Comparison of toxicity and outcomes of concurrent radiotherapy with carboplatin/paclitaxel or cisplatin/etoposide in stage III non–small cell lung cancer

Abstract

Concurrent chemoradiotherapy (CCRT) has become the standard of care for patients with unresectable stage III non–small cell lung cancer (NSCLC). The comparative merits of two widely used regimens: carboplatin/paclitaxel (PC) and cisplatin/etoposide (PE), each with concurrent radiotherapy, remain largely undefined. Records for consecutive patients with stage III NSCLC treated with PC or PE and ≥60 Gy chest radiotherapy between 2000 and 2011 were reviewed for outcomes and toxicity. Survival was estimated using the Kaplan–Meier method and Cox modeling with the Wald test. Comparison across groups was done using the student's t and chi-squared tests. Seventy-five (PC: 44, PE: 31) patients were analyzed. PC patients were older (median 71 vs. 63 years; P = 0.0006). Other characteristics were comparable between groups. With PE, there was significantly increased grade ≥3 neutropenia (39% vs. 14%, P = 0.024) and thrombocytopenia (10% vs. 0%, P = 0.039). Radiation pneumonitis was more common with PC (66% vs. 38%, P = 0.033). Five treatment-related deaths occurred (PC: 3 vs. PE: 2, P = 1.000). With a median follow-up of 51.6 months, there were no significant differences in relapse-free survival (median PC 12.0 vs. PE 11.5 months, P = 0.700) or overall survival (median PC 20.7 vs. PE 13.7 months; P = 0.989). In multivariate analyses, no factors predicted for improved survival for either regimen. PC was more likely to be used in elderly patients. Despite this, PC resulted in significantly less hematological toxicity but achieved similar survival outcomes as PE. PC is an acceptable CCRT regimen, especially in older patients with multiple comorbidities.

Concomitant etoposide and cisplatin provided improved survival compared with docetaxel and cisplatin in patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy

“…[22] The incidence of severe neutropenia and thrombocytopenia was considerably lower in our study (12% and 0%, respectively) compared with other studies including PE regimen (39% vs. 10%). [22] Variations in terms of efficiency and toxicity have been reported between different nations receiving the same CT regimens. [37] These differences mainly emerge from ethnic instabilities in single-nucleotide polymorphism distributions that affect CT transport and metabolism.…”

“…[19] Several recent studies compared PE with PC in terms of efficiency and produced conflicting results. [14,20–22] However, docetaxel is a third-generation CT agent and its effectiveness has been demonstrated in many studies indicating that the docetaxel-cisplatin (DP) regimen was equal or superior to a PV combination. [23–26] In addition, docetaxel proved its superiority to vinca-alkaloids in combinations in both metastatic and LA-NSCLC.…”

DNA repair gene ERCC1 C118T polymorphism predicts sensitivity of recurrent esophageal cancer to radiochemotherapy in a Chinese population

“…Liew et al . demonstrated that a taxane‐contained regimen of concurrent chemotherapy could lead to serious radiation pneumonitis in non‐small cell lung cancer patients . This phenomenon suggests that a TP regimen must be used with caution in cases of concurrent radiochemotherapy.…”

Radio(chemo)therapy in locally advanced nonsmall cell lung cancer

“…Patient comorbidities may help guide the choice of agent. While overall survival seems to be similar with these, less haematological toxicity but a higher risk of radiation pneumonitis was observed with Carbo/paclitaxel when compared to Cis/Eto [41]. Pemetrexed (Pem)/Cis seems to have a survival benefit for patients with metastatic non-squamous NSCLC [42]; however, no clear advantages are reported in locally advanced disease.…”