Chemo Plus RT Improves Survival in NSCLC

PARIS, France--Comparison of two sequential Radiation TherapyOncology Group (RTOG) trials has shown that the addition of cisplatin(Platinol) and etoposide (VePesid) to hyperfractionated radiationtherapy significantly boosts survival in patients with inoperablenon-small-cell lung cancer (NSCLC), Ritsuko Komaki, MD, reportedat the American Radium Society meeting.

"Today lung cancer is the number one cancer killer of bothmen and women in the United States, and a major commitment ofthe RTOG is clinical trials of bronchogenic carcinoma," saidDr. Komaki, of the University of Texas M.D. Anderson Cancer Center.

She explained that the most recent RTOG phase II NSCLC trial,91-06, turned to concurrent platinum-based combination chemotherapyin an effort to achieve both improved local control and eliminationof distant metastases.

An earlier randomized RTOG trial, 83-11, had established thata total dose of 69.6 Gy, achieved by hyperfractionation in twice-dailydoses of 1.2 Gy, was superior to lower doses in decreasing localrecurrences and enhancing survival.

The 76 patients enrolled in RTOG 91-06 received two cycles ofcisplatin, 50 mg/m² IV on days 1 and 8, and etoposide, 50mg orally twice a day on days 1 through 14, starting on the firstday of hyperfractionated radiation therapy and repeated on day29.

To weigh the relative contributions of hyperfractionation andchemotherapy to clinical outcome, these patients were comparedwith the 203 patients who had been randomized to the total doseof 69.6 Gy in RTOG 83-11.

Dr. Komaki pointed out that the response rates were nearly identicalin both patient groups, although concurrent cisplatin and etoposidemarkedly increased the incidence of acute hematologic and nonhematologictoxicity.

Patients treated with combined chemotherapy and hyperfractionationsurvived for a median of 18.9 months, and had 1- and 2-year survivalrates of 67% and 36%, respectively, she said. In contrast, amongpatients who received hyperfractionated radiation alone, mediansurvival was only 10.6 months, and the 1- and 2-year survivalrates were 48% and 22%, respectively (see figure below).

"It is worth noting that there were no striking differencesin failure patterns between the two groups," she said. Onethird of patients in each protocol experienced local failure.Multivariate analysis revealed weight loss to be the dominantprognostic variable.

An ongoing RTOG phase III trial is comparing hyperfractionatedradiation therapy plus cisplatin and etoposide with standard inductioncisplatin/vinblastine chemotherapy plus radiation therapy, Dr.Komaki said.[see"Studies of Taxane/Platinum Regimens in AdvancedNSCLC" and "Gemcitabine /Cisplatin Shows Good ResponseRate And Favorable Toxicity Profile in Advanced NSCLC"}