Paclitaxel, Carboplatin and Gemcitabine Combination as Induction Chemotherapy for Stage IIIA N2 Bulky Non-Small Cell Lung Cancer

Abstract

Background: Induction chemotherapy followed by surgical resection or definitive radiotherapy for patients affected by stage IIIA N2 bulky non-small cell lung cancer (NSCLC) has been investigated in several trials. Patients and Methods: In this present study, 52 patients with stage IIIA N2 bulky NSCLC with cytologically or histologically confirmed mediastinal lymph node involvement received paclitaxel 175 mg/mq on day 1, carboplatin AUC 5 on day 1 and gemcitabine 1,000 mg/mq on day 1 and 8 every 3 weeks for three cycles as induction chemotherapy. Results: Objective response (4 complete remission and 36 partial remission) was achieved in 40/52 patients. No early or toxic deaths were observed. Twenty-two patients were surgically explored. Fifteen were excluded for resection for biopsy-proven residual tumour in mediastinal nodes. Complete surgical resection was performed in 15 patients with confirmed pathological downstaging. Pathological complete response was achieved in 4 patients. No surgery-related mortality or significant morbidity was reported. Adjuvant radiotherapy was delivered in 15 patients, and 30 patients received definitive radiotherapy. Conclusion: In the present study, the combination of paclitaxel, carboplatin and gemcitabine has been a safe and active regimen in poor-prognosis stage IIIA N2 bulky NSCLC.

Final Overall Results of a Study with a Novel Triplet Induction Chemotherapy Regimen (PACCAGE) Followed by Consolidation Radiotherapy in Locally Advanced Inoperable Non-small Cell Lung Cancer (NSCLC)

“…12 Of notice is the superior response in stage IIIA (72%) versus IIIB (46%) patients indicating a higher activity of chemotherapy with lower tumor burden. In the study by Abratt et al and Giannotti et al,11,24 81.5% and 72.7% OR was obtained after three cycles of an identical regimen before surgery in 29 stage IIIA (out of a total of 44) and 52 bulky stage IIIAN2 patients, respectively. Although OR was high in these studies, a pathologic complete responder was rather exceptional (five and four patients, respectively).…”

Is trimodality approach better then bimodality in stage IIIA, N2 positive non-small cell lung cancer?

“…We used paclitaxel 50 mg/m 2 /week for 5 weeks in CCRT, which may have been insufficient for disease eradication. In contrast, in previous studies of neoadjuvant chemotherapy with paclitaxel containing combination chemotherapy for stage IIIA NSCLC, paclitaxel 175 or 200 mg/m 2 was given every 3 weeks for two to three times, and the achieved pCR rates varied from 17% to 21% [28][29][30][31]. Kuten et al studied neoadjuvant CCRT with weekly paclitaxel and carboplatin, followed by surgery in locally advanced NSCLC [12].…”

Stage N2/IIIA Non Small Cell Lung Cancer: An Evidence-Based Review

“…Surgery even when combined with neoadjuvant chemotherapy does not have a 5yr survival greater than 5% in these patients and should not be offered as part of treatment as a general rule. However in select patients where there is a marked clinical response or complete response after chemo and radiation therapy it may be considered although this is controversial [56][57][58]. The SWOG 8805 trial, where feasibility of concurrent induction chemoradiation therapy followed by surgery in stage IIIA and IIIB patients was studied; demonstrated an objective response rate of 59% and a further 30% had stable disease.…”