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Sculier J, Thiriaux J, Bureau G, Lafitte J, Recloux P, Brohee D, Berchier M, Sergysels R, Mommen P, Paesmans M, Klastersky J, Lecomte J, Vanschaardenburg C, Richard V, Diana D, Fortin F, Tagnon A, Kustner U. A phase-ii study testing weekly platinum derivative combination chemotherapy as 2nd-line treatment in patients with advanced small-cell lung-cancer. Int J Oncol 2012; 6:425-9. [PMID: 21556555 DOI: 10.3892/ijo.6.2.425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A phase II trial was conducted to determine the effectiveness of weekly administration of cisplatin (25 mg/m(2) on day 1) and carboplatin (100 mg/m(2) on day 1) as salvage chemotherapy for patients with small cell lung cancer after first-line chemotherapy without platinum derivatives. Of 40 eligible patients, 38 were evaluable for response. Interval between last course of first-line chemotherapy and first course of salvage therapy was less than 3 months in 34 and greater in 4. Five partial responses (13%; confidence interval at 95%:0.01-0.25) were documented (including 4 in patients with a treatment-free interval <3 months) as well as 8 no change, 21 progressions and 4 early deaths due to malignant disease. Toxicity consisted mainly of moderate thrombopenia and leucopenia. Grade I nephrotoxicity was observed in 6 patients. In conclusion, weekly administration of moderate doses of cisplatin and carboplatin as salvage chemotherapy for small cell lung cancer appeared feasible and was associated with a moderate but definitive anticancer activity.
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Affiliation(s)
- J Sculier
- HOP CIVIL CHARLEROI,CHARLEROI,BELGIUM. GRP MED ST REMI,REIMS,FRANCE. HOP A CALMETTE,LILLE,FRANCE. HOP AMBROISE PARE,MONS,BELGIUM. CHU ANDRE VESALE,MONTIGNIES TILLEUL,BELGIUM. HOP HAYANGE,HAYANGE,FRANCE. ACAD ZIEKENHUIS MIDDELHEIM,ANTWERP,BELGIUM. CLIN LOUIS CATY,BAUDOUR,BELGIUM. CLIN LOUVIERE,LILLE,FRANCE. IMC MUTUALIT SOCIALISTES,TOURNAI,BELGIUM. LUNGENKLIN HECKESHORN,BERLIN,GERMANY
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Paesmans M, Lafitte J, Berghmans T, Lecomte J, Alexopoulos C, Van Cutsem O, Giner V, Efremidis A, Berchier M, Sculier J. How much can patients, with low Karnofsky performance status and advanced non-small cell lung cancer, benefit from cisplatin-based chemotherapy? A retrospective analysis of a phase III randomised trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19516 Background: Performance status (PS) is a strong independent prognostic factor for survival in patients with advanced non- small cell lung cancer and administration of platinum-based chemotherapy (CT) in patients with poor PS is associated to more severe toxicity. Our purpose was to determine whether poor PS patients (ie those registered with a performance index of 60–70 on the Karnofsky scale) could benefit from CT in terms of clinical improvement defined as reaching, during CT, a PS of at least 80 on the same scale (ECOG PS 0 or 1). Methods: Retrospective analysis of a randomised trial performed in advanced NSCLC where 485 patients received three courses of GIP (gemcitabine + ifosfamide + cisplatin) induction CT, in order to determine the potential clinical benefit of conventional cisplatin-based CT in patients with poor PS defined as 60–70 on the Karnofsky scale. Results: 387 (80%) patients had good PS (Karnofsky 80–100) and 98 (20%) poor PS. Response rates were respectively 38 and 28% (p=0.06), no independent predictive value for PS was found using response to CT as endpoint. Clinical improvement was observed in 25% (95% CI : 15%-38%) of the poor PS patients (respectively 38%, 20% and 14% in case of response, no change and progression, p=0.05). Nine additional patients improved from 60 to 70 during induction CT. Improvement occurred earlier in responders (rates of patients with improvement were 12% after 1 course, 31% after 2 courses and 38% after 3 courses compared to 3%, 5% and 17% in the non responders). Survival of patients with poor PS was significantly worse but survival of responders was similar, whatever initial poor or good PS (logrank test after landmark, p=0.47, HR=1.18, 95%CI: 0.76–1.84 for poor responders). If non fatal toxicity was relatively similar as well as dose intensity delivered after 3 CT courses, there were more toxic deaths (including vascular and cardiac fatalities) in poor PS patients (2.1% versus 9.2%; p=0.002). Conclusions: Although toxicity is increased, combination chemotherapy is associated with clinical improvement in a non negligible rate of patients with poor PS in case of advanced NSCLC. No significant financial relationships to disclose.
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Affiliation(s)
- M. Paesmans
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - J. Lafitte
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - T. Berghmans
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - J. Lecomte
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - C. Alexopoulos
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - O. Van Cutsem
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - V. Giner
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - A. Efremidis
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - M. Berchier
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
| | - J. Sculier
- Institut Jules Bordet, Brussels, Belgium; CHRU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos Hospital, Athens, Greece; Clinique Saint Luc, Bouge, Belgium; Hospital de Sagunto, Valencia, Spain; Hellenic Cancer Institut, St Savas Hospital, Athens, Greece; Hôpital de Hayange, Hayange, France
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Sculier J, Lafitte J, Lecomte J, Alexopoulos C, Van Cutsem O, Giner V, Efremidis A, Scherpereel A, Paesmans M, Berghmans T. A phase III randomised trial comparing sequential to standard chemotherapy in advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7012 Background: Cisplatin-based chemotherapy and taxans are effective treatments for advanced NSCLC. We performed a phase III randomised trial to determine if the sequential administration of cisplatin-based chemotherapy followed by paclitaxel is superior to a cisplatin-based standard chemotherapy, with the use of paclitaxel as salvage treatment. Methods: Untreated advanced NSCLC with adequate PS, hematological, hepatic, cardiac and renal functions were treated by 3 courses of GIP (cisplatin 50 mg/m2, ifosfamide 3 g/m2, gemcitabine 1 g/m2). Patients with a non-progressing tumour were randomised between 3 further courses of GIP or 3 courses of paclitaxel (225 mg/m2). To detect an increase in the survival rates (primary endpoint) from 20% in the GIP arm to 35% in the sequential arm, with 80% probability using a two-sided logrank test with a significance level of 5%, we needed to observe 178 events, requiring to randomise 123 patients in each arm. Results: From January 2000 to February 2004, 485 patients received 3 courses of induction GIP of which 140 were randomised in the GIP arm and 141 in the paclitaxel arm. Median survival times were 14.1 (95% CI: 12.0–16.3) and 16.4 (95% CI: 14.0–18.8) months for the paclitaxel and the GIP arms, respectively (p = 0.17). When treatment comparison was adjusted for the two independent prognostic factors (sex and haemoglobin) revealed by a Cox multivariate analysis, the observed HR was 0.81 (95% CI: 0.63–1.09) in favour of the GIP arm (p = 0.10). There were more grades III/IV thrombopenia with GIP (p< 0.01) and more alopecia with paclitaxel (p = 0.04). Conclusion: Sequential cisplatin-based chemotherapy by paclitaxel does not result in better survival than standard chemotherapy, with the use of paclitaxel as salvage treatment. No significant financial relationships to disclose.
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Affiliation(s)
- J. Sculier
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - J. Lafitte
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - J. Lecomte
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - C. Alexopoulos
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - O. Van Cutsem
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - V. Giner
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - A. Efremidis
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - A. Scherpereel
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - M. Paesmans
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
| | - T. Berghmans
- Institut Jules Bordet, Bruxelles, Belgium; CHU Calmette, Lille, France; CHU Charleroi, Charleroi, Belgium; Evangelismos General Hospital, Athens, Greece; Clinique St. Luc, Namur, Belgium; Hospital de Sagunto, Valence, Spain; Hellenic Cancer Institute, Athens, Greece
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