Gemcitabine and cisplatin in a multimodality treatment for locally advanced non-small cell lung cancer

Abstract

The role of new cytotoxic agents like gemcitabine has not yet been proven in the neoadjuvant settings. We designed a phase II study to test the feasibility of using gemcitabine and cisplatin before local treatment for stage III non-small cell lung cancer patients. Patients received three cycles of induction chemotherapy of gemcitabine (1000 mg m 72 , days 1, 8, 15) and cisplatin (90 mg m 72 , day 15) every 4 weeks before evaluation for operability. Operable patients underwent radical resection. Inoperable patients and patients who had incomplete resection received concurrent chemoradiotherapy with daily low dose cisplatin. All patients who did not progress after local treatment received three more cycles of adjuvant chemotherapy of gemcitabine and cisplatin. Fifty-two patients received induction treatment. Two patients had complete response and 31 patients had partial response (response rate 63.5%) after induction chemotherapy. Thirty-six patients (69%) were operable. Eighteen patients (35%) had their tumours completely resected. Two patients had pathological complete response. Median overall survival was 19.1 months, projected 1-year survival was 66% and 2-year survival was 34%. Three cycles of gemcitabine and cisplatin is effective and can be used as induction treatment before surgery for locally advanced non-small cell lung cancer patients.

Surgery after induction chemotherapy in stage IIIA-N2 non-small cell lung cancer: Why pneumonectomy should be avoided

“…When evaluating our results in review of the literature, a few differences are noteworthy. Firstly, although comparable to response rates in advanced NSCLC [14][15][16], our response rate of 34% was relatively low compared with previous studies using gemcitabine/cisplatin in the neoadjuvant setting [11,13]. We cannot explain this difference, other than that the actual response might have been underestimated on radiological imaging.…”

“…Thereafter, treatment preferably consisted of 2-4 cycles of gemcitabine (1250 mg/m 2 ) and cisplatin (75 mg/m 2 ), a regimen that has been studied by van Zandwijk et al [11]. In several phase II and III studies, this doublet produced response rates up to 70% [13], and was reported to be more effective than combinations of cisplatin-etoposide or mitomycin-ifosfamide-cisplatin [14][15][16].…”

Comprehensive Analysis of the Incidence and Survival Patterns of Lung Cancer by Histologies, Including Rare Subtypes, in the Era of Molecular Medicine and Targeted Therapy

“…Before the FDA's approval of epidermal growth factor receptor (EGFR) inhibitors to treat non–small cell lung cancer (NSCLC) in 2003, the overall survival for advanced lung cancer patients treated with chemotherapy was similar for Asian and Western countries. 5 – 8 However, the prognosis of lung cancer became different after the introduction of EGFR inhibitors. Lung cancers with EGFR mutations are more likely to be adenocarcinoma and occur more often in women, East Asians, and nonsmokers.…”

Effector mechanism of magnolol‐induced apoptosis in human lung squamous carcinoma CH27 cells

“…However, cancer chemotherapy has progressed since its introduction into clinical practice and represents the most promising treatment modality. Various chemotherapy drugs, including doxorubicin, 5‐fluorouracil, cisplatin, etoposide and gemcitabine, have been used to treat lung cancer (Scarpati et al ., 2001; Worden & Kalemkerian, 2000; Yang et al ., 2002). But all of these anticancer drugs affect not only pathological tumour cells, but also normal cells, especially bone marrow cells or intestinal epithelia with high turnover rate, causing serious complications and toxicity.…”