Treatment of patients with inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC) often involves concurrent chemotherapy and radiation therapy. A phase II clinical trial that assessed the effect of giving an initial course of chemotherapy (induction chemotherapy) prior to concurrent chemotherapy and radiation therapy suggests that the addition of induction chemotherapy may improve survival. These results were published in the International Journal of Radiation Oncology, Biology, Physics.

Lung cancer remains the leading cause of cancer deaths in the U.S. and Europe. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for approximately 75%-80% of all lung cancers.

Stage IIIA NSCLC is a single cancer mass that is not invading any adjacent organs and involves one or more lymph nodes away from the primary cancer. Stage IIIA cancers are further subdivided into N1 and N2 subgroups. N1 cancers involve lymph nodes farther away from the mediastinum and are easier to remove with surgery. N2 cancers involve lymph nodes in the mediastinum and may be difficult to remove surgically.

Stage IIIB NSCLC has already spread to more than one location in the chest, but cannot be detected outside the chest cavity with currently available diagnostic tests. Unfortunately, most of these patients have undetectable spread of cancer outside the chest. This undetectable cancer is the cause of relapse or recurrence of cancer in the majority of patients.

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To assess the effect of induction chemotherapy prior to standard treatment with concurrent chemotherapy and radiation therapy, researchers in Korea evaluated 40 patients with inoperable stage IIIA or IIIB NSCLC. The median age of the patients was 59 years. Induction chemotherapy involved three cycles of gemcitabine and vinorelbine. This was followed by oral etoposide and cisplatin given concurrently with radiation therapy.

  • 29 patients (73%) experienced at least a partial reduction in cancer following treatment. Disease remained stable in four patients (10%) and worsened in seven patients (17%).
  • Median survival was 23 months.
  • Two-year survival was 44%.
  • Survival varied by whether or not the cancer involved the supraclavicular lymph nodes. Patients with supraclavicular lymph node involvement survived for a median of 12 months, compared to 28 months among those without supraclavicular lymph node involvement.
  • The most common toxic effect of induction therapy was neutropenia, but only seven of the 40 patients developed febrile neutropenia.
  • Toxicity was more common during concurrent chemotherapy and radiation therapy. Blood-related adverse effects occurred in 76% of patients, esophagitis occurred in 24% of patients, and there were two deaths due to treatment.

The researchers conclude that induction chemotherapy with gemcitabine and vinorelbine, followed by concurrent chemotherapy and radiation therapy, may improve the survival of patients with stage III NSCLC.

Reference: Lee DH, Han J-Y, Cho KH et al. Phase II Study of Induction Chemotherapy with Gemcitabine and Vinorelbine Followed By Concurrent Chemoradiotherapy With Oral Etoposide and Cisplatin in Patients with Inoperable Stage III non-small-cell lung cancer. International Journal of Radiation Oncology, Biology, Physics. 2005;63:1037-1044.

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