Radiosensitization With Carboplatin for Patients With Unresectable Stage III Non–Small-Cell Lung Cancer: A Phase III Trial of the Cancer and Leukemia Group B and the Eastern Cooperative Oncology Group

Abstract

Carboplatin at the dose and schedule used did not significantly impact on disease control or survival. The relapse rate within the chest remained more than 50%. More effective regimens will be required to impact on local disease control and survival.

Platinum drugs in the treatment of non-small-cell lung cancer

“…The NSCLCCG meta-analysis confirmed the survival benefit provided by giving cisplatinbased chemotherapy before radiotherapy over radiotherapy alone (Non-Small Cell Lung Cancer Collaborative Group, 1995). Although it is standard to use induction chemotherapy followed by radiotherapy, there are some arguments favouring concurrent chemoradiation using chemotherapy at systemic dosages (Eberhardt et al, 1998;Jeremic et al, 1999) or at radiosensitising dosages (Trovo et al, 1992;Schaake-Koning et al, 1994;Bardet et al, 1997;Clamon et al, 1999). These two different treatment modalities have been studied in a number of promising phase II trials but there are very limited data from positive randomised phase III trials (Schaake-Koning et al, 1994;Furuse et al, 1999).…”

Chemo‐radiotherapy for advanced non‐small cell lung cancer: concurrent or sequential? It's no longer the question: a systematic review

“…Similar results were obtained for subgroup analysis of the five Phase-III trials. 15,19,20,21,37 Patterns of failure Pooling data of the initial relapse sites (Figure 2), difference between overall relapses (locoregional or distant) in both groups was statistically significant (OR ¼ 0.82; 95%CI: 0.69-0.97; p ¼ 0.02) in favor of concurrent group. Subset analyses revealed that isolated loco-regional relapses (primary tumor and/or regional nodes) were significantly lower frequent in the concurrent RT-CT than in the sequential arm (OR ¼ 0.68; 95%CI: 0.52-0.87; p ¼ 0.002), while the number of distant (e.g., brain, bone, or liver) relapses (OR ¼ 1.01; 95%CI: 0.79-1.30; p ¼ 0.927) and relapses at both sites (locoregional þ distant) (OR ¼ 0.74; 95%CI: 0.43-1.12; p ¼ 0.267) were similar in the two arms.…”

“…For analyses of the survival, 33 patients (concurrent arm-16; sequential arm-17) had been excluded from the trial reported by Calmon et al 20 The main reason for exclusion was failure to meet eligibility criteria (e.g., weight loss more than the limit, incorrect clinical stage, and ineligible histology). Among the 10 trials, 3 trials showed a significant enhancement of survival for the concurrent RT-CT.…”

“…[15][16][17][18][19][20][21][22][23]37,38 Main characteristics of the 11 trials are described in Table 1. Of the 11 trials, 6 were randomized phase III trials, 15,16,[19][20][21]37 and the remaining 5 were randomized phase II trials. As of August 2009, 10 trials have already been published as full length articles and one was presented at the 2003 Annual Meeting of the ASCO.…”

“…The concurrent approach yields a significantly increased response rate and enhanced median survival duration over the sequential arm in some trials; [15][16][17] but these results are not substantiated by other studies. [18][19][20] Furthermore, comparisons between concurrent RT-CT and sequential RT-CT have been mainly based on small sample size data, with inadequate statistical power to detect modest therapeutic advances. [21][22][23] The determination of the best sequence of RT-CT for advanced NSCLC has potential importance for offering clinicians a further basis when making treatment choices.…”