According to a study published in the Journal of Clinical Oncology, patients with unresectable stage III non-small-cell lung cancer (NSCLC) survive longer, but have more toxic effects of treatment, when treated initially with concurrent chemotherapy and radiation therapy. Additional, subsequent chemotherapy may also provide benefit.
Lung cancer remains the leading cause of cancer-related mortality in the United States and Europe. NSCLC refers to the type of cell in which the cancer originated. It accounts for approximately 75% to 80% of all lung cancers. If NSCLC cannot be surgically removed, either due to its location, the extent of spread, or the patient’s overall medical condition, it is referred to as “unresectable”.
Treatment of unresectable stage III NSCLC has progressed from treatment with radiation alone, which resulted in poor survival, to improved survival with sequential therapy (chemotherapy followed by radiation therapy). More recently, researchers have focused on the role of concurrent therapy (chemotherapy and radiation given at the same time).
In order to test the effectiveness of different treatment approaches for NSCLC, researchers in the US conducted a phase II clinical trial. Patients with stage IIIA or IIIB NSCLC were given one of three treatments: sequential therapy (chemotherapy followed by radiation); induction/concurrent therapy (chemotherapy followed by chemotherapy plus radiation); or concurrent/consolidation therapy (chemotherapy plus radiation followed by additional chemotherapy). The chemotherapy drugs used were paclitaxel and carboplatin. A previous trial had suggested that treatment with sequential therapy (chemotherapy followed by radiation) resulted in a median survival of 13 months.
Patients treated with sequential therapy (chemotherapy followed by radiation) or induction/concurrent therapy (chemotherapy followed by chemotherapy plus radiation) had similar survival; both groups of patients survived for a median of 13 months. Patients treated with concurrent/consolidation therapy (chemotherapy plus radiation followed by additional chemotherapy) survived for a median of 16 months. Toxic effects of treatment were more common among patients receiving concurrent chemotherapy and radiation, and the most common severe adverse effect was esophagitis (inflammation of the esophagus).
An accompanying editorial summarizes the evidence from this and related studies. It concludes that treatment of stage III NSCLC with concurrent chemotherapy and radiation therapy appears to improve survival, although with increased toxicity. Induction chemotherapy (chemotherapy before the concurrent chemotherapy and radiation) does not appear to produce a benefit. Consolidation chemotherapy (chemotherapy after the concurrent chemotherapy and radiation) has an uncertain role and will need to be evaluated in further studies.
Patients with NSCLC may wish to talk with their doctor about the risks and benefits of participating in a clinical trial evaluating therapeutic options for NSCLC. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.
Reference: Belani CP, Choy H, Bonomi P et al. Combined chemotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. Journal of Clinical Oncology. 2005;23:5883-5891.
Accompanying editorial: Vokes EE. Optimal therapy for unresectable stage III non-small-cell lung cancer. Journal of Clinical Oncology. 2005;23:5853-5855.
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