Radiation No Extra Benefit To Stage IIIA/N2 NSCLC Neoadjuvant Chemotherapy

Neoadjuvant chemoradiotherapy does not offer greater survival for stage IIIA/N2 non-small-cell lung cancer patients than neoadjuvant chemotherapy

medwireNews: Adding radiotherapy to neoadjvuant chemotherapy does not improve survival outcomes in patients undergoing resection for stage IIIA/N2 non-small-cell lung cancer (NSCLC), suggest results from a phase III trial.

The 117 patients who were randomly assigned to receive three cycles of cisplatin and docetaxel chemotherapy followed by 44 Gy radiation in 22 fractions over 3 weeks before surgery achieved a median event-free survival of 12.8 months and a median overall survival of 37.1 months.

These outcomes did not significantly differ from the 11.6 months and 26.2 months, respectively, achieved by 115 patients who were given three cycles of neoadjuvant chemotherapy only before resection.

The majority (91%) of patients completed three cycles of neoadjuvant chemotherapy, with adverse effects prompting 17–18% of patients to switch to carboplatin and 15–16% to reduce their docetaxel dose.

Radiotherapy was “feasible” and side effects were “generally mild”, although 9% of patients reported grade 3 or 4 events, most commonly oesophagitis, add Miklos Pless, from Kantonsspital Winterthur in Switzerland, and co-workers.

Writing in The Lancet, the authors observe that previous trials have demonstrated that adjuvant chemotherapy improves the outcome of radical surgery or definitive radiotherapy in patients with stage IIIA/N2 NSCLC but the role of a third modality “remains unclear”.

They therefore conclude that “that the use of one local treatment, whether definitive radiotherapy or surgery, in combination with chemotherapy would be sufficient in patients with stage III/2N non-small-cell lung cancer and should be considered as standard treatment.”

Researchers from University Hospital Essen in Germany write in an accompanying comment that  “[t]rying to find a one-treatment-fits-all approach, therefore, might not be wise” because of the heterogeneous nature of stage III NSCLC with regard to tumour volume and bulk, nodal spread and comorbidity.

Recommending a multidisciplinary team approach to treatment decisions for stage III/2N, Wilfried Eberhardt and Martin Stuschke suggest: “Personalised treatment based on existing comorbidity risks might be a better solution.

“Patients with higher operative and surgical risks might be ideal candidates for bimodal therapy without surgery, whereas those with lower risks might be the best candidates for approaches that include surgery.”

References

Pless M, Stupp R, Ris H-B, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet 2015; Advance online publication 11 August. DOI: http://dx.doi.org/10.1016/S0140-6736(15)60294-X

Eberhardt WEE, Stuschke M. Multimodal treatment of non-small-cell lung cancer. Lancet 2015; Advance online publication 11 August. DOI: http://dx.doi.org/10.1016/S0140-6736(15)61083-2

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