ORLANDO, FloridaAn 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(Drug information on carboplatin) (Paraplatin) and paclitaxel(Drug information on 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(Drug information on filgrastim) [Neupogen]) as induction therapy, followed on day 43 by concurrent carboplatin/paclitaxel and dose-escalated TCRT.