A prospective phase II study of induction carboplatin and vinorelbine followed by concomitant topotecan and accelerated radiotherapy (ART) in locally advanced non-small cell lung cancer (NSCLC)

Samir H. Patel, Munther Ajlouni, Robert Chapman, Mei Lu, Benjamin Movsas, Jae Ho Kim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Survival of locally advanced/unresectable non-small cell lung cancer (NSCLC) has improved with the use of concurrent radiation and chemotherapy over the past decades, but local and distant failure remain high. In addition, a key limiting factor in combining chemotherapy with accelerated radiotherapy (ART) is severe esophagitis. We investigated the toxicity, response rate, and overall survival (OS) with induction carboplatin and vinorelbine followed by concomitant topotecan and ART in patients with locally advanced/unresectable NSCLC. METHODS: In this phase II trial, stage IIIA or IIIB NSCLC patients with a Karnofsky performance score >60 were eligible. Patients received induction carboplatin (area under the curve = 5.5) on days 1 and 22, and vinorelbine (25 mg/m) on days 1, 8, 22, and 29. During the concurrent chemoradiation, patients received intravenous topotecan (0.5 mg/m) on days 43 to 47, days 57 to 61, and days 71 to 75 before the morning radiotherapy (RT) fraction. RT was administered in an accelerated fashion at 2 Gy per fraction, twice daily for five consecutive days, every other week, to a cumulative dose of 60 Gy during a 5-week period. RESULTS: Thirty-seven patients were accrued; of these, 35 were evaluable. Overall response rate was 71% (14% complete response, 57% partial response). Six of 35 (17%) patients had stable disease. Four (11%) patients progressed during treatment. At a median follow-up of 45 months for surviving patients, the median survival based on Kaplan-Meier estimates is 17.9 months. OS at 1, 2, and 3 years is 62%, 41%, and 33%, respectively. Actuarial 5-year OS is 21%. The median time to first relapse is 12.2 months (9.1-24.7 months). There were no cases of grade 3 or 4 esophagitis. CONCLUSIONS: This combined-modality regimen yielded encouraging OS rates, with no severe esophagitis. Using four-dimensional RT treatment planning, we plan to further evaluate altered fractionation RT and chemotherapy for this group of patients.

Original languageEnglish (US)
Pages (from-to)831-837
Number of pages7
JournalJournal of Thoracic Oncology
Volume2
Issue number9
DOIs
StatePublished - Sep 2007
Externally publishedYes

Fingerprint

Topotecan
Carboplatin
Non-Small Cell Lung Carcinoma
Radiotherapy
Esophagitis
Survival
Drug Therapy
Survival Rate
vinorelbine
Kaplan-Meier Estimate
Area Under Curve
Radiation
Recurrence

Keywords

  • Accelerated radiation
  • Lung cancer
  • Topotecan

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

A prospective phase II study of induction carboplatin and vinorelbine followed by concomitant topotecan and accelerated radiotherapy (ART) in locally advanced non-small cell lung cancer (NSCLC). / Patel, Samir H.; Ajlouni, Munther; Chapman, Robert; Lu, Mei; Movsas, Benjamin; Kim, Jae Ho.

In: Journal of Thoracic Oncology, Vol. 2, No. 9, 09.2007, p. 831-837.

Research output: Contribution to journalArticle

@article{876b9b443d774e9384a3546979d4c4af,
title = "A prospective phase II study of induction carboplatin and vinorelbine followed by concomitant topotecan and accelerated radiotherapy (ART) in locally advanced non-small cell lung cancer (NSCLC)",
abstract = "BACKGROUND: Survival of locally advanced/unresectable non-small cell lung cancer (NSCLC) has improved with the use of concurrent radiation and chemotherapy over the past decades, but local and distant failure remain high. In addition, a key limiting factor in combining chemotherapy with accelerated radiotherapy (ART) is severe esophagitis. We investigated the toxicity, response rate, and overall survival (OS) with induction carboplatin and vinorelbine followed by concomitant topotecan and ART in patients with locally advanced/unresectable NSCLC. METHODS: In this phase II trial, stage IIIA or IIIB NSCLC patients with a Karnofsky performance score >60 were eligible. Patients received induction carboplatin (area under the curve = 5.5) on days 1 and 22, and vinorelbine (25 mg/m) on days 1, 8, 22, and 29. During the concurrent chemoradiation, patients received intravenous topotecan (0.5 mg/m) on days 43 to 47, days 57 to 61, and days 71 to 75 before the morning radiotherapy (RT) fraction. RT was administered in an accelerated fashion at 2 Gy per fraction, twice daily for five consecutive days, every other week, to a cumulative dose of 60 Gy during a 5-week period. RESULTS: Thirty-seven patients were accrued; of these, 35 were evaluable. Overall response rate was 71{\%} (14{\%} complete response, 57{\%} partial response). Six of 35 (17{\%}) patients had stable disease. Four (11{\%}) patients progressed during treatment. At a median follow-up of 45 months for surviving patients, the median survival based on Kaplan-Meier estimates is 17.9 months. OS at 1, 2, and 3 years is 62{\%}, 41{\%}, and 33{\%}, respectively. Actuarial 5-year OS is 21{\%}. The median time to first relapse is 12.2 months (9.1-24.7 months). There were no cases of grade 3 or 4 esophagitis. CONCLUSIONS: This combined-modality regimen yielded encouraging OS rates, with no severe esophagitis. Using four-dimensional RT treatment planning, we plan to further evaluate altered fractionation RT and chemotherapy for this group of patients.",
keywords = "Accelerated radiation, Lung cancer, Topotecan",
author = "Patel, {Samir H.} and Munther Ajlouni and Robert Chapman and Mei Lu and Benjamin Movsas and Kim, {Jae Ho}",
year = "2007",
month = "9",
doi = "10.1097/JTO.0b013e318145b2e5",
language = "English (US)",
volume = "2",
pages = "831--837",
journal = "Journal of Thoracic Oncology",
issn = "1556-0864",
publisher = "International Association for the Study of Lung Cancer",
number = "9",

}

TY - JOUR

T1 - A prospective phase II study of induction carboplatin and vinorelbine followed by concomitant topotecan and accelerated radiotherapy (ART) in locally advanced non-small cell lung cancer (NSCLC)

AU - Patel, Samir H.

AU - Ajlouni, Munther

AU - Chapman, Robert

AU - Lu, Mei

AU - Movsas, Benjamin

AU - Kim, Jae Ho

PY - 2007/9

Y1 - 2007/9

N2 - BACKGROUND: Survival of locally advanced/unresectable non-small cell lung cancer (NSCLC) has improved with the use of concurrent radiation and chemotherapy over the past decades, but local and distant failure remain high. In addition, a key limiting factor in combining chemotherapy with accelerated radiotherapy (ART) is severe esophagitis. We investigated the toxicity, response rate, and overall survival (OS) with induction carboplatin and vinorelbine followed by concomitant topotecan and ART in patients with locally advanced/unresectable NSCLC. METHODS: In this phase II trial, stage IIIA or IIIB NSCLC patients with a Karnofsky performance score >60 were eligible. Patients received induction carboplatin (area under the curve = 5.5) on days 1 and 22, and vinorelbine (25 mg/m) on days 1, 8, 22, and 29. During the concurrent chemoradiation, patients received intravenous topotecan (0.5 mg/m) on days 43 to 47, days 57 to 61, and days 71 to 75 before the morning radiotherapy (RT) fraction. RT was administered in an accelerated fashion at 2 Gy per fraction, twice daily for five consecutive days, every other week, to a cumulative dose of 60 Gy during a 5-week period. RESULTS: Thirty-seven patients were accrued; of these, 35 were evaluable. Overall response rate was 71% (14% complete response, 57% partial response). Six of 35 (17%) patients had stable disease. Four (11%) patients progressed during treatment. At a median follow-up of 45 months for surviving patients, the median survival based on Kaplan-Meier estimates is 17.9 months. OS at 1, 2, and 3 years is 62%, 41%, and 33%, respectively. Actuarial 5-year OS is 21%. The median time to first relapse is 12.2 months (9.1-24.7 months). There were no cases of grade 3 or 4 esophagitis. CONCLUSIONS: This combined-modality regimen yielded encouraging OS rates, with no severe esophagitis. Using four-dimensional RT treatment planning, we plan to further evaluate altered fractionation RT and chemotherapy for this group of patients.

AB - BACKGROUND: Survival of locally advanced/unresectable non-small cell lung cancer (NSCLC) has improved with the use of concurrent radiation and chemotherapy over the past decades, but local and distant failure remain high. In addition, a key limiting factor in combining chemotherapy with accelerated radiotherapy (ART) is severe esophagitis. We investigated the toxicity, response rate, and overall survival (OS) with induction carboplatin and vinorelbine followed by concomitant topotecan and ART in patients with locally advanced/unresectable NSCLC. METHODS: In this phase II trial, stage IIIA or IIIB NSCLC patients with a Karnofsky performance score >60 were eligible. Patients received induction carboplatin (area under the curve = 5.5) on days 1 and 22, and vinorelbine (25 mg/m) on days 1, 8, 22, and 29. During the concurrent chemoradiation, patients received intravenous topotecan (0.5 mg/m) on days 43 to 47, days 57 to 61, and days 71 to 75 before the morning radiotherapy (RT) fraction. RT was administered in an accelerated fashion at 2 Gy per fraction, twice daily for five consecutive days, every other week, to a cumulative dose of 60 Gy during a 5-week period. RESULTS: Thirty-seven patients were accrued; of these, 35 were evaluable. Overall response rate was 71% (14% complete response, 57% partial response). Six of 35 (17%) patients had stable disease. Four (11%) patients progressed during treatment. At a median follow-up of 45 months for surviving patients, the median survival based on Kaplan-Meier estimates is 17.9 months. OS at 1, 2, and 3 years is 62%, 41%, and 33%, respectively. Actuarial 5-year OS is 21%. The median time to first relapse is 12.2 months (9.1-24.7 months). There were no cases of grade 3 or 4 esophagitis. CONCLUSIONS: This combined-modality regimen yielded encouraging OS rates, with no severe esophagitis. Using four-dimensional RT treatment planning, we plan to further evaluate altered fractionation RT and chemotherapy for this group of patients.

KW - Accelerated radiation

KW - Lung cancer

KW - Topotecan

UR - http://www.scopus.com/inward/record.url?scp=34548390956&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548390956&partnerID=8YFLogxK

U2 - 10.1097/JTO.0b013e318145b2e5

DO - 10.1097/JTO.0b013e318145b2e5

M3 - Article

C2 - 17805061

AN - SCOPUS:34548390956

VL - 2

SP - 831

EP - 837

JO - Journal of Thoracic Oncology

JF - Journal of Thoracic Oncology

SN - 1556-0864

IS - 9

ER -