Randomized trial of chemotherapy and radiation therapy with or without warfarin for limited-stage small-cell lung cancer: a Cancer and Leukemia Group B study
| Autor: | L H Maurer, L L Zacharski, James E. Herndon, Mark R. Green, Joseph Aisner, Donna Hollis, Arthur T. Skarin, Robert W. Carey, Walter L. Eaton, Michael C. Perry, S Hammond |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Amsacrine Male Oncology Cancer Research medicine.medical_specialty Lung Neoplasms Cyclophosphamide medicine.medical_treatment Hemorrhage Small-cell carcinoma Disease-Free Survival Recurrence Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Carcinoma Small Cell Lung cancer Etoposide Aged Chemotherapy business.industry Cytarabine Warfarin Anticoagulants Cancer Middle Aged medicine.disease Combined Modality Therapy Survival Analysis Surgery Radiation therapy Female Cisplatin business medicine.drug |
| Zdroj: | Journal of Clinical Oncology. 15:3378-3387 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.1997.15.11.3378 |
| Popis: | PURPOSE Studies by the Veterans Administration Cooperative Studies Program and Cancer and Leukemia Group B (CALGB) suggested that the addition of warfarin to chemotherapy might enhance response and/or survival in small-cell lung cancer (SCLC). This randomized study evaluated the effect of warfarin with chemotherapy and radiation therapy in limited-stage SCLC. PATIENTS AND METHODS Patients were randomized to receive warfarin or no warfarin. All patients received three cycles of doxorubicin, cyclophosphamide, and etoposide (ACE). Cycles 4 and 5 (cisplatin, cyclophosphamide, and etoposide [PCE]) were given concurrently with radiation therapy. Three cycles of ACE were given after chemoradiation therapy, but were discontinued due to a high rate of pulmonary toxicity. RESULTS There were no significant differences in response rates, survival, failure-free survival, disease-free survival, or patterns of relapse between the warfarin-treated and control groups. In patients treated according to the initial design, an increase in failure-free survival seen with warfarin treatment approached significance (P = .07). Preamendment results, while not significant, did not have superimposable treatment survival curves. A landmark analysis at 8 months showed a median survival time after the landmark for complete responders of 33 months with warfarin treatment compared with < or = 13.75 months for complete or partial responders not treated with warfarin (P = .05). Differences between the complete responders in this preamendment population were not significant (P = .103). CONCLUSION Warfarin does not appear to improve outcome significantly in limited-stage SCLC. However, the differences in some variables between populations before the protocol amendment correspond to the favorable effects of anticoagulants observed in previous studies. |
| Databáze: | OpenAIRE |
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