CHICAGOConcurrent chemo-radiotherapy and consolidation docetaxel
(Taxotere) achieved an unprecedented 3-year survival rate of 40% in patients
with stage IIIB non-small-cell lung cancer (NSCLC) in a phase II trial (SWOG
"The survival comparison at 3 years of 40% with SWOG 9504 and 18% with
SWOG 9019 (as a historical control) are very encouraging. But since these
results are in a phase II study, they need to be interpreted with
caution," David R. Gandara, MD, said at the Second International Chicago
Symposium on Malignancies of the Chest and Head & Neck.
Dr. Gandara, professor of medicine and associate director for clinical
research, University of California, Davis, Cancer Center, Sacramento, and chair
of the Southwest Oncology Group (SWOG) Lung Committee, explained the hypothesis
behind recent SWOG trials for NSCLC: that concurrent chemoradiotherapy plus
full-dose consolidation chemotherapy may improve outcomes in patients with
locally advanced disease.
Two Potential Designs
"If we look at locally advanced stage III disease as a two-compartment
model, where we have to address both the loco-regional disease and the distant
metastases, then combination sequential and concurrent chemoradiotherapy may
be optimal," he said.
There are two potential designs for optimizing combination chemotherapy and
radiotherapy. "The first would be to give full-dose induction chemotherapy
followed by concurrent chemoradiation. Depending on the agent, this would
sometimes require a marked decrease in the dose of chemotherapy given with
radiation," Dr. Gandara said.
The flip side of this coin, he said, would be to give a lower locoregional
chemotherapy dose first, followed by full-dose consolidation chemotherapy, the
scheme followed in SWOG 9504.