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Monnet I, Vergnenègre A, Robinet G, Berard H, Lamy R, Falchero L, Vieillot S, Schott R, Ricordel C, Chouabe S, Thomas P, Gervais R, Madroszyk A, Abdiche S, Chiappa AM, Greillier L, Decroisette C, Auliac JB, Chouaïd C. Phase III randomized study of carboplatin pemetrexed with or without bevacizumab with initial versus "at progression" cerebral radiotherapy in advanced non squamous non-small cell lung cancer with asymptomatic brain metastasis. Ther Adv Med Oncol 2021; 13:17588359211006983. [PMID: 33948123 PMCID: PMC8053829 DOI: 10.1177/17588359211006983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/11/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The role and timing of whole or stereotaxic brain radiotherapy (BR) in patients with advanced non-small cell lung cancer (aNSCLC) and asymptomatic brain metastases (aBMs) are not well established. This study investigates whether deferring BR until cerebral progression was superior to upfront BR for patients with aNSCLC and aBM. Methods: This open-label, multicenter, phase III trial, randomized (1:1) aNSCLC patients with aBMs to receive upfront BR and chemotherapy: platin–pemetrexed and bevacizumab in eligible patients, followed by maintenance pemetrexed with or without bevacizumab, BR arm, or the same chemotherapy with BR only at cerebral progression, chemotherapy (ChT) arm. Primary endpoint was progression-free survival (PFS), secondary endpoints were overall survival (OS), global, extra-cerebral and cerebral objective response rate (ORR), toxicity, and quality of life [ClinicalTrials.gov identifier: NCT02162537]. Results: The trial was stopped early because of slow recruitment. Among 95 included patients, 91 were randomized in 24 centers: 45 to BR and 46 to ChT arms (age: 60 ± 8.1, men: 79%, PS 0/1: 51.7%/48.3%; adenocarcinomas: 92.2%, extra-cerebral metastases: 57.8%, without differences between arms.) Significantly more patients in the BR-arm received BR compare with those in the ChT arm (87% versus 20%; p < 0.001); there were no significant differences between BR and ChT arms for median PFS: 4.7, 95% confidence interval (CI):3.4–7.5 versus 4.8, 95% CI: 2.4–6.5 months, for median OS: 8.5, 95% CI:.6–11.1 versus 8.3, 95% CI:4.5–11.5 months, cerebral and extra-cerebral ORR (27% versus 13%, p = 0.064, and 30% versus 41%, p = 0.245, respectively). The ChT arm had more grade 3/4 neutropenia than the BR arm (13% versus 6%, p = 0.045); others toxicities were comparable. Conclusion: The significant BR rate difference between the two arms suggests that upfront BR is not mandatory in aNSCLC with aBM but this trial failed to show that deferring BR for aBM is superior in terms of PFS from upfront BR.
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Affiliation(s)
| | | | | | - Henri Berard
- Service de Pneumologie, Hôpital d'instruction des armées Sainte-Anne, Toulon, France
| | - Regine Lamy
- Service de Pneumologie, CH Bretagne Sud, Lorient, France
| | - Lionel Falchero
- Service de Pneumologie, Centre Hospitalier de Villefranche de Rouergue, Villefranche, France
| | | | - Roland Schott
- Service d'Oncologie, Centre Paul Strauss, Strasbourg, France
| | | | - Stephane Chouabe
- Service de Pneumologie, CH Charleville Mézière, Charleville Mézière, France
| | | | - Radj Gervais
- Service d'Oncologie, Centre François Baclesse, Caen, France
| | - Anne Madroszyk
- Service d'Oncologie, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, APHM, Hôpital Nord, Marseille, France
| | | | | | - Christos Chouaïd
- Service de Pneumologie, CHI Créteil, 40 avenue de Verdun, Créteil, 94010, France
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Giraud N, Abdiche S, Trouette R. Stereotactic radiotherapy in targeted therapy treated oligo-metastatic oncogene-addicted (non-small-cell) lung cancer. Cancer Radiother 2019; 23:346-354. [PMID: 31130373 DOI: 10.1016/j.canrad.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/23/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
While the prognosis of metastatic non-small-cell lung cancer has shown significant progress these last years, notably with the discovery of oncogen-driven subtypes and the development of targeted therapies, significant improvements are still needed. More recently, numerous authors studied the oligo-metastasis concept, where the metastasis are limited in number and sites involved, and that could benefit from an aggressive approach of these lesions, for instance with the help of stereotactic radiotherapy. Nevertheless, there is no clear consensus existing for the time being for the treatment of these tumors. Three main clinical situations can be distinguished: oligo-metastasis state de novo at diagnosis (synchronous) or as first metastatic event of an initially locally limited affection (metachronous); oligo-progression during systemic treatment of a pluri-metastatic disease; and finally oligo-persistence of some remaining metastatic lesions at the nadir of the systemic therapy effect. In this review, we will discuss the place of stereotactic radiotherapy in the treatment of non-small-cell oligo-metastatic oncogene-addicted cancers treated with targeted therapies, differentiating these three main clinical situations. In all these indications, this technique could provide a benefit in terms of local control, possibly even in specific survival, when associated with targeted therapy continuation, related to local control of the oligo-metastatic cerebral or extracerebral lesions.
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Affiliation(s)
- N Giraud
- Service d'oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France.
| | - S Abdiche
- Service d'oncologie-radiothérapie, hôpital Robert-Boulin, 112, rue de la Marne, 33500 Libourne cedex, France
| | - R Trouette
- Service d'oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
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Lledo G, Michel P, Dahan L, Mineur L, Galais M, Dupuis O, Abdiche S, Jovenin N, Chibaudel B, De Gramont A. Chemoradiation with FOLFOX plus cetuximab in locally advanced cardia or esophageal cancer: Final results of a GERCOR phase II trial (ERaFOX). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.8] [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: 11/20/2022] Open
Abstract
8 Background: Chemoradiotherapy (CRT) for locally advanced cardia and esophageal cancer is based on 5-FU combined with cisplatin, which could be favorably replaced by oxaliplatin (Ox). Cetuximab (C) has demonstrated synergism with both radiotherapy (RT) and platinum-based chemotherapy. ERaFOX trial was evaluating the safety and efficacy of the addition of C to CRT with FOLFOX. Methods: Main inclusion criteria were: stage III squamous cell or adenocarcinoma of the esophagus or gastroesophageal junction; WHO PS 0-1; age 18-80 years; weight loss <15% in the last 6 months. Patients (pts) received 2 cycles of FOLFOX induction therapy (Ox 85 mg/m2/d1, folinic acid 400 mg/m2/d1, 5-FU 2,400 mg/m2/d1-2, q2w) plus C (first infusion 400 mg/m2 then 250 mg/m2, q1w), then RT 50.4 Gy (1.8Gy/d x 28 fractions) with FOLFOX plus C (same doses, except 5-FU 1,800mg/m2/d1-2). Tumor evaluation was performed at the end of CRT (RECIST and endoscopic ultrasonography). The primary endpoint was overall response rate (ORR), with a 50% threshold for efficacy (Simon Minimax two-stage design). Results: From Nov 2007 to Feb 2010, 80 pts were enrolled in 12 centers. The characteristics of the 79 eligible pts were (1 ineligible pt for stage IV disease): male/female 60/19, median age 63 (23-79), PS 0/1/ND 47/31/1, squamous/adenocarcinoma/undifferentiated 53/25/1; esophagus/cardia 74/5; median daily caloric intake 1,720 Kcal (550-3160). 74 pts were treated by CRT (5 pts experienced anaphylaxis during the first cetuximab infusion). ORR (ITT) was achieved in 61 pts (77.2%), 6 pts (7.6%) had stable disease, and 9 pts (11.4%) had disease progression (3 pts were not evaluable). Grade 3-4 toxicities induction therapy/CRT were (%): neutropenia: 7.6/28.4; febrile neutropenia: 0.0/2.7; vomiting: 1.3/4.0; mucositis: 1.3/5.4; diarrhea: 3.8/2.7; dysphagia-esophagitis: 1.3/13.5; rash: 7.6/10.8; allergy 8.9/0.0. One toxic death (1.3%) occurred after CRT related to esophagitis with GI bleeding. Conclusions: Threshold for efficacy was reached with an ORR of 77.2%. Chemoradiotherapy with FOLFOX plus cetuximab is active and has an acceptable toxicity profile in patients with locally advanced cardia or esophageal cancer. No significant financial relationships to disclose.
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Affiliation(s)
- G. Lledo
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - P. Michel
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - L. Dahan
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - L. Mineur
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - M. Galais
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - O. Dupuis
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - S. Abdiche
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - N. Jovenin
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - B. Chibaudel
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - A. De Gramont
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
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