Long-term Outcomes of Induction Carboplatin and Gemcitabine Followed by Concurrent Radiotherapy With Low-dose Paclitaxel and Gemcitabine for Stage III Non–small-cell Lung Cancer

Catherine Guilbault, Aurelie Garant, Sergio Faria, Scott Owen, Linda Ofiara, Marie Duclos, Vera Hirsh, Neil Kopek

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

We report the long-term outcomes of 142 protocol and nonprotocol patients with stage III non–small-cell lung cancer who were treated with induction carboplatin and gemcitabine followed by chemo-radiation. In addition to having a favorable toxicity profile, this regimen appears to have similar clinical outcomes as those associated with immediate concurrent chemo-radiation. Background Standard treatment for unresectable stage III non–small-cell lung cancer (NSCLC) is concurrent chemo-radiation (CRT). A regimen of induction carboplatin and gemcitabine followed by CRT was developed at the McGill University Health Centre to prevent delays in treatment initiation. We report the long-term outcomes with this regimen based on a pooled analysis of both protocol patients from a phase II study and nonprotocol patients. Methods and Materials Outcomes and toxicity data were retrieved for 142 patients with stage III NSCLC: 43 patients treated on protocol between January 2003 and November 2004, and 101 patients treated off-protocol between December 2004 and August 2013. Patients received 2 cycles of carboplatin with an area under the curve of 5 intravenously (IV) on day 1 and gemcitabine 1000 mg/m2 IV on days 1 and 8 every 3 weeks, followed on day 50 by CRT, 60 Gy/30 over 6 weeks, concomitantly with 2 cycles of paclitaxel 50 mg/m2 IV and gemcitabine 100 mg/m2 IV on days 1 and 8 every 3 weeks. Results The median overall survival was 23.2 months. With a median follow-up of 23.8 months, the 3-, 4-, and 5-year overall survival was 38%, 30%, and 26%, respectively. The median and 5-year progression-free survival rates were 12.5 months and 25%, respectively. Rates of grade ≥ 3 hematologic, esophageal, and respiratory toxicity were 20%, 10%, and 10%, respectively. Forty-eight patients received further lines of chemotherapy. Conclusion The present analysis affirms the favorable toxicity profile of this novel induction chemotherapy, without apparent compromise in clinical outcomes, when compared with regimens using immediate concurrent CRT.

Original languageEnglish (US)
Pages (from-to)565-571
Number of pages7
JournalClinical Lung Cancer
Volume18
Issue number5
DOIs
StatePublished - Sep 2017
Externally publishedYes

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Keywords

  • Combined modality therapy
  • Concurrent chemo-radiation
  • Lung neoplasms
  • Outcomes
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

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