Concomitant pemetrexed/carboplatin chemotherapy with 3-D conformal radiotherapy followed by pemetrexed/carboplatin consolidation chemotherapy in locally advanced non-small cell lung cancer in a Chinese population

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e18502-e18502
Author(s):  
S. Ma ◽  
Y. Xu ◽  
X. Yu
Keyword(s):  
Lung Cancer ◽  
Chinese Population ◽  
Advanced Nsclc ◽  
Radiation Pneumonitis ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc ◽  
Grade 3 ◽  
Carboplatin Auc

e18502 Background: Pemetrexed in combination with carboplatin has been shown to have promising activity, as well as superior toxicity profile in advanced non-small cell lung cancer(NSCLC). Radiotherapy(RT) has been shown to improve survival of patients with locally advanced NSCLC when combined with other platin doublets. This phase II study of concomitant pemetrexed/carboplatin chemotherapy(CT) with 3-D conformal RT followed by pemetrexed/carboplatin consolidation CT in locally advanced NSCLC was designed to evaluate the efficacy and safety of this novel regimen. This report presents preliminary information of 10 patients who have completed treatment. Methods: 10 chemoradiation (CRT)-naive and stage IIIA or IIIB (not effusion) with KPS≥80 patients were included in this study between February 2008 and October 2008. Patients received pemetrexed 500 mg/m2, carboplatin AUC 5 CT repeated q3 weeks for 2 cycles concomitant with RT and 3 cycles of consolidation pemetrexed (500 mg/m2) and carboplatin (AUC=5) q3 weeks. Median total dose of RT, without elective nodal irradiation, was 62 Gy (range: 60-66 Gy) with 2 Gy daily fractions. Results: 1 (10%) and 8 patients (80%) had a complete or partial response respectively, while 1 patient(10%) had progression of the disease(brain metastases). The overall response rate (90%,95% confidence interval (CI): 68%-97%) exceeded the goal per study design. After concomitant CRT, the main toxicity was neutropenia, with a median ANC nadir of 1.6, three patients had Grade 3 neutropenia, One patient had Grade 4 neutropenia. Grade 3 thrombocytopenia was seen in one patient, grade 3 esophagitis in one patient and grade 3 radiation pneumonitis in one patient. Consolidation CT was not administered to 3 patients- one due to the development of brain metastases during the first month after chemoradiation, one due to patient refusal and one due to grade 3 radiation pneumonitis. Conclusions: This preliminary data suggests that concomitant treatment was well tolerated, with promising activity and a significant improvement of QoL in a Chinese population with locally advanced NSCLC. No significant financial relationships to disclose.

scholarly journals Initial Experience of Video-Assisted Thoracic Surgery Lobectomy After Neoadjuvant Chemotherapy Plus Toripalimab in a Patient with Locally Advanced Non-Small Cell Lung Cancer: A Case Report

2021 ◽  
Author(s):  
Wei Li ◽  
Chunbo Zhai ◽  
Jianpeng Che ◽  
Weiqian Wang ◽  
Bingchun Liu
Keyword(s):  
Lung Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Thoracic Surgery ◽  
Small Cell Lung Cancer ◽  
Immune Checkpoint ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Abstract Background: Immune checkpoint inhibitors were used for patients with advanced non-small cell lung cancer (NSCLC) more and more frequently and the effects were thrilling. Toripalimab as a new immune checkpoint inhibitor has been shown to be effective in patients with advanced NSCLC. However, data regarding the safety and feasibility of surgical resection after treatment with toripalimab for NSCLC remain scarce. Here, we present a case with locally advanced NSCLC that received video-assisted thoracic surgery (VATS) lobectomy after treatment with toripalimab in combination with chemotherapy.Case presentation: A 62-year-old male patient with a history of coronary artery stenting operation for two times was found a 3.4 × 3.2cm cavity mass in the upper lobe of the left lung and enlarged left hilar and mediastinal lymph nodes. Pathological results identified squamous cell carcinoma. The patient was diagnosed with a locally advanced NSCLC and received VATS left upper lobectomy and lymph node dissection after neoadjuvant chemotherapy plus toripalimab for 3 cycles. The postoperative pathological results showed complete tumor remission. Short-term follow-up results were excellent, and long-term results remain to be revealed.Conclusions: Our preliminary results showed that the use of neoadjuvant toripalimab and chemotherapy for the locally advanced NSCLC before surgical resection is safe and feasible.

scholarly journals Surgery after chemoradiotherapy in patients with stage III (N2 or N3, excluding T4) non-small cell lung cancer: a systematic review

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
A. Swaminath ◽  
E. T. Vella ◽  
K. Ramchandar ◽  
A. Robinson ◽  
C. Simone ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Background: Chemoradiation with curative intent is considered standard of care in patients with locally-advanced, stage III non-small cell lung cancer (NSCLC). However, there may be patients with stage III (N2 or N3, including T4) NSCLC who may be eligible for surgery. The objective of this systematic review was to investigate the efficacy of surgery after chemoradiotherapy compared with chemoradiotherapy alone in patients with locally-advanced NSCLC.Methods: MEDLINE, EMBASE, and PubMed were searched for randomized controlled trials (RCTs) comparing surgery after chemoradiotherapy versus chemoradiotherapy alone in patients with stage III (N2 or N3, excluding T4) NSCLC.Results: Three included RCTs consistently found no statistically significant difference in overall survival between patients with locally-advanced NSCLC who received surgery and chemoradiotherapy or chemoradiotherapy alone. Only one RCT found a significantly longer progression-free survival (PFS) in patients treated with chemoradiation and surgery (HR, 0.77; 95% confidence interval [CI], 0.62 to 0.96). In a post-hoc analysis of the same trial, the rate of overall survival was higher in the surgical group compared with patients matched in the chemoradiation-alone group if a lobectomy was performed (p=0.002), but not when a pneumonectomy was performed. Furthermore, fewer treatment-related deaths occurred among patients who received lobectomy compared with pneumonectomy.Conclusion: For patients with locally-advanced NSCLC, the benefits of surgery following chemoradiation were uncertain. Surgery after chemoradiation for patients who do not require a pneumonectomy may be an option.

scholarly journals Acute-Onset Pneumonitis while Administering the First Dose of Durvalumab

2019 ◽  
Vol 12 (2) ◽  
pp. 621-624 ◽  
Author(s):  
Erwin H.J. Tonk ◽  
Anne S.R. van Lindert ◽  
Joost J.C. Verhoeff ◽  
Karijn P.M. Suijkerbuijk
Keyword(s):  
Lung Cancer ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Acute Onset ◽  
Small Cell ◽  
Steroid Treatment ◽  
Consolidation Therapy ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc ◽  
Nsclc Patients

In locally advanced non-small cell lung cancer (NSCLC) patients, consolidation therapy with durvalumab (an anti-PD-L1 monoclonal antibody) has proven to significantly increase both progression free and overall survival after chemoradiotherapy. Here, we describe a case of acute pneumonitis during durvalumab administration for locally advanced NSCLC, causing persistent symptomatology and steroid treatment to date. To our knowledge, acute-onset pneumonitis during infusion of a PD-L1 inhibitor has not been described previously. This case illustrates that ICI-induced pneumonitis can occur anytime during treatment, especially after chemoradiation.

Favorable outcomes with chemoradiation and surgery for locally advanced non-small cell lung cancer: The BC Cancer Agency Vancouver experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7020-7020
Author(s):  
Wen Wen Shan ◽  
Sophie Sun ◽  
Janessa J. Laskin ◽  
Cheryl Ho ◽  
Barbara L. Melosky ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Surgical Resection ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Mortality Rates ◽  
Small Cell ◽  
Small Cell Lung ◽  
Trimodality Therapy ◽  
Locally Advanced Nsclc ◽  
Cancer Agency

7020 Background: The role of surgery following concurrent platinum-based chemotherapy and radiation for locally advanced non-small cell lung cancer (NSCLC) remains controversial, with high surgical mortality rates reported in a large randomized clinical trial. In this retrospective study, we evaluated the safety and efficacy of concurrent chemoradiation with or without surgery over an 11 period at the BC Cancer Agency. Methods: Patients were identified by the Vancouver Centre Pharmacy database. Charts were reviewed and data extracted included patient characteristics, weight loss, performance status, and method of mediastinal staging. Outcome measures were overall survival, pathological response rate, and treatment-associated morbidity and mortality. Results: Between January 1999-2010, 177 patients were identified with locally advanced NSCLC (stage IIIA/B) treated with platinum and etoposide and ≥40Gy radiation therapy, with or without surgical resection. The majority of treatment plans were reached by a multidisciplinary conference consensus. 74% (n=131) of patients received chemoradiation alone (bimodality therapy) and 36% (n=46) received chemoradiation followed by surgical resection (trimodality therapy). Among the trimodality therapy group, 16 patients underwent pneumonectomy and 30 lobectomy. Conclusions: In this series, bimodality therapy for patients with locally advanced NSCLC had similar treatment associated mortality and survival outcomes as reported in the literature. Trimodality therapy was associated with low treatment mortality rates and favourable survival. These two groups cannot be directly compared in this retrospective study. However, these results support a multidisciplinary approach to identify and carefully select patients with locally advanced NSCLC to undergo additional surgical resection following concurrent chemoradiation. [Table: see text]

scholarly journals Efficacy of erlotinib as neoadjuvant regimen in EGFR-mutant locally advanced non-small cell lung cancer patients

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051988727 ◽  
Author(s):  
Liwen Xiong ◽  
Yuqing Lou ◽  
Hao Bai ◽  
Rong Li ◽  
Jinjing Xia ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Advanced Nsclc ◽  
Response Rate ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Locally Advanced Nsclc ◽  
Iiia Nsclc ◽  
Egfr Mutant

Background The optimal neoadjuvant regimen for locally advanced resectable non-small cell lung cancer (NSCLC) remains controversial. EGFR inhibitors have significantly improved survival in patients with EGFR-mutant advanced NSCLC. However, their efficacy in neoadjuvant settings, particularly for treating locally advanced NSCLC, remains unclear. We compared the clinical benefits of chemotherapy and erlotinib as neoadjuvant therapy for stage IIIA NSCLC. Method Thirty-one treatment-naïve Chinese patients with stage IIIA NSCLC were enrolled. Patients without EGFR mutation received cisplatin-based doublet chemotherapy (n = 16; N-chemo group) while EGFR-mutant patients received erlotinib (n = 15; N-TKI group) as neoadjuvant therapy. Results After completing neoadjuvant treatment, 12 and 8 patients from the N-TKI and N-chemo groups underwent surgery, respectively. Our data revealed that patients who received erlotinib had a marginally better clinical objective response rate (67% vs. 19%), pathological response rate (67% vs. 38%), and overall survival (51.0 months vs. 20.9 months) compared with those who received chemotherapy. Furthermore, patients in the N-TKI group had a significantly greater reduction in tumor diameter, serum carcinoembryonic level, and maximum allelic fraction. Conclusion Our findings demonstrate that erlotinib is an effective neoadjuvant regimen in patients with EGFR-mutant locally advanced NSCLC, paving the way for its extended use in neoadjuvant settings. [ClinicalTrials.gov identifier: NCT01217619]

Lung Cancer in the Elderly

2007 ◽  
Vol 25 (14) ◽  
pp. 1898-1907 ◽  
Author(s):  
Cesare Gridelli ◽  
Corey Langer ◽  
Paolo Maione ◽  
Antonio Rossi ◽  
Steven E. Schild
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Small Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
The Elderly ◽  
Small Cell ◽  
Small Cell Lung ◽  
Younger Patients ◽  
Locally Advanced Nsclc

PurposeElderly patients often have comorbidities and other characteristics that make the selection of treatment daunting.MethodsWe have reviewed the available evidence in the literature to gauge the results of therapy for elderly lung cancer patients.ResultsThe beneficial results achieved with adjuvant chemotherapy in the general population with early non–small-cell lung cancer (NSCLC) cannot be automatically extrapolated to the elderly, who are at higher risk of toxicity. Retrospective analyses of combined chemoradiotherapy in locally advanced NSCLC patients suggest equivalent therapeutic benefit for younger and older patients, despite heightened toxicity. There have been no elderly-specific phase III trials for locally advanced NSCLC. For advanced NSCLC, on the basis of evidence-based data, single-agent chemotherapy remains the standard of care for nonselected elderly patients. However, retrospective analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with increased but acceptable toxicity for elderly patients. In limited-disease small-cell lung cancer (SCLC), sequential chemoradiotherapy is clearly less toxic compared with a standard concurrent approach, but our assessment of treatment is hindered by the absence of prospective elderly-specific trials. Although prophylactic cranial irradiation has emerged as a standard strategy, it should be omitted in patients with cognitive impairment. In extensive SCLC, etoposide in combination with either cisplatin or carboplatin has emerged as standard treatment; hematopoietic support may be necessary.ConclusionWith the exception of advanced NSCLC, prospective elderly-specific studies are lacking. Available data suggest that outcomes in the fit elderly mirror results observed in younger patients, although toxicity is generally worse.

scholarly journals Phase I Study of Weekly Nab-Paclitaxel Plus Carboplatin And Concurrent Thoracic Radiotherapy in Elderly Patients with Unresectable Locally Advanced Non-Small-Cell Lung Cancer

2021 ◽  
Author(s):  
Shota Omori ◽  
Hideyuki Harada ◽  
Keita Mori ◽  
Yasushi Hisamatsu ◽  
Yuko Tsuboguchi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Phase I Study ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Recommended Dose ◽  
Thoracic Radiotherapy ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Abstract Few clinical studies have been designed for elderly patients with locally advanced non-small cell lung cancer (NSCLC). We conducted a phase I study to evaluate the tolerability of carboplatin/nab-paclitaxel and concurrent thoracic radiotherapy in elderly patients with locally advanced NSCLC. The eligibility criteria were: unresectable stage III NSCLC, performance status 0 or 1, and age ≥75 years. Eligible patients received 6 weeks of weekly carboplatin/nab-paclitaxel and concurrent thoracic radiotherapy with a total dose of 64 Gy in 32 fractions. Carboplatin was fixed to an area under the plasma concentration time curve (AUC) of 2 mg/mL/min, and the recommended dose of nab-paclitaxel was evaluated using a dose-escalation study (30 or 40 mg/m2). Tolerability at the recommended dose was evaluated in an expansion study. Nineteen patients were enrolled at four institutions, all of whom were eligible and assessable. The recommended nab-paclitaxel dose was set at 30 mg/m2 because two patients experienced dose-limiting toxicity at 40 mg/m2. The treatment completion rate of the 17 patients analyzed at the recommended dose was 100% (80% confidence interval (CI), 83.8–100%). The overall response rate was 76.5%, and the median progression free survival was 13.4 months (95% CI, 4.2–21.4 months). Common grade 3 and 4 toxicities included leukopenia (23.5%), neutropenia (17.6%), anemia (5.9%), and infection (5.9%). One treatment-related death due to pneumonitis was observed six months after the end of the study. In conclusion, carboplatin/nab-paclitaxel and concurrent thoracic radiotherapy show good tolerability and exhibit promising efficacy in elderly patients with locally advanced NSCLC. This trial was registered with the Japan Registry of Clinical Trials on March 11, 2019 (trial no. jRCTs042180077).

Efficacy comparison of concurrent chemoradiotherapy with nedaplatin and cisplatin in inoperable locally-advanced non-small cell lung cancer

2020 ◽  
Vol 20 (5) ◽  
pp. 355-376
Author(s):  
Yongli WU ◽  
◽  
Kuantang CHEN ◽  
Jun WANG
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
High Energy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Objective： To compare the efficacy and safety of concurrent chemoradiotherapy with nedaplatin and cisplatin in inoperative locally-advanced non-small cell lung cancer（NSCLC）.Methods： Eighty patients with locally-advanced NSCLC treated in Guanyun County People’s Hospital，Lianyungang，Jiangsu Province，from January 2015 to January 2019 were enrolled as study subjects，and were randomly divided into the nedaplatin group and the cisplatin group，each consisting of 40 patients.The patients in the 2 groups were treated with linear accelerator 6 MV high energy X-ray and 3D-CRT，5 times a week for a succession of 6 weeks，with a total dosage of 55-66 Gy.Then，the patients were given paclitaxel（155 mg/m2） intravenously for 3 hours in the first day after radiotherapy，and the patients in the cisplatin group were treated with cisplatin（80 mg/m2） intravenously for 3 to 4 days，and the patients in the nedaplatin group were given nedaplatin（80 mg/m2） intravenously also for 3 to 4 days.The efficacy，the levels of such serum tumor markers as carcinoembryonic antigen（CEA），carbohydrate antigen 125（CA125），neuron specific enolase（NSE） and cytokeratin fragment antigen 21-1（CYFRA21-1），as well as the rate of adverse drug reactions（ADRs） were compared between the 2 groups.Results： There was no statistical significance in remission rate and disease control rate，when comparisons were made between the 2 groups（P>0.05）.After treatment，CEA，CA125，NSE and CYFRA21-1 levels in the 2 groups were significantly lower than those before treatment（P<0.05）.There were no significant differences in CEA and CA125 levels，when comparisons were made between the 2 groups（P>0.05）.However，NSE and CYFRA21-1 levels in the patients of the nedaplatin group were significantly lower than those of the cisplatin group（P<0.05）.The rates of leucopenia，neutropenia，nausea and vomiting，constipation or diarrhea，increase of blood urea nitrogen or creatinine，and weight loss in the nedaplatin group were significantly lower than those in the cisplatin group（P<0.05）.Conclusion： Nedaplatin has similar efficacy as cisplatin in the treatment of inoperable locally-advanced NSCLC，with higher safety，meanwhile it could decrease the levels of NSE and CYFRA21-1.For this reason，it is worthy further clinical promotion.

Phase II trial of cisplatin (C), etoposide (E) and radiation (RT) followed by gemcitabine (G) vs G and docetaxel (D) in stage III A/B unresectable non-small cell lung cancer (NSCLC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7120-7120
Author(s):  
B. Movsas ◽  
C. Langer ◽  
L. H. Wang ◽  
R. M. Jotte ◽  
F. Xu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Advanced Nsclc ◽  
Phase Ii Trial ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Consolidation Treatment ◽  
Locally Advanced Nsclc ◽  
C 50 ◽  
Stage Iii A

7120 Background: SWOG 9504 demonstrated the benefit of D consolidation after E + C with radiation therapy in pts with locally advanced NSCLC. This study was developed to assess the feasibility and efficacy of consolidation with either G alone or with D after the same chemoradiation schedule as SWOG 9504. Methods: The treatment schema included concurrent C 50 mg/m2 Day 1, 8 + E 50 mg/m2 Day 1–5 for two 28-day cycles + RT 180 cGy daily for 7 weeks after which pts were randomized to consolidation treatment of either G 1000 mg/m2 Day 1, 8 (Arm A) or G 1000 mg/m2 Day 1, 8 + D 75 mg/m2 Day 1 (Arm B) every 21 days for 3 cycles. Forty-six pts have been accrued; data is currently available in 28. Conclusions: Preliminary data indicate that G or G + D following chemoradiation in locally advanced NSCLC is well tolerated. The doublet, as expected, results in more toxicity, particularly myelosuppression and fatigue. Response, survival and TTP data will be presented at the time of the meeting. [Table: see text] [Table: see text]

Radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent radiotherapy and gemcitabine after induction with gemcitabine and carboplatin

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e18504-e18504
Author(s):  
R. M. Michel ◽  
D. Gallardo-Rincon ◽  
C. Villarreal-Garza ◽  
A. Astorga-Ramos ◽  
J. Zamora ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Radiation Pneumonitis ◽  
Locally Advanced ◽  
Disease Patient ◽  
Small Cell ◽  
Small Cell Lung ◽  
Thoracic Radiation ◽  
Grade 3

e18504 Background: The combination of chemotherapy (CT) and thoracic radiation (RT) is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). The most favorable CT regime, timing of full-dose CT and the best way to combine CT with RT to maximize systemic and radiosensitizing effects remain to be determined. The aim of this study was to assess the efficacy, safety and tolerability of gemcitabine concurrent with RT after induction CT (gemcitabine + carboplatin) in locally advanced NSCLC. Methods: Patients with histologically proven NSCLC IIIA and IIIB received carboplatin (AUC of 2.5) and gemcitabine (800 mg/m2) on day 1 and 8, every 21 days (two cycles), followed by conventional fractioned RT (60Gy) with concomitant weekly gemcitabine 200 mg/m2 and by consolidation CT. Survival was analyzed with Kaplan-Meier. Results: Median follow-up was of 11.9 months, 11 patients (57.9%) had stage IIIB disease. Patient inclusion was discontinued due to high grade 3/4 radiation pneumonitis events (5/19 patients, 26.3%). One treatment-related death from radiation pneumonitis occurred. The most common hematological side effects grade 3/4 were anemia and neutropenia 3/19 (15.8%) each and thrombocytopenia 4/19 (21.1%) during induction CT. Partial response was observed in 11 patients (57.9%) following induction. After concurrent chemo-radiotherapy, overall response was 68.4%. Four patients underwent surgical resection. Median progression-free survival was 12 ± 1 months (95% CI, 9.8 -14.1). Overall survival was of 21 ± 3.5 months (95% CI, 14–27.9). Conclusions: Concurrent RT with gemcitabine after induction CT with gemcitabine and carboplatin showed a high response rate. However, it is associated with excessive pulmonary toxicity. Adjustments in gemcitabine dosage during RT or changes in RT planning could reduce toxicity. No significant financial relationships to disclose.

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