Daily low-dose cisplatin plus concurrent high-dose thoracic irradiation in locally advanced unresectable non-small-cell lung cancer: Results of a phase II Southwest Oncology Group study

M. B. Hazuka, J. J. Crowley, P. A. Bunn, M. O'Rourke, T. J. Braun, Robert B Livingston

Research output: Contribution to journalArticle

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Abstract

Purpose: This single-arm phase II trial was designed to evaluate the efficacy and toxicity of continuous-course, high-dose thoracic irradiation (RT) combined with concurrent daily low-dose cisplatin followed by high-dose cisplatin consolidation in patients with locally advanced unresectable non- small-cell lung cancer (NSCLC). The daily chemotherapy regimen was designed to optimize the radiosensitizing properties of cisplatin. Patients and Methods: Sixty-five patients from 21 participating institutions were entered onto the study between April 1989 and May 1991. Protocol therapy consisted of daily intravenous (IV) cisplatin (5 mg/m2) plus concurrent continuous- course RT (61 Gy over 6 1/2 weeks) both delivered Monday through Friday each week. After a 3- to 4-week rest period, this was followed by three 28-day cycles of cisplatin at 100 mg/m2 or subsequently 50 mg/m2 administered IV on days 1 and 8 of each cycle. Results: Sixty-four patients were eligible; the majority had unresectable stage IIIa (36%) or IIIb (55%) NSCLC. The remaining 9% had recurrent disease confined to the chest (five patients) or stage II disease (one patient). The feasibility of this regimen is demonstrated by the fact that only five patients (8%) were unable to complete daily cisplatin and RT because of toxicity. Esophagitis (16%), leukopenia (14%), nausea (8%), and vomiting (6%) were the most common severe (grade 3) toxicities. There was only one life-threatening toxicity (grade 4 nausea) and no treatment-related deaths. The objective response rate was 39%, and six patients (9%) achieved a radiographic complete response (CR). The median survival duration for all patients was 14 months, and the 1- and 2-year actuarial survival rates were 56% and 24%, respectively. For stage IIIa patients, the median survival duration and 2-year survival rate were 17 months and 38%, as compared with 10 months and 14% for stage IIIb patients, respectively. Conclusion: Daily low-dose cisplatin plus concurrent high-dose continuous-course RT is a well-tolerated outpatient regimen. The survival results are encouraging and appear to be equivalent to more toxic combined approaches. These results warrant further testing of combined daily platinum analogs with RT.

Original languageEnglish (US)
Pages (from-to)1814-1820
Number of pages7
JournalJournal of Clinical Oncology
Volume12
Issue number9
StatePublished - Sep 1994
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Cisplatin
Thorax
Nausea
Survival
Survival Rate
Esophagitis
Poisons
Leukopenia
Platinum
Vomiting
Outpatients
Drug Therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Daily low-dose cisplatin plus concurrent high-dose thoracic irradiation in locally advanced unresectable non-small-cell lung cancer : Results of a phase II Southwest Oncology Group study. / Hazuka, M. B.; Crowley, J. J.; Bunn, P. A.; O'Rourke, M.; Braun, T. J.; Livingston, Robert B.

In: Journal of Clinical Oncology, Vol. 12, No. 9, 09.1994, p. 1814-1820.

Research output: Contribution to journalArticle

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title = "Daily low-dose cisplatin plus concurrent high-dose thoracic irradiation in locally advanced unresectable non-small-cell lung cancer: Results of a phase II Southwest Oncology Group study",
abstract = "Purpose: This single-arm phase II trial was designed to evaluate the efficacy and toxicity of continuous-course, high-dose thoracic irradiation (RT) combined with concurrent daily low-dose cisplatin followed by high-dose cisplatin consolidation in patients with locally advanced unresectable non- small-cell lung cancer (NSCLC). The daily chemotherapy regimen was designed to optimize the radiosensitizing properties of cisplatin. Patients and Methods: Sixty-five patients from 21 participating institutions were entered onto the study between April 1989 and May 1991. Protocol therapy consisted of daily intravenous (IV) cisplatin (5 mg/m2) plus concurrent continuous- course RT (61 Gy over 6 1/2 weeks) both delivered Monday through Friday each week. After a 3- to 4-week rest period, this was followed by three 28-day cycles of cisplatin at 100 mg/m2 or subsequently 50 mg/m2 administered IV on days 1 and 8 of each cycle. Results: Sixty-four patients were eligible; the majority had unresectable stage IIIa (36{\%}) or IIIb (55{\%}) NSCLC. The remaining 9{\%} had recurrent disease confined to the chest (five patients) or stage II disease (one patient). The feasibility of this regimen is demonstrated by the fact that only five patients (8{\%}) were unable to complete daily cisplatin and RT because of toxicity. Esophagitis (16{\%}), leukopenia (14{\%}), nausea (8{\%}), and vomiting (6{\%}) were the most common severe (grade 3) toxicities. There was only one life-threatening toxicity (grade 4 nausea) and no treatment-related deaths. The objective response rate was 39{\%}, and six patients (9{\%}) achieved a radiographic complete response (CR). The median survival duration for all patients was 14 months, and the 1- and 2-year actuarial survival rates were 56{\%} and 24{\%}, respectively. For stage IIIa patients, the median survival duration and 2-year survival rate were 17 months and 38{\%}, as compared with 10 months and 14{\%} for stage IIIb patients, respectively. Conclusion: Daily low-dose cisplatin plus concurrent high-dose continuous-course RT is a well-tolerated outpatient regimen. The survival results are encouraging and appear to be equivalent to more toxic combined approaches. These results warrant further testing of combined daily platinum analogs with RT.",
author = "Hazuka, {M. B.} and Crowley, {J. J.} and Bunn, {P. A.} and M. O'Rourke and Braun, {T. J.} and Livingston, {Robert B}",
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T1 - Daily low-dose cisplatin plus concurrent high-dose thoracic irradiation in locally advanced unresectable non-small-cell lung cancer

T2 - Results of a phase II Southwest Oncology Group study

AU - Hazuka, M. B.

AU - Crowley, J. J.

AU - Bunn, P. A.

AU - O'Rourke, M.

AU - Braun, T. J.

AU - Livingston, Robert B

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N2 - Purpose: This single-arm phase II trial was designed to evaluate the efficacy and toxicity of continuous-course, high-dose thoracic irradiation (RT) combined with concurrent daily low-dose cisplatin followed by high-dose cisplatin consolidation in patients with locally advanced unresectable non- small-cell lung cancer (NSCLC). The daily chemotherapy regimen was designed to optimize the radiosensitizing properties of cisplatin. Patients and Methods: Sixty-five patients from 21 participating institutions were entered onto the study between April 1989 and May 1991. Protocol therapy consisted of daily intravenous (IV) cisplatin (5 mg/m2) plus concurrent continuous- course RT (61 Gy over 6 1/2 weeks) both delivered Monday through Friday each week. After a 3- to 4-week rest period, this was followed by three 28-day cycles of cisplatin at 100 mg/m2 or subsequently 50 mg/m2 administered IV on days 1 and 8 of each cycle. Results: Sixty-four patients were eligible; the majority had unresectable stage IIIa (36%) or IIIb (55%) NSCLC. The remaining 9% had recurrent disease confined to the chest (five patients) or stage II disease (one patient). The feasibility of this regimen is demonstrated by the fact that only five patients (8%) were unable to complete daily cisplatin and RT because of toxicity. Esophagitis (16%), leukopenia (14%), nausea (8%), and vomiting (6%) were the most common severe (grade 3) toxicities. There was only one life-threatening toxicity (grade 4 nausea) and no treatment-related deaths. The objective response rate was 39%, and six patients (9%) achieved a radiographic complete response (CR). The median survival duration for all patients was 14 months, and the 1- and 2-year actuarial survival rates were 56% and 24%, respectively. For stage IIIa patients, the median survival duration and 2-year survival rate were 17 months and 38%, as compared with 10 months and 14% for stage IIIb patients, respectively. Conclusion: Daily low-dose cisplatin plus concurrent high-dose continuous-course RT is a well-tolerated outpatient regimen. The survival results are encouraging and appear to be equivalent to more toxic combined approaches. These results warrant further testing of combined daily platinum analogs with RT.

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