SAN FRANCISCOSurvival of patients with limited-stage small-cell
lung cancer (SCLC) has doubled in the past 2 decades, largely because of
advances in thoracic radiation, according to an analysis of more than 2 dozen
randomized clinical trials and the SEER database. The findings were presented
at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO
Pasi Jänne, MD, PhD, of Dana-Farber Cancer Institute and Harvard Medical
School, presented the analysis of 26 phase III North American clinical trials
performed by cooperative groups. The trials were drawn from a group of 44
trials identified from the SEER database and a MEDLINE search.
The sample included 5,245 patients evaluated in 6 trials of thoracic
radiation therapy, 14 trials of chemotherapy regimens, and 6 trials of biologic
modifiers. The analysis examined two time periods: 1972 to 1981 and 1982 to
1992 (completed by 1996).
Studies from 1972 to 1981 reported fewer patients per arm: 116 vs 308 for
studies from the more recent period. Median response rate was 75% and median
survival was 12 months for these earlier studies. The more recent period, 1982
to 1992, showed an 85% response rate and a significantly higher median survival
of 17 months (P < .001), Dr. Jänne said.
In the SEER database, there has been a linear 5-month increase in median
survival of limited-stage SCLC patients from 1973 to 1996. Since 1975, the
5-year survival of these patients has more than doubled, from 5.2% to 12.2% (P
Five of the 26 studies (19%) had a statistically significant prolongation in
survival for the experimental vs the control arms, and all five evaluated some
aspect of thoracic radiation therapy. Fourteen of 14 chemotherapy studies and 6
of 6 studies of biologic agents demonstrated equivalency between the treatment
and experimental arms, Dr. Jänne reported.
Which Studies Should Go Forward?