Infusional topotecan with concurrent radiation followed by consolidation etoposide platinum and docetaxel for patients with high risk unresectable stage III non-small cell lung cancer (NSCLC)
| Autor: | B. K. Fisher, S. Seung, H. J. Ross |
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| Rok vydání: | 2006 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 24:17042-17042 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | 17042 Background: Good PS patients (pts) with locally advanced NSCLC treated with concurrent chemoradiotherapy have a 20–40% 3 year survival. Treatment is arduous and poor PS or high risk pts often cannot complete a full course of treatment. The optimal combination of chemotherapy and radiation and the role of consolidation chemotherapy are unknown. Despite response rates exceeding 50%, most pts eventually progress with brain as the first site of relapse in up to 30%. Continuous infusion chemotherapy is better tolerated than intermittent chemotherapy combined with radiation and may improve outcome in other locally advanced aerodigestive malignancies, however it has not been studied extensively in NSCLC. Topotecan is active in NSCLC, can safely be combined with radiation, can be given by continuous infusion and penetrates the CNS making it an attractive study agent in locally advanced NSCLC. Methods: In this pilot study, 20 pts were treated with infusional topotecan 0.4 mg/m2/d with 3D conformal radiation to 63 Gy both delivered M-F for 7 weeks. Pts without progressive disease underwent consolidation chemotherapy with etoposide and platinum for one cycle to take advantage of upregulation of topoisomerase II by topotecan. Two cycles of docetaxel consolidation followed. Study endpoints include response, time to progression, survival, toxicity and development of CNS metastases. Results: All pts have completed induction chemoradiotherapy. 12/20 have completed consolidation. 17/20 pts had a PR and 1/20 SD after induction chemoradiation. 1 pt developed CNS metastases 228 days after study entry and is alive with disease at 541 days. 3 pts had pulmonary emboli. Therapy has been well tolerated with 1/20 grade 4 lymphopenia. Grade 3 hematologic toxicity was seen in 17/20 pts. Other grade 3 toxicities include esophagitis (3/20), esophageal stricture (2/20), pneumonitis (6/20), fatigue (6/20), weight loss (1/20). Conclusion: Continuous infusion topotecan with radiation is well tolerated and shows evidence of activity in the management of poor risk patients with unresectable stage III NSCLC. Survival data will be presented at the meeting. No significant financial relationships to disclose. |
| Databáze: | OpenAIRE |
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