-regional failure (LRF) and overall survival (OS) with respect to radiotherapy dose intensity. METHODS AND MATERIALS This study combined data from seven Radiation Therapy Oncology Group (RTOG) trials in which chemoradiotherapy was used for LA-NSCLC: RTOG 88-08 (chemoradiation arm only), 90-15, 91-06, 92-04, 93-09 (nonoperative arm only), 94-10, and 98-01. The radiotherapeutic biologically effective dose (BED) received by each individual patient was calculated, as was the overall treatment time-adjusted BED (tBED) using standard formulae. Heterogeneity testing was done with chi-squared statistics, and weighted pooled hazard ratio estimates were used. Cox and Fine and Gray's proportional hazard models were used for OS and LRF, respectively, to test the associations between BED and tBED adjusted for other covariates. RESULTS A total of 1,356 patients were analyzed for BED (1,348 for tBED). The 2-year and 5-year OS rates were 38% and 15%, respectively. The 2-year and 5-year LRF rates were 46% and 52%, respectively. The BED (and tBED) were highly significantly associated with both OS and LRF, with or without adjustment for other covariates on multivariate analysis (p < 0.0001). A 1-Gy BED increase in radiotherapy dose intensity was statistically significantly associated with approximately 4% relative improvement in survival; this is another way of expressing the finding that the pool-adjusted hazard ratio for survival as a function of BED was 0.96. Similarly, a 1-Gy tBED increase in radiotherapy dose intensity was statistically significantly associated with approximately 3% relative improvement in local-regional control; this is another way of expressing the finding that the pool-adjusted hazard ratio as a function of tBED was 0.97. CONCLUSIONS Higher radiotherapy dose intensity is associated with improved local-regional control and survival in the setting of chemoradiotherapy.
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Affiliation(s)
- Mitchell Machtay
- University Hospitals/Case Western Reserve University, Cleveland, OH 44106, USA.
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Gubens MA, Wakelee HA. Docetaxel in the treatment of non-small cell lung carcinoma: an update and analysis. LUNG CANCER-TARGETS AND THERAPY 2010; 1:63-76. [PMID: 28210107 DOI: 10.2147/lctt.s6499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Docetaxel, a semisynthetic taxane, was the first agent to show efficacy in the second-line treatment of non-small cell lung cancer (NSCLC), and has since become a mainstay of NSCLC therapy. We review its mode of action, pharmacology, toxicity and efficacy and describe both its established role in the treatment of NSCLC and future directions in research. Docetaxel works primarily by promoting microtubule assembly and polymerization, and through this hyperstabilization, causes cell cycle arrest and death. The primary toxicity of docetaxel is neutropenia, which can be mitigated by weekly administration in selected patients. Less common toxicities are peripheral edema, which can be reduced by appropriate premedication and interstitial pneumonitis. Hypersensitivity reactions are less frequent than with paclitaxel. Docetaxel has shown a survival and quality of life advantage as a single agent first- and second-line versus placebo, as well as first-line in a platinum-based doublet therapy compared to a single agent. Increasingly docetaxel has also been used effectively in adjuvant regimens in earlier stages of the disease. Future areas of research include combinations with novel targeted therapies, and a greater understanding of biomarkers that might help predict efficacy and personalize therapy.
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Affiliation(s)
- Matthew A Gubens
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
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Huber RM, Borgmeier A, Flentje M, Willner J, Schmidt M, Manegold C, Bramlage P, Debus J. Concurrent Chemoradiation Therapy With Docetaxel/Cisplatin Followed by Docetaxel Consolidation Therapy in Inoperable Stage IIIA/B Non–Small-Cell Lung Cancer: Results of a Phase I Study. Clin Lung Cancer 2010; 11:45-50. [DOI: 10.3816/clc.2010.n.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hodge CW, Tomé WA, Fain SB, Bentzen SM, Mehta MP. On the use of hyperpolarized helium MRI for conformal avoidance lung radiotherapy. Med Dosim 2009; 35:297-303. [PMID: 19944585 DOI: 10.1016/j.meddos.2009.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 09/04/2009] [Accepted: 09/23/2009] [Indexed: 12/25/2022]
Abstract
We wanted to illustrate the feasibility of using hyperpolarized helium magnetic resonance imaging (HPH-MRI) to obtain functional information that may assist in improving conformal avoidance of ventilating lung tissue during thoracic radiotherapy. HPH-MRI images were obtained from a volunteer patient and were first fused with a proton density-weighted (PD(w)) MRI to provide corresponding anatomic detail; they were then fused with the treatment planning computed tomography scan of a patient from our treatment planning database who possessed equivalent thoracic dimensions. An optimized treatment plan was then generated using the TomoTherapy treatment planning system, designating the HPH-enhancing regions as ventilation volume (VV). A dose-volume histogram compares the dosimetry of the lungs as a paired organ, the VV, and the lungs minus the VV. The clinical consequences of these changes was estimated using a bio-effect model, the parallel architecture model, or the local damage (f(dam)) model. Model parameters were chosen from published studies linking the incidence of grade 3+ pneumonitis, with the dose and volume irradiated. For two hypothetical treatment plans of 60 Gy in 30 fractions delivered to a right upper-lobe lung mass, one using and one ignoring the VV as an avoidance structure, the mean normalized total dose (NTD(mean)) values for the lung subvolumes were: lungs = 12.5 Gy₃ vs. 13.52 Gy₃, VV = 9.94 Gy₃ vs. 13.95 Gy₃, and lungs minus VV = 16.69 Gy₃ vs. 19.16 Gy₃. Using the f(dam) values generated from these plans, one would predict a reduction of the incidence of grade 3+ radiation pneumonitis from 12%-4% when compared with a conventionally optimized plan. The use of HPH-MRI to identify ventilated lung subvolumes is feasible and has the potential to be incorporated into conformal avoidance treatment planning paradigms. A prospective clinical study evaluating this imaging technique is being developed.
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Affiliation(s)
- C W Hodge
- Department of Human Oncology, University of Wisconsin, Madison, 53792, USA
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Caglar HB, Baldini EH, Othus M, Rabin MS, Bueno R, Sugarbaker DJ, Mentzer SJ, Jänne PA, Johnson BE, Allen AM. Outcomes of patients with stage III nonsmall cell lung cancer treated with chemotherapy and radiation with and without surgery. Cancer 2009; 115:4156-66. [PMID: 19551884 DOI: 10.1002/cncr.24492] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to identify the factors associated with improved outcome after treatment for stage III nonsmall cell lung cancer (NSCLC). METHODS A retrospective review of stage III NSCLC patients treated at who were treated at the Dana-Farber Cancer Institute/Brigham and Women's Cancer Center was done with institutional review board approval. Patients were followed for toxicity, local and distant failure, and overall survival. Multivariate Cox logistic regression analysis was used to determine the factors associated with treatment outcome. RESULTS Between August 2000 and November 2006, 144 patients received concurrent chemoradiation (CRT) for stage III NSCLC. Eighty of 144 patients were men (56%), and the median age was 61 years (range, 33-81 years). Sixty-two patients (43%) had stage IIIA NSCLC, and 82 patients (57%) had stage IIIB NSCLC. Radiotherapy (RT) was given concurrently with chemotherapy to all patients; 100 patients (69%) received CRT without surgery, and 44 patients (31%) received with neoadjuvant CRT followed by surgical resection. The median RT dose was 60 grays (Gy) (range, 46-70 Gy). The median follow-up was 15 months (range, 3-64 months), the median potential follow-up was 37 months (range, 12-84 months), and the median overall survival was 22 months (95% confidence interval, 15-28 months). The 1-year and 2-year survival rates were 68% and 47%, respectively. Among the 44 patients who underwent resection, the median survival was 61 months, and the 2-year survival rate was 73%. On multivariate analysis, stage at the time of treatment (stage IIIA vs stage IIIB) and use of surgery were the only factors associated with improved outcome (P=.01 and P=.001, respectively). CONCLUSIONS In this retrospective series, those patients who were able to undergo resection appeared to have improved outcome after induction CRT.
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Affiliation(s)
- Hale B Caglar
- Department of Radiation Oncology Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts 02215, USA
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Impact of the ASCO 2007 Presentation of HOG Lun 01-24/USO-023 on the Prescribing Plans of American Medical Oncologists for Patients with Stage IIIB Non-small Cell Lung Cancer. J Thorac Oncol 2009; 4:983-7. [DOI: 10.1097/jto.0b013e3181adeefb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Neoadjuvant chemotherapy and radiotherapy followed by surgery in selected patients with stage IIIB non-small-cell lung cancer: a multicentre phase II trial. Lancet Oncol 2009; 10:785-93. [DOI: 10.1016/s1470-2045(09)70172-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jain AK, Hughes RS, Sandler AB, Dowlati A, Schwartzberg LS, Dobbs T, Schlabach L, Wu J, Muldowney NJ, Choy H. A phase II study of concurrent chemoradiation with weekly docetaxel, carboplatin, and radiation therapy followed by consolidation chemotherapy with docetaxel and carboplatin for locally advanced inoperable non-small cell lung cancer (NSCLC). J Thorac Oncol 2009; 4:722-7. [PMID: 19404213 DOI: 10.1097/jto.0b013e3181a5275c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The current standard of care for good performance status patients with locally advanced non-small cell lung carcinoma is concurrent chemoradiation, although a clearly superior regimen has not been identified. Docetaxel has been shown to possess good single-agent activity against non-small cell lung cancer (NSCLC) and radiosensitizing properties, both alone and synergistically with carboplatin. We undertook this phase II study to determine the safety and efficacy of weekly docetaxel-carboplatin and concurrent radiation therapy followed by docetaxel-carboplatin consolidation for the treatment of locally advanced NSCLC. METHODS Sixty-seven patients having previously untreated stage IIIA or IIIB unresectable NSCLC were enrolled, with 61 patients evaluated for endpoints. Docetaxel 20 mg/m IV infusion over 30 minutes followed by carboplatin area under the curve = 2 over 30 minutes was administered weekly during concurrent thoracic radiotherapy. After 3 week rest, consolidation docetaxel 75 mg/m(2) IV infusion over 60 minutes and carboplatin area under the curve = 6 over 30 minutes was administered every 3 weeks for two cycles. Concurrent thoracic radiation consisted of 45 Gy (1.8 Gy fractions 5 d/wk for first 5 weeks) followed by 18 Gy boost (2.0 Gy fractions 5 d/wk for 2 weeks) for a total dose of 63 Gy. RESULTS One and 2 years overall survival rates were 45 and 20%, respectively. Progression free survival at 1 year was 27%. Median survival time was 12 months. Median time to progression was 8 months. The primary hematologic toxicity was leukopenia. The primary nonhematologic toxicity was esophagitis. CONCLUSION The administered regimen of weekly docetaxel-carboplatin and concurrent radiation therapy followed by docetaxel-carboplatin consolidation has acceptable toxicity profile. However, the overall survivals at 1 and 2 years are somewhat disappointing.
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Affiliation(s)
- Anshu K Jain
- Department of Radiation Oncology, UT Southwestern Medical Center at Dallas, Dallas, TX, USA
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Vokes EE, Senan S, Treat JA, Iscoe NA. PROCLAIM: A phase III study of pemetrexed, cisplatin, and radiation therapy followed by consolidation pemetrexed versus etoposide, cisplatin, and radiation therapy followed by consolidation cytotoxic chemotherapy of choice in locally advanced stage III non-small-cell lung cancer of other than predominantly squamous cell histology. Clin Lung Cancer 2009; 10:193-8. [PMID: 19443340 DOI: 10.3816/clc.2009.n.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This clinical trial summary provides the background and rationale for a randomized trial examining the benefits of pemetrexed/ cisplatin chemotherapy combined with radiation followed by consolidation pemetrexed in patients with unresectable stage IIIA/B non-small-cell lung cancer. The rationale for the selection of the control arm is provided, and study design limitations are discussed. The primary outcome is survival, and secondary outcomes include progression-free survival, toxicities, and 1-, 2-, and 3-year survival rates. Radiation quality control is a key component of the trial.
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Late complications of high-dose (>/=66 Gy) thoracic conformal radiation therapy in combined modality trials in unresectable stage III non-small cell lung cancer. J Thorac Oncol 2009; 4:74-9. [PMID: 19096310 DOI: 10.1097/jto.0b013e3181915028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Combined modality treatment is the standard of care for patients (pts) with unresectable stage III non-small cell lung cancer. Dose escalation of radiotherapy is one strategy used to improve locoregional control and survival, but it increases the risk of both early and late treatment related toxicities. METHODS From May 1996 to August 2004, a total of 112 stage III non-small cell lung cancer pts were treated on 4 phase I/II or phase II trials to assess the safety and feasibility of high-dose (60-90 Gy) thoracic conformal radiotherapy. Patients who received >/=66 Gy (n = 88) were included in an analysis of late complications. Late complications were defined as complications that developed or persisted >/=90 days postradiotherapy. The classic lung toxicities of radiation pneumonitis and fibrosis were not included in this analysis. RESULTS Of the 88 patients included in this analysis of late complications, 21 patients (24%) developed a late complication and a total of 28 late complications were observed. The late complications were: pulmonary (n = 5; bronchial stenosis [n = 3] and fatal pulmonary hemoptysis [n = 2]), esophageal (n = 6), cardiac (n = 9), osseous (n = 6), and second primary tumor (n = 2). The median survival for all patients enrolled on the 4 trials (with 95% confidence interval [CI]) was 24.7 months (18.1-30.4 months), and the 5-year overall survival (with 95% CI) was 24% (16-32%). Data to assess for radiographic evidence of local progression were available for 99 patients, and the rate of local progression was 43% (95% CI 34-53%). CONCLUSIONS High-dose thoracic conformal radiotherapy is feasible and results in promising survival outcomes. Late complications occur in a minority of patients.
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