Chemoradiotherapy Followed by Docetaxel May Increase Life Expectancy in Non-Small-Cell Lung Cancer Patients

The administration of docetaxel (Taxotere)immediately after conventional chemotherapy with cisplatin (Platinol)/etoposide and radiotherapy results in prolonged survival inpatients with stage IIIB non-small-cell lung cancer, reported researchers fromthe Southwest Oncology Group (SWOG) at the Ninth World Conference on LungCancer. Results of the phase II trial showed that 53% of patients remained aliveat 2-year follow-up, which until now, was the highest reported2-year survival rate for this cohort of patients since a previous SWOG studyreported a 34% survival rate.

"Most patients with locally advanced non-small-cell lungcancer continue to die of progressive disease despite advances in combinedmodality treatment," said David R. Gandara, md, the study’s principalinvestigator, professor of medicine and director of clinical trials at theUniversity of California Medical Center, Davis. "Our data show that theaddition of docetaxel to concurrent chemotherapy and radiation therapy resultsin over 50% of patients remaining alive at 2 years of follow-up."

Patient Characteristics and Dosing Schedule

The 83 study participants had newly diagnosed primarybronchogenic non-small-cell lung cancer and pathologically documented stageIIIB disease that was too extensive to be surgically cured. Patients ranged from34 to 80 years old, and their performance status ranged from 0 to 2.

All patients received cisplatin, 50 mg/m², administeredintravenously on days 1 and 8, and etoposide, 50 mg/m², administeredintravenously each day for 5 days. The chemotherapy regimen was repeated 4 weekslater. On the day chemotherapy began, radiotherapy was also initiated, andcontinued for 5 days a week for 5 weeks. Docetaxel, 75 to 100 mg/m², wasadministered intravenously starting about 4 weeks after the completion ofchemoradiotherapy, with the treatment repeating every 21 days for three cycles.

Contrasting Results

The median survival was 26 months, and the 1-year survival ratewas 76%. In the earlier SWOG trial, in which two additional cycles ofcisplatin/etoposide were administered after initial concurrent chemotherapy andradiotherapy, the median survival was 15 months with a 1-year survival of 58%.

Concurrent chemotherapy with radiotherapy was reasonably welltolerated. Side effects during consolidation treatment with docetaxel includedneutropenia, and three patients died of pulmonary complications.