Lung Cancer Patients More Likely to be Eligible for Surgery

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After Neoadjuvant Chemotherapy: Presented at ICACT

http://www.docguide.com/news/content.ns ... 7D00705A03

By Jill Stein

PARIS, FRANCE -- February 9, 2007 -- Use of induction chemotherapy with doxetaxel plus carboplatin followed by concomitant chemotherapy/radiotherapy increases the number of patients who can undergo surgical resection for advanced non-small-cell lung cancer (NSCLC), according to preliminary data presented here at the 18th International Congress on Anti-Cancer Treatment (ICACT).

While surgical resection is the optimal treatment for NSCLC, patients are frequently ineligible because of advanced disease.

Guido Del Conte, MD, director, division of medical oncology, Trieste Hospital, Trieste, Italy, and colleagues reported results in 23 patients who received docetaxel 100 mg/m2 on day 1 plus carboplatin AUC 6 on day 2 every 21 days for a total of 2 cycles in combination with granulocyte colony-stimulating factor 300 mcg/m2 every other day.

After 6 to 7 weeks, patients received radiotherapy at varying dosages from 45 to 54 Gy (depending on treatment tolerability and the patient's condition) combined with lower dose chemotherapy with carboplatin AUC 2 and docetaxel 15 mg/m2 on the first day of each week of radiotherapy.

Participants in the trial had stage III NSCLC and were thus considered initially eligible for surgery.

Results showed that 13 of the 23 patients were considered operable at the end of treatment. Overall, 5 (22%) patients underwent a lobectomy, 2 (9%) had a pneumonectomy, and 6 (26%) had only a thoracotomy. The remaining 10 patients (43%), were considered inoperable, Dr. Del Conte said in a presentation on February 9th.

Overall, there were no cases of severe hematologic toxicity. Severe mucositis developed in 3 patients.

The median survival was 26 months.

"While treatment protocols are reasonably well established for stage I, II, and IV NSCLC, the therapeutic approach to stage III disease remains less well-defined and continues to be an area of active investigation," Dr. Del Conte explained. "Among the difficulties in determining the optimal treatment is the fact that stage III disease includes a very heterogeneous group with different prognoses."

Most of the cases are initially unresectable and are candidates for combined modality therapy, he continued. Different strategies have been attempted over the last decade to identify the best combination of chemotherapy and radiotherapy.

"The results of this prospective study of induction chemotherapy followed by concurrent chemotherapy and radiation therapy suggest that this regimen increases the number of patients who can undergo surgical resection with a relatively low toxicity," he said.