title: Chemotherapy in non-small cell lung cancer: opportunities for advancement.
abstract: Locally advanced non-small cell lung cancer (NSCLC) continues to be a challenging disease to treat. With high rates of both local and distant failures, there is significant interest in finding more biologically active chemotherapy regimens that can contribute to reduce both failures. The phase III PROCLAIM trial, recently published in the Journal of Clinical Oncology entitled "PROCLAIM: randomized phase III trial of pemetrexed-cisplatin or etoposide-cisplatin plus thoracic radiation therapy followed by consolidation chemotherapy in locally advanced nonsquamous non-small-cell lung cancer", compared two different chemotherapy regimens given concurrently with radiotherapy in patients with stage III non-squamous lung cancer: pemetrexed plus cisplatin versus cisplatin plus etoposide. Both groups received consolidation chemotherapy. After enrolling 598 of planned 600 patients, the study was stopped early due to futility as no difference was seen in the primary end-point of overall survival. Since PROCLAIM was designed as a superiority trial, these results suggest that pemetrexed regimens do not offer a clinical advantage over standard cisplatin plus etoposide. There are some subpopulations who might still benefit from pemetrexed, especially if clinicians are concerned about myelosuppression-related adverse events. Future trials are needed to investigate novel biologic agents and irradiation techniques that can result in more durable local and distant disease control in locally advanced NSCLC.
authors.affiliation: Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Weil Cornell Medical College, 6565 Fannin, Ste#DB1-077, Houston, TX, 77030, USA.|Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Houston, TX, 77555, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Akhtari
authors.affiliation: Cancer Center, Thoracic Medical Oncology, Houston Methodist Hospital, Houston, TX, 77030, USA.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Bernicker
authors.affiliation: Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Weil Cornell Medical College, 6565 Fannin, Ste#DB1-077, Houston, TX, 77030, USA. bteh@houstonmethodist.org.
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000068437:Pemetrexed / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents; D000068437:Pemetrexed; D005047:Etoposide; D002945:Cisplatin
keywords: Chemotherapy; Lung cancer; Radiotherapy