Expanding role of chemotherapy in lung cancer

Loriot, Yohann; Soria, Jean Charles; Chevalier, Thierry Le

doi:10.1093/annonc/mdl246

Cited by 3 publications

(2 citation statements)

References 79 publications

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“…For patients with advanced NSCLC and wild-type EGFR, platinum-based doublets chemotherapy rather than TKIs has been regarded as the standard treatment during the past two decades. Despite the therapeutic benefits of combined chemotherapy, outcomes for patients with advanced NSCLC remain poor, and the median OS was only 8–10 months ( 17 ). Recent research has focused on the oligometastatic state where limited number of metastatic tumors (usually 1–5) localized in few anatomic sites, providing new opportunity in the management of advanced NSCLC with LAT.…”

Section: Discussionmentioning

confidence: 99%

Assessing efficacy and safety of stereotactic body radiation therapy for oligometastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR) wild type

Hu¹,

Li²,

Liu³

et al. 2021

Transl Cancer Res TCR

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Background: Stereotactic body radiation therapy (SBRT) is an emerging therapy for oligometastatic cancer. The aim of this study was to investigate the efficacy and safety of high-dose radiotherapy for primary and oligometastatic lesions in epidermal growth factor receptor (EGFR) wild-type non-small cell lung cancer (NSCLC).Methods: A total of 40 EGFR wild-type oligometastatic NSCLC patients (defined as ≤5 metastases) treated with SBRT in our department between 2009 and 2016 were analyzed retrospectively. SBRT was delivered to the lesions with a median biologically effective dose at alpha/beta 10 (BED10) value of 102.7 Gy (range, 94.5-113.5 Gy). Primary endpoints including progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. Factors potentially affecting OS and PFS were evaluated by univariate and multivariate Cox-regression analyses.Results: After a median follow-up of 39 months, the median OS observed in this study was 40 months (95% CI: 32.562-47.438 months). One-, 2-, and 3-year OS rates were 100.0%, 72.5%, and 62.5% respectively. Twenty-nine patients (72.5%) succumbed to tumor burden and median PFS was 13 months (range, 10.687-15.313 months). One-, 2-, and 3-year PFS rates were 65.0%, 10.0%, and 0% respectively. Multivariate analysis suggested Eastern Cooperative Oncology Group performance status (ECOG PS) <2 and high-dose radiation regimens were independent prognostic factors of longer OS (P<0.001 and 0.049, respectively), and patients receiving radiotherapy with BED10 ≥100 Gy showed a better PFS than those undergoing low dose (P=0.047). There were no patients of CTCAE v 5.0 grade 4-5 toxicity or treatment-related deaths. Grade 3 toxicity occurred in 2 (5.0%) patients and 36 (90.0%) patients experienced grade 1-2 adverse reactions. Conclusions:The current study suggested systemic chemotherapy combined with SBRT for pulmonary and metastatic lesions was feasible and tolerable to improve outcomes of EGFR wild-type oligometastatic NSCLC patients.

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Section: Discussionmentioning

confidence: 99%

Assessing efficacy and safety of stereotactic body radiation therapy for oligometastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR) wild type

Hu¹,

Li²,

Liu³

et al. 2021

Transl Cancer Res TCR

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“…Current standards of treatment of advanced non-small cell lungcancer(NSCLC)areusuallybasedontheadministration ofdoubletsofcytotoxicdrugs.Unfortunately,onlyathirdof NSCLCcasesrespondtothisintervention,whilelimitedtolerabilityofthecurrentchemotherapeuticschemesremainsa serious issue [1,2]. Recent advances in the development of targeted drugs have opened new avenues for the treatment of inoperable NSCLC.…”

Section: Introductionmentioning

confidence: 99%

Down-Staging of EGFR Mutation-Positive Advanced Lung Carcinoma with Gefitinib Followed by Surgical Intervention: Follow-Up of Two Cases

Levchenko

Moiseyenko²,

Matsko³

et al. 2009

Onkologie

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Background: Non-small cell lung carcinomas (NSCLC) carrying a mutation in the epidermal growth factor receptor (EGFR) gene show unprecedented sensitivity to gefitinib or erlotinib. Case Reports: We present the follow-up data of 2 EGFR mutation-positive stage IV NSCLC patients who received upfront 250 mg gefitinib daily, then underwent potentially curative surgery, and resumed gefitinib therapy in the adjuvant setting. Patient 1 was diagnosed with a rightsided adenocarcinoma of the upper lobe with multiple metastases to the middle lobe. After 2 months of gefitinib treatment, only a small primary lesion was seen, and a bilobectomy with lymph node dissection was performed. The patient remained disease-free during a scheduled 12-month adjuvant therapy but relapsed 9 weeks after cessation of this treatment. Patient 2 presented with adenocarcinoma of the lower lobe of the right lung and a single metastasis to the left adrenal. After 3 months of receiving gefitinib, the metastasis was no longer detectable, and the primary tumor was significantly reduced. Surgery included lobectomy and adrenalectomy. This patient relapsed with metastasis in the remaining adrenal 4 months after the start of adjuvant therapy. Conclusion: Gefitinib can be used preoperatively for the management of advanced EGFR mutation-positive NSCLC. It remains to be established whether surgical intervention indeed renders survival advantage for this category of patients.

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Vinorelbine and oxaliplatin in stage IV nonsmall cell lung cancer patients unfit for cisplatin: a single-center experience

Mir

Alexandre²,

Ropert³

et al. 2009

Anti-Cancer Drugs

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Many patients with stage IV nonsmall cell lung cancer (NSCLC) are unfit for cisplatin-based chemotherapy because of poor performance status, impaired renal function or severe comorbidity. We documented the feasibility of a combination of weekly vinorelbine and biweekly oxaliplatin in a population of stage IV NSCLC patients unable to receive cisplatin. Fifty-five chemo-naive patients (40 males, median age 60 years, range 43-84) were treated on an outpatient basis, and received every 2 weeks: vinorelbine 25 mg/m intravenously on day 1 and 60 mg/m orally on day 8, and oxaliplatin 85 mg/m intravenously on day 1. Patients were considered unfit for cisplatin because of performance status > or =2 (30 patients), impaired renal function (17 patients) or severe comorbidities (eight patients). Twenty-two patients (40%) had two or more metastatic sites, and 14 (25%) had central nervous system metastases. A total of 288 cycles were given (median per patient: 4, range 1-11). The planned dose intensity of vinorelbine was administered in 65% of patients. One complete and 13 partial responses were observed, providing an objective response rate of 26% (95% confidence interval: 14.4-37.6). The median progression-free survival and overall survival were 3.5 months and 9.5 months, respectively. The 1-year survival rate was 24% (95% confidence interval: 12.7-35.3). The main grade 3/4 toxicities were: neutropenia (15 patients, 27%), anaemia (12 patients, 22%) and peripheral neuropathy (eight patients, 15%). Three patients (5.5%) experienced febrile neutropenia. In a nonselected NSCLC patient population, the vinorelbine-oxaliplatin doublet had clinical activity in the same range as cisplatin-based combinations. This doublet allows combining a platinum derivative with a sustained dose intensity of vinorelbine in unfit patients.

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Expanding role of chemotherapy in lung cancer

Cited by 3 publications

References 79 publications

Assessing efficacy and safety of stereotactic body radiation therapy for oligometastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR) wild type

Assessing efficacy and safety of stereotactic body radiation therapy for oligometastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR) wild type

Down-Staging of EGFR Mutation-Positive Advanced Lung Carcinoma with Gefitinib Followed by Surgical Intervention: Follow-Up of Two Cases

Vinorelbine and oxaliplatin in stage IV nonsmall cell lung cancer patients unfit for cisplatin: a single-center experience

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