Induction gemcitabine in standard dose or prolonged low-dose with cisplatin followed by concurrent radiochemotherapy in locally advanced non-small cell lung cancer: a randomized phase II clinical trial

Abstract

Disclosure: No potential conflicts of interest were disclosed.Background. The optimal combination of chemotherapy with radiation therapy for treatment locally advanced non-small cell lung cancer (NSCLC) remains an open issue. This randomized phase II study compared gemcitabine in two different schedules and cisplatin -as induction chemotherapy, followed by radiation therapy concurrent with cisplatin and etoposid.Patients and methods. Eligible patients had microscopically confirmed inoperable non-metastatic non-small cell lung cancer; fulfilled the standard criteria for platin-based chemotherapy; and signed informed consent. Patients were treated with 3 cycles of induction chemotherapy with gemcitabine and cisplatin. Two different aplications of gemcitabine were compared: patients in arm A received gemcitabine at 1250 mg/m 2 in a standard half hour i.v. infusion on days 1 and 8; patients in arm B received gemcitabine at 250 mg/m 2 in prolonged 6-hours i.v. infusion on days 1 and 8. In both arms, cisplatin 75 mg/m 2 on day 2 was administered. All patients continued treatment with radiation therapy with 60-66 Gy concurrent with cisplatin 50 mg/m 2 on days 1, 8, 29 and 36 and etoposid 50 mg/m 2 on days 1-5 and 29-33. The primary endpoint was response rate (RR) after induction chemotherapy; secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS).Results. From September 2005 to November 2010, 106 patients were recruited to this study. No statistically signifficant differences were found in RR after induction chemotherapy between the two arms (48.1% and 57.4%, p = 0.34).Toxicity profile was comparable and mild with grade 3/4 neutropenia as primary toxicity in both arms. One patient in arm B suffered from acute peripheral ischemia grade 4 and an amputation of lower limb was needed. With a median follow-up of 69.3 months, progression-free survival and median survival in arm A were 15.7 and 24.8 months compared to 18.9 and 28.6 months in arm B. The figures for 1-and 3-year overall survival were 73.1% and 30.8% in arm A, and 81.5 % and 44.4% in arm B, respectively.Conclusions. Among the two cisplatin-based doublets of induction chemotherapy for inoperable NSCLC, both schedules of gemcitabine have a comparable toxicity profile. Figures for RR, PFS and OS are among the best reported in current literature. While there is a trend towards better efficacy of the treament with prolonged infusion of gemcitabine, the difference between the two arms did not reach statistical significance.

Clinical outcomes in stage III non-small cell lung cancer patients treated with durvalumab after sequential or concurrent platinum-based chemoradiotherapy – single institute experience

“…The results of PFS and OS in our series of patients with stage III NSCLC treated with durvalumab after ChT-RT confirmed improved survival compared to our historical data of treatment before durvalumab introduction. 10 , 11 , 12 After the median follow-up time of 23 months, 12- and 24-month PFS (71% and 45.8%, respectively) and OS (86.7% and 68.6%, respectively) in our series were comparable with those in the PACIFIC trial (PFS 55.3% and 44.8% and OS 83.1% and 66.3%). 1 , 2 , 3 , 4 In addition, data from other real-world reports have confirmed the advantage of maintenance treatment with durvalumab over ChT-RT only.…”

“…Treatment with induction gemcitabine in our historical analysis had not revealed excessive AE 10 , 11 , 12 . Induction, sequential and concomitant regimes were well tolerated also in the present series (data not shown).…”

PD-L1 expression can be regarded as prognostic factor for survival of non-small cell lung cancer patients after chemoradiotherapy

“…All patients underwent three-dimensional CT-based conformal RT with a linear accelerator photon beam of 5-10 MV with a total dose of 60-66 Gy in 2 Gy fractions 5 times weekly. Concurrently, patients were treated with two cycles of cisplatin and etoposide [3].…”

Independent clinical research may alleviate disparities in cancer treatment

“…A reader interested in this particular treatment will find more information in publications which come from a wide spectrum of countries: Slovenia, India, China, Mexico and Egypt. [123456789]…”