CHICAGOConcurrent chemo-radiotherapy and consolidation docetaxel(Drug information on 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 9504).
"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.