ORLANDO, Florida—An aggressive strategy of induction and concurrent
chemoradiotherapy was feasible and well tolerated in a North Carolina study of
advanced non-small-cell lung cancer (NSCLC) patients, reported Mark A.
Socinski, MD, director of both the Multidisciplinary Thoracic Oncology Program
and the Clinical Trials Program, University of North Carolina, Chapel Hill (ASCO
abstract 1266).

"This is a population of patients that is potentially curable, but with
standard treatment approaches we only cure 15% to 20%." Dr. Socinski
pointed out. "The main problems are local and distant failure, so in this
study we incorporated more aggressive systemic therapy with a triplet, and gave
more aggressive locoregional therapy in terms of dose escalation with
concurrent therapy," he added.

‘Thinking Outside the Box’

The investigators previously demonstrated that induction and concurrent
carboplatin (Paraplatin) and paclitaxel with thoracic conformal radiation
therapy (TCRT) to a total dose of 74 Gy is tolerable and associated with
favorable survival outcomes. Patients receiving this regimen achieved a median
survival of 26 months and 1-year survival of 40%. (Cancer 92:1213-1223, 2001).
Analysis of the pattern of failure suggested that both locoregional and distant
failures were problematic; therefore, a more aggressive regimen was
incorporated into a subsequent trial.

Dr. Socinski said this approach reflects the benefit of "thinking
outside the box."

"We’ve been stuck with using 60 to 66 Gy, and we know this doesn’t
provide locoregional control as well as it should," he said.
"Therefore, we think this escalation of dose may be more effective."

The current regimen involved the triplet of carboplatin/irinotecan (CPT-11,
Camptosar)/paclitaxel supported by granulocyte colony-stimulating factor (G-CSF,
filgrastim [Neupogen]) as induction therapy, followed on day 43 by concurrent
carboplatin/paclitaxel and dose-escalated TCRT.