Trials of radical radiotherapy versus chemotherapy plus radical radiotherapy in non-small cell lung cancer.
Currently available treatments for patients with inoperable non-small cell lung cancer have had little impact on long-term survival. Cisplatin-containing chemotherapy regimens have achieved the best response rates (ie, 30% to 50%) in this disease, but trials using these have, for the most part, been too small to detect significant improvements in survival. Two randomized trials have shown a significant impact on survival, including the largest trial published to date (353 cases). Other trials have shown a trend in favor of the combined-modality arm. The only two trials with a trend in favor of radiotherapy alone were those with the smallest number of randomized cases (48 and 65 patients). A meta-analysis of trials of cisplatin-containing chemotherapy plus radiotherapy versus radiotherapy alone is thus likely to show a small survival advantage for the combined-modality approach when published in early 1994. In addition, a multicenter trial of mitomycin/ifosfamide/cisplatin (MIC) plus radiotherapy versus radiotherapy alone being performed in the United Kingdom is expected to accrue 500 patients. Preliminary results obtained in 150 patients randomized to receive the combined modality show an objective response rate to chemotherapy of 51%, which supports the findings of the phase 2 study using this regimen. Moreover, both responders and nonresponders to MIC experienced symptomatic improvement (a parameter largely ignored in previous trials) following treatment. Consequently, the MIC trial will be large enough to detect worthwhile survival improvements, should they exist, as well as illustrate the impact of treatment on patients' symptoms.
Cullen
M H
MH
Birmingham Oncology Centre, Queen Elizabeth Hospital, UK.
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*