Long-term Outcomes of Induction Carboplatin and Gemcitabine Followed by Concurrent Radiotherapy With Low-dose Paclitaxel and Gemcitabine for Stage III Non-small-cell Lung Cancer.
Standard treatment for unresectable stage III non-small-cell lung cancer (NSCLC) is concurrent chemo-radiation (CRT). A regimen of induction carboplatin and gemcitabine followed by CRT was developed at the McGill University Health Centre to prevent delays in treatment initiation. We report the long-term outcomes with this regimen based on a pooled analysis of both protocol patients from a phase II study and nonprotocol patients.



Outcomes and toxicity data were retrieved for 142 patients with stage III NSCLC: 43 patients treated on protocol between January 2003 and November 2004, and 101 patients treated off-protocol between December 2004 and August 2013. Patients received 2 cycles of carboplatin with an area under the curve of 5 intravenously (IV) on day 1 and gemcitabine 1000 mg/m2IV on days 1 and 8 every 3 weeks, followed on day 50 by CRT, 60 Gy/30 over 6 weeks, concomitantly with 2 cycles of paclitaxel 50 mg/m2IV and gemcitabine 100 mg/m2IV on days 1 and 8 every 3 weeks.



The median overall survival was 23.2 months. With a median follow-up of 23.8 months, the 3-, 4-, and 5-year overall survival was 38%, 30%, and 26%, respectively. The median and 5-year progression-free survival rates were 12.5 months and 25%, respectively. Rates of grade ≥ 3 hematologic, esophageal, and respiratory toxicity were 20%, 10%, and 10%, respectively. Forty-eight patients received further lines of chemotherapy.



The present analysis affirms the favorable toxicity profile of this novel induction chemotherapy, without apparent compromise in clinical outcomes, when compared with regimens using immediate concurrent CRT.
Division of Medical Oncology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: catherine.guilbault@mail.mcgill.ca.
Catherine
C
Guilbault
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
Aurelie
A
Garant
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
Sergio
S
Faria
Division of Medical Oncology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Scott
S
Owen
Division of Respirology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Linda
L
Ofiara
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
Marie
M
Duclos
Division of Medical Oncology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Vera
V
Hirsh
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
Neil
N
Kopek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D017322:Clinical Trials, Phase II as Topic; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004941:Esophagitis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D017564:Radiation Pneumonitis / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D000093542:Gemcitabine
D003841:Deoxycytidine; D016190:Carboplatin; D017239:Paclitaxel; D000093542:Gemcitabine
Combined modality therapy; Concurrent chemo-radiation; Lung neoplasms; Outcomes; Toxicity