Phase II trial of sequential chemotherapy followed by chemoradiation, surgery, and postoperative chemotherapy for the treatment of stage IIIA/IIIB non-small-cell lung cancer

Prudence Lam*, Stuart Berman, Robert Thurer, Simon Ashiku, Malcolm DeCamp, Michael Goldstein, Susan Schumer, Balazs Halmos, Daniel Karp, Danielle Coute, Mark Bergman, Cynthia Boyd-Sirard, Sai Hong Ou, Alona Muzikansky, Cally Woodard, Mark Huberman

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The optimal treatment of locally advanced non-small-cell lung cancer remains a challenge. Although the benefit of combined chemoradiation has been established, the optimal chemotherapy regimen, timing of full-dose chemotherapy, and how best to combine chemotherapy with radiation to maximize systemic and radiosensitizing effects remain unclear. Patients and methods: Twenty-nine patients with pathologically confirmed stage IIIA/IIIB non-small-cell lung cancer were included in a phase II trial of sequential carboplatin/paclitaxel followed by chemoradiation, surgery, and postoperative gemcitabine. Twenty-five patients (86%) completed the concurrent chemotherapy and radiation therapy phase and were eligible for surgery. At restaging, 7 patients (21%) showed disease progression. Seventeen patients (59%) went on to surgery. Few were able to tolerate full postoperative chemotherapy. Results: The 1-year overall survival rate was 61%, with a 2-year survival rate of 56%. Median overall survival was 25.2 months. Seven of the patients are alive and without recurrence at the time of this writing. Our median follow-up time was 22.2 months. Reversible grade 3/4 toxicities were fairly common, experienced in 45% of patients. Conclusion: Our results with this combined modality approach are comparable with those of previous, similar studies. Postoperative chemotherapy after initial combined modality therapy is often not feasible, reinforcing the value of initial systemic therapy. Long-term results are still suboptimal and await studies adding targeted therapies to our usual chemotherapy/radiation approaches.

Original languageEnglish (US)
Pages (from-to)122-129
Number of pages8
JournalClinical Lung Cancer
Volume8
Issue number2
DOIs
StatePublished - Jan 1 2006

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Non-Small Cell Lung Carcinoma
Drug Therapy
gemcitabine
Therapeutics
Survival Rate
Radiation
Radiation-Sensitizing Agents
Combined Modality Therapy
Carboplatin
Paclitaxel
Disease Progression
Radiotherapy
Recurrence
Survival

Keywords

  • Mediastinal staging
  • Multimodality therapy
  • Radiosensitizing
  • Timing of administration

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Lam, Prudence ; Berman, Stuart ; Thurer, Robert ; Ashiku, Simon ; DeCamp, Malcolm ; Goldstein, Michael ; Schumer, Susan ; Halmos, Balazs ; Karp, Daniel ; Coute, Danielle ; Bergman, Mark ; Boyd-Sirard, Cynthia ; Ou, Sai Hong ; Muzikansky, Alona ; Woodard, Cally ; Huberman, Mark. / Phase II trial of sequential chemotherapy followed by chemoradiation, surgery, and postoperative chemotherapy for the treatment of stage IIIA/IIIB non-small-cell lung cancer. In: Clinical Lung Cancer. 2006 ; Vol. 8, No. 2. pp. 122-129.
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title = "Phase II trial of sequential chemotherapy followed by chemoradiation, surgery, and postoperative chemotherapy for the treatment of stage IIIA/IIIB non-small-cell lung cancer",
abstract = "Background: The optimal treatment of locally advanced non-small-cell lung cancer remains a challenge. Although the benefit of combined chemoradiation has been established, the optimal chemotherapy regimen, timing of full-dose chemotherapy, and how best to combine chemotherapy with radiation to maximize systemic and radiosensitizing effects remain unclear. Patients and methods: Twenty-nine patients with pathologically confirmed stage IIIA/IIIB non-small-cell lung cancer were included in a phase II trial of sequential carboplatin/paclitaxel followed by chemoradiation, surgery, and postoperative gemcitabine. Twenty-five patients (86{\%}) completed the concurrent chemotherapy and radiation therapy phase and were eligible for surgery. At restaging, 7 patients (21{\%}) showed disease progression. Seventeen patients (59{\%}) went on to surgery. Few were able to tolerate full postoperative chemotherapy. Results: The 1-year overall survival rate was 61{\%}, with a 2-year survival rate of 56{\%}. Median overall survival was 25.2 months. Seven of the patients are alive and without recurrence at the time of this writing. Our median follow-up time was 22.2 months. Reversible grade 3/4 toxicities were fairly common, experienced in 45{\%} of patients. Conclusion: Our results with this combined modality approach are comparable with those of previous, similar studies. Postoperative chemotherapy after initial combined modality therapy is often not feasible, reinforcing the value of initial systemic therapy. Long-term results are still suboptimal and await studies adding targeted therapies to our usual chemotherapy/radiation approaches.",
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author = "Prudence Lam and Stuart Berman and Robert Thurer and Simon Ashiku and Malcolm DeCamp and Michael Goldstein and Susan Schumer and Balazs Halmos and Daniel Karp and Danielle Coute and Mark Bergman and Cynthia Boyd-Sirard and Ou, {Sai Hong} and Alona Muzikansky and Cally Woodard and Mark Huberman",
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Lam, P, Berman, S, Thurer, R, Ashiku, S, DeCamp, M, Goldstein, M, Schumer, S, Halmos, B, Karp, D, Coute, D, Bergman, M, Boyd-Sirard, C, Ou, SH, Muzikansky, A, Woodard, C & Huberman, M 2006, 'Phase II trial of sequential chemotherapy followed by chemoradiation, surgery, and postoperative chemotherapy for the treatment of stage IIIA/IIIB non-small-cell lung cancer', Clinical Lung Cancer, vol. 8, no. 2, pp. 122-129. https://doi.org/10.3816/CLC.2006.n.040

Phase II trial of sequential chemotherapy followed by chemoradiation, surgery, and postoperative chemotherapy for the treatment of stage IIIA/IIIB non-small-cell lung cancer. / Lam, Prudence; Berman, Stuart; Thurer, Robert; Ashiku, Simon; DeCamp, Malcolm; Goldstein, Michael; Schumer, Susan; Halmos, Balazs; Karp, Daniel; Coute, Danielle; Bergman, Mark; Boyd-Sirard, Cynthia; Ou, Sai Hong; Muzikansky, Alona; Woodard, Cally; Huberman, Mark.

In: Clinical Lung Cancer, Vol. 8, No. 2, 01.01.2006, p. 122-129.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Phase II trial of sequential chemotherapy followed by chemoradiation, surgery, and postoperative chemotherapy for the treatment of stage IIIA/IIIB non-small-cell lung cancer

AU - Lam, Prudence

AU - Berman, Stuart

AU - Thurer, Robert

AU - Ashiku, Simon

AU - DeCamp, Malcolm

AU - Goldstein, Michael

AU - Schumer, Susan

AU - Halmos, Balazs

AU - Karp, Daniel

AU - Coute, Danielle

AU - Bergman, Mark

AU - Boyd-Sirard, Cynthia

AU - Ou, Sai Hong

AU - Muzikansky, Alona

AU - Woodard, Cally

AU - Huberman, Mark

PY - 2006/1/1

Y1 - 2006/1/1

N2 - Background: The optimal treatment of locally advanced non-small-cell lung cancer remains a challenge. Although the benefit of combined chemoradiation has been established, the optimal chemotherapy regimen, timing of full-dose chemotherapy, and how best to combine chemotherapy with radiation to maximize systemic and radiosensitizing effects remain unclear. Patients and methods: Twenty-nine patients with pathologically confirmed stage IIIA/IIIB non-small-cell lung cancer were included in a phase II trial of sequential carboplatin/paclitaxel followed by chemoradiation, surgery, and postoperative gemcitabine. Twenty-five patients (86%) completed the concurrent chemotherapy and radiation therapy phase and were eligible for surgery. At restaging, 7 patients (21%) showed disease progression. Seventeen patients (59%) went on to surgery. Few were able to tolerate full postoperative chemotherapy. Results: The 1-year overall survival rate was 61%, with a 2-year survival rate of 56%. Median overall survival was 25.2 months. Seven of the patients are alive and without recurrence at the time of this writing. Our median follow-up time was 22.2 months. Reversible grade 3/4 toxicities were fairly common, experienced in 45% of patients. Conclusion: Our results with this combined modality approach are comparable with those of previous, similar studies. Postoperative chemotherapy after initial combined modality therapy is often not feasible, reinforcing the value of initial systemic therapy. Long-term results are still suboptimal and await studies adding targeted therapies to our usual chemotherapy/radiation approaches.

AB - Background: The optimal treatment of locally advanced non-small-cell lung cancer remains a challenge. Although the benefit of combined chemoradiation has been established, the optimal chemotherapy regimen, timing of full-dose chemotherapy, and how best to combine chemotherapy with radiation to maximize systemic and radiosensitizing effects remain unclear. Patients and methods: Twenty-nine patients with pathologically confirmed stage IIIA/IIIB non-small-cell lung cancer were included in a phase II trial of sequential carboplatin/paclitaxel followed by chemoradiation, surgery, and postoperative gemcitabine. Twenty-five patients (86%) completed the concurrent chemotherapy and radiation therapy phase and were eligible for surgery. At restaging, 7 patients (21%) showed disease progression. Seventeen patients (59%) went on to surgery. Few were able to tolerate full postoperative chemotherapy. Results: The 1-year overall survival rate was 61%, with a 2-year survival rate of 56%. Median overall survival was 25.2 months. Seven of the patients are alive and without recurrence at the time of this writing. Our median follow-up time was 22.2 months. Reversible grade 3/4 toxicities were fairly common, experienced in 45% of patients. Conclusion: Our results with this combined modality approach are comparable with those of previous, similar studies. Postoperative chemotherapy after initial combined modality therapy is often not feasible, reinforcing the value of initial systemic therapy. Long-term results are still suboptimal and await studies adding targeted therapies to our usual chemotherapy/radiation approaches.

KW - Mediastinal staging

KW - Multimodality therapy

KW - Radiosensitizing

KW - Timing of administration

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