Randomized phase II trial of cisplatin, etoposide, and radiation followed by gemcitabine alone or by combined gemcitabine and docetaxel in stage III A/B unresectable non-small cell lung cancer

Benjamin Movsas, Corey J. Langer, Helen J. Ross, Luhua Wang, Robert M. Jotte, Steve Feigenberg, Feng Xu, Chao H. Huang, Matthew J. Monberg, Coleman K. Obasaju

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Purpose: Southwest Oncology Group 9504 demonstrated the feasibility and potential benefit of docetaxel consolidation after etoposide, cisplatin, and radiotherapy in patients with locally advanced non-small cell lung cancer. Our study assessed consolidation with either gemcitabine alone or with docetaxel after identical chemoradiation as used in Southwest Oncology Group 9504. Methods: Patients with stage III non-small cell lung cancer and good performance status were included. Treatment consisted of concurrent cisplatin 50 mg/m 2 on days 1 and 8 plus etoposide 50 mg/m2 on days 1 to 5 for two 28-day cycles plus radiotherapy (62 Gy, 2 Gy daily in 31 fractions over 7 weeks), followed by randomization to either gemcitabine 1000 mg/m on days 1 and 8 (G) or gemcitabine 1000 mg/m2 on days 1 and 8 plus docetaxel 75 mg/m2 on day 1 (GD) every 21 days for three cycles. Results: Eighty-three patients were entered, 81 received induction therapy, and 64 were randomized (32 in each arm). Grade 3 or four events, including neutropenia (56.3% vs. 28.1%, p = 0.03), anemia (18.8% vs. 3.1%, p = 0.05), and fatigue (15.6% vs. 6.3%, p = NS), were more frequent with GD compared with G. Among all patients, median survival from registration was 20.8 months (95% confidence interval: 16.4-33.8), and 2-year survival was 46.7% (95% confidence interval: 35.6-57.1). From randomization, median progression-free survival was 5.4 months for G and 13.4 months for GD, and median survival was 16.1 months for G and 29.5 months for GD. Two-year survival rates were 40.6% for G and 55.7% for GD. Conclusion: The doublet, as expected, resulted in more toxicity, particularly myelosuppression and fatigue. Survival associated with the GD treatment arm of this trial exceeds that of previously reported trials.

Original languageEnglish (US)
Pages (from-to)673-679
Number of pages7
JournalJournal of Thoracic Oncology
Volume5
Issue number5
DOIs
StatePublished - May 2010

Keywords

  • Consolidation
  • Docetaxel
  • Gemcitabine
  • NSCLC
  • Stage IIIA/B

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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