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.

scholarly journals Radiotherapy combined with gefitinib for patients with locally advanced non-small cell lung cancer who are unfit for surgery or concurrent chemoradiotherapy: A phase Ⅱ clinical trial

2020 ◽  
Author(s):  
Zhixue Fu ◽  
Jun Liang ◽  
Yang Xu ◽  
Wenqing Wang ◽  
Deng Lei ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Survival Time ◽  
Concurrent Chemoradiotherapy ◽  
Advanced Nsclc ◽  
Response Rate ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Abstract Background: The objectives of this study were to determine the objective effective response rate, survival, and safety of radiotherapy combined with gefitinib in patients with locally advanced non-small cell lung cancer (NSCLC) who were unfit for surgery or concurrent chemoradiotherapy.Methods: The patients with the locally advanced NSCLC who were unfit to receive surgery or concurrent chemoradiotherapy, received thoracic intensity-modulated radiotherapy (IMRT) combined with gefitinib 250 mg daily.Results: Twenty-nine patients were enrolled between July 2014 and March 2017. Of the 29 patients, 21 (72.4%) experienced a partial response, 6 (20.7%) had stable disease, and 2 (6.9%) experienced progression of disease. The objective response rate was 72.4%, and the disease control rate was 93.1%. The median follow-up time was 51 months. The disease progression showed in 26 (89.7%) patients, including local progression in 20 (69.0%) and distant metastasis in 16 (55.2%). The median survival time (MST) and progression-free survival time (PFS) were 26 and 11 months, respectively. The 3-, 4-, 5-year survival rates were 37.6%, 29%, and 29%, respectively. The PFS rates were 17.2%, 9.2%, and 9.2%. Two patients developed grade 3 acute adverse events, and two patients developed grade 2 acute irradiation pneumonitis.Conclusions: For patients with locally advanced NSCLC who are not eligible for surgery or concurrent chemoradiotherapy, IMRT combined with gefitinib can improve the objective effective rate and is generally well-tolerated.

Blood-based TMB detection and dynamic monitor in local advanced non-small cell lung cancer (NSCLC) patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20039-e20039
Author(s):  
Xi Yang ◽  
Zhengfei Zhu
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Standard Treatment ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Nccn Guidelines

e20039 Background: TMB detection has been recommended by NCCN guidelines as an effective biomarker for immunotherapy of advanced non-small cell lung cancer(NSCLC). Blood based TMB(b-TMB) detection is considered to be able to predict the efficacy of immunotherapy in patients with advanced NSCLC. Concurrent chemoradiotherapy is the standard treatment for locally advanced NSCLC(LA-NSCLC) and subsequent consolidated immunotherapy has become the standard treatment. Therefore, the b-TMB status and dynamic changes in patients with LA-NSCLC are particularly important. Methods: We enrolled 7 patients with LA-NSCLC, each receiving 60Gy chest radiotherapy and docetaxel plus cisplatin weekly regimen chemotherapy. We tested the TMB by next-generation sequencing with 520 genes panal in tissues and blood of each patient at baseline. In addition, b-TMB was measured dynamically in 6 patients at different time points during chemoradiotherapy, each two patients were tested for over four times within one week of treatment, two weeks later and four weeks later. Results: As shown in the table, the baseline b-TMB matched the tissue TMB. Except for one ALK fusion patient, the positive rate of b-TMB was 100% and the Spearman correlation value was 0.899(p = 0.015). B-TMB fluctuated but did not change much within first two weeks of concurrent chemoradiotherapy. After the fourth week of chemoradiotherapy, b-TMB significantly decreased in all patient. Conclusions: In patients with LA-NSCLC, b-TMB is a reliable biomarker, which is likely to change in the later stage of concurrent chemoradiotherapy. Its dynamic monitor will help to distinguish which patients may benefit from consolidated immunotherapy after concurrent chemoradiotherapy. [Table: see text]

Weekly paclitaxel and cisplatin with concurrent radiotherapy in locally advanced non-small-cell lung cancer: a phase I study.

1997 ◽  
Vol 15 (4) ◽  
pp. 1409-1417 ◽  
Author(s):  
G Frasci ◽  
P Comella ◽  
G Scoppa ◽  
C Guida ◽  
A Gravina ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Hematologic Toxicity ◽  
Small Cell Lung ◽  
Antitumor Effects ◽  
Locally Advanced Nsclc

PURPOSE Both cisplatin (CDDP) and paclitaxel have shown good antitumor activity in non-small-cell lung cancer (NSCLC) patients and are able to potentiate the antitumor effects of radiation therapy (RT). This study aimed to determine the maximum-tolerated doses (MTDs) of CDDP and paclitaxel (escalated alternately) when given concurrently with RT and to define the nature of the dose-limiting toxicity (DLT). PATIENTS AND METHODS Chemotherapy-naive patients with locally advanced NSCLC received six weekly administrations of a CDDP-paclitaxel combination with concurrent local RT. The starting doses of CDDP and paclitaxel were 30 mg/m2/wk and 35 mg/m2/wk, respectively. RT was initially given at the dose of 1.2 Gy twice daily for 5 days per week for 5 weeks (total dose, 60 Gy) and at a single daily dose of 2 Gy for 5 days per week for 6 weeks in the last two cohorts of patients. The drug doses were escalated alternately until DLT occurred in more than one third of the patients in a given cohort. RESULTS Overall, 25 patients were recruited through five different cohorts. All were assessable for toxicity. Esophagitis was the main toxicity and occurred in 16 of 25 patients (64%) and was grade 3 or 4 in five of them. At step 3 (CDDP 35 mg/m2/wk and paclitaxel 45 mg/m2/wk), two of five patients had to discontinue treatment because of severe esophagitis and one of these died of complications related to grade 4 esophagitis. However, keeping the same doses of chemotherapy and replacing hyperfractionation with a standard single-day fraction, weekly doses of CDDP and paclitaxel of 35 mg/m2 and 45 mg/m2 could be safely administered. Neutropenia was by far the most relevant hematologic toxicity and occurred in 33 of 141 weekly delivered courses, but it was of grade 4 in only four courses. Substantial pulmonary or neurologic toxicity was not observed in this study. Two complete responses (CRs) and 13 partial responses (PRs) were observed, for a 60% overall response rate (95% confidence interval [CI], 39% to 79%). The median survival time was 16 months, with a 66% 1-year survival probability. CONCLUSION CDDP 35 mg/m2/wk and paclitaxel 45 mg/m2/wk can be safely administered with concurrent standard RT. The use of hyperfractionation is associated with a more frequent occurrence of severe esophagitis and requires a reduction of the CDDP dose to 30 mg/m2/ wk. Only future randomized trials will elucidate which of these two approaches (standard or hyperfractionated RT) is the better option to improve the outcome of patients with locally advanced NSCLC.

Surgical Treatment of Initially Unresectable Locally Advanced Non-small Cell Lung Cancer Following Tislelizumab Plus Chemotherapy: A Case Report

2021 ◽  
Author(s):  
Chen Huang ◽  
Yongmei Dai ◽  
Qianshun Chen ◽  
Feng Li ◽  
Xunyu Xu
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Small Cell ◽  
Stage Iiib ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Abstract Background: Radical concurrent chemoradiotherapy is the preferred treatment for patients with stage IIIB non-small cell lung cancer (NSCLC), but the prognosis is poor. The emergence of immune checkpoint inhibitors has changed the treatment strategy for advanced NSCLC, providing new opportunities for therapy. However, neoadjuvant immunotherapy of locally advanced NSCLC is still in the exploratory stage. Case presentation: A 47-year-old male with stage IIIB squamous cell lung cancer with invasion of the pulmonary artery, left superior pulmonary vein (LSPV), and left atrium (LA) at diagnosis. The patient’s lesions were significantly reduced after four cycles of combined treatment with tislelizumab and carboplatin plus nab-paclitaxel, he then underwent successful left pneumonectomy with mediastinal lymph node dissection, and postoperative pathology showed a pathologic complete response (pCR). Conclusions: The findings demonstrated that chemotherapy in combination with immunotherapy can provide an opportunity for radical surgery in some patients with locally advanced NSCLC.

scholarly journals Evaluation of a prognostic scoring system based on the systemic inflammatory and nutritional status of patients with locally advanced non-small-cell lung cancer treated with chemoradiotherapy

2017 ◽  
Vol 59 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Takamasa Mitsuyoshi ◽  
Yukinori Matsuo ◽  
Hitoshi Itou ◽  
Takashi Shintani ◽  
Yusuke Iizuka ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Nutritional Status ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Skeletal Mass ◽  
Locally Advanced Nsclc

Abstract Systemic inflammation and poor nutritional status have a negative effect on the outcomes of cancer. Here, we analyzed the effects of the pretreatment inflammatory and nutritional status on clinical outcomes of locally advanced non-small-cell lung cancer (NSCLC) patients treated with chemoradiotherapy. We retrospectively reviewed 89 patients with locally advanced NSCLC treated with chemoradiotherapy between July 2006 and June 2013. Serum C-reactive protein (CRP) was assessed as an inflammatory marker, and serum albumin, body mass index (BMI) and skeletal mass index were assessed as nutritional status markers. The relationships between these markers and overall survival (OS) were assessed. The median OS was 24.6 months [95% confidence interval (CI): 19.4–39.3 months]. During follow-up, 58 patients (65%) had disease recurrence and 52 patients (58%) died. In multivariate Cox hazard analysis, CRP levels and BMI approached but did not achieve a significant association with OS (P = 0.062 and 0.094, respectively). Recursive partitioning analysis identified three prognostic groups based on hazard similarity (CRP-BMI scores): 0 = CRP &lt; 0.3 mg/dl, 1 = CRP ≥ 0.3 mg/dl and BMI ≥ 18.5 kg/m2, and 2 = CRP ≥ 0.3 mg/dl and BMI &lt; 18.5 kg/m2. The CRP-BMI score was significantly associated with OS (P = 0.023). Patients with scores of 0, 1 and 2 had median OS of 39.3, 24.5 and 14.5 months, respectively, and the scores also predicted the probability of receiving salvage treatment after recurrence. The CRP-BMI score is thus a simple and useful prognostic marker of clinical outcome for patients with locally advanced NSCLC treated with chemoradiotherapy.

scholarly journals Efficacy and Toxicity of Different Concurrent Chemoradiotherapy Regimens in Patients With Locally Advanced Non-Small Cell Lung Cancer-a Network Meta-Analysis­

2021 ◽  
Author(s):  
Qiang-qiang Zheng ◽  
Shi-hui Min ◽  
Qing-hua Zhou
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Indirect Evidence ◽  
Small Cell ◽  
Cochrane Central Register ◽  
Small Cell Lung

Abstract Background: Concurrent chemoradiotherapy (CCRT) is the cornerstone treatment for patients with locally advanced non-small cell lung cancer (LA-NSCLC). The aim of this study was to compare the efficacy and toxicity of different CCRT regimens in the treatment of LA-NSCLC by adopting a network meta-analysis.Methods: PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were exhaustively searched to identify relevant studies from inception up to October 1, 2020. Direct and indirect evidence were combined to calculate the odds radio (OR) and its 95% confidence interval (CI), as well as to draw the surface under the cumulative ranking (SUCRA) curves. Cluster analyses were adopted to compare efficacy and toxicity of different CCRT regimens according to the similarity of 2 variables. Publication bias was detected by comparison-adjusted funnel plot.Results: Twenty-two studies were enrolled in this network meta-analysis, including 18 CCRT regimens: CCRT (cisplatin+etoposide), CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+carboplatin), CCRT (pemetrexed+cisplatin), CCRT (docetaxel+cisplatin), CCRT (S-1+cisplatin), CCRT (mitomycin+vindesine+cisplatin), CCRT (cisplatin+vinorelbine), CCRT (cisplatin), CCRT (etoposide+cisplatin+amifostine), RT, CCRT (5-FU), CCRT (paclitaxel+cisplatin), CCRT (irinotecan+carboplatin), CCRT (nedaplatin), CCRT (carboplatin+etoposide), CCRT (paclitaxel), and CCRT (carboplatin). The results indicated that the regimens with CCRT (cisplatin+etoposide), CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+cisplatin), CCRT (S-1+cisplatin), and CCRT (cisplatin+vinorelbine) had relatively better efficacy compared with other regimens. As for toxicity of different CCRT regimens, the CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+cisplatin), and CCRT (docetaxel+cisplatin) were relatively lower.Conclusions: Our study demonstrated that CCRT (pemetrexed+cisplatin) and CCRT (carboplatin+paclitaxel) might be the best choice of CCRT regimens in the treatment of LA-NSCLC, and the 3-year overall survival (OS) rate of CCRT (pemetrexed+cisplatin) was the highest among these regimens.

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.

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