Therapeutic Strategies for Combined-Modality Therapy of Locally Advanced-Stage Non–Small-Cell Lung Cancer: Rationale for Consolidation Docetaxel Therapy

doi:10.3816/CLC.2005.s.017

Clinical Lung Cancer

Volume 7, Supplement 3, December 2005, Pages S93-S97

https://doi.org/10.3816/CLC.2005.s.017 Get rights and content

Abstract

Currently, there is no accepted standard of care for locally advanced and surgically unresectable non–smallcell lung cancer. Typically, treatment for patients with good performance status consists of a combination of chemotherapy and thoracic radiation therapy (RT), but the integration of these modalities and the respective dose schedules vary considerably. Herein, we review the rationale for a treatment paradigm employing consolidation docetaxel therapy after concurrent chemotherapy/RT and the results of recent clinical trials using this approach.

References (30)

K Kelly et al.
SWOG 0023: A randomized phase III trial of cisplatin/etoposide (PE) plus radiation therapy followed by consolidation docetaxel then maintenance therapy with gefitinib or placebo in patients with locally advance unresectable stage III non-small cell lung cancer (NSCLC)
Lung Cancer
(2005)
V Rusch et al.
Induction chemoradiation and surgical resection for non-small cell lung carcinomas of the superior sulcus: initial results of Southwest Oncology Group trial 9416 (Intergroup trial 0160)
J Thorac Cardiovasc Surg
(2001)
V Rusch et al.
Phase III trial of concurrent chemotherapy and radiotherapy (CT/RT) vs CT/RT followed by surgical resection for stage IIIA(pN2P)non–small cell lung cancer (NSCLC): outcomes and implications for surgical management in North American Intergroup 0139 (RTOG 9309)
Lung Cancer
(2005)
RO Dillman et al.
Improved survival in stage III non-smallcell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial
J Natl Cancer Inst
(1996)
T Le Chevalier et al.
Radiotherapy alone versus combined chemotherapy and radiotherapy in non-resectable non-small cell lung cancer: first analysis of a randomized trial of 353 patients
J Natl Cancer Inst
(1991)
Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized clinical trials
Br Med J
(1995)
R Rosell et al.
A randomized trial comparing pre-operative chemotherapy plus surgery with surgery alone in patients with non-small cell lung cancer
N Engl J Med
(1994)
JA Roth et al.
A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small cell lung cancer
J Natl Cancer Inst
(1994)
DR Gandara et al.
Integration of novel therapeutics into combined modality therapy of locally advanced non-small cell lung cancer
Clin Cancer Res
(2005)
Z Goldberg et al.
Combined-Modality Treatment of Non-Small Cell Lung Cancer

DR Gandara et al.

Activity of docetaxel in platinum-treated nonsmall cell lung cancer: results of a phase II multicenter trial

J Clin Oncol

(2000)

FA Shepherd et al.

Prospective randomized trial of docetaxel versus best supportive care in patients with non-small cell lung cancer previously treated with platinum-based chemotherapy

J Clin Oncol

(2000)

JS Lanni et al.

p53-independent apoptosis induced by paclitaxel through an indirect mechanism

Proc Natl Acad Sci U S A

(1997)

PH Gumerlock et al.

Bcl-2 phosphorylation and p27 induction as potential p53-independent mechanisms of apoptotic response to taxanes in nonsmall cell lung carcinoma

Proc Am Assoc Cancer Res

(1999)

V Rusch et al.

Aberrant p53 expression predicts clinical resistance to cisplatin-based chemotherapy in locally advanced non-small cell lung cancer

Cancer Res

(1995)

Cited by (4)

Long-term survival with concurrent chemoradiation therapy followed by consolidation docetaxel in stage IIIB non-small-cell lung cancer: A phase II Southwest Oncology Group study (S9504)
2006, Clinical Lung Cancer
Here we report 5-year survival data from S9504, a Southwest Oncology Group phase II trial evaluating consolidation docetaxel after concurrent cisplatin/etoposide and thoracic radiation therapy in patients with pathologically documented stage IIIB non–small-cell lung cancer. Survival outcomes were compared with a predecessor study (S9019) with identical eligibility, staging criteria, and treatment, excepting docetaxel consolidationg.
Treatment consisted of cisplatin 50 mg/m² per day on days 1, 8, 29, and 36; etoposide 50 mg/m² per day on days 1–5 and 29–33; and concurrent thoracic radiation therapy (total dose, 61 Gy). Consolidation docetaxel (75 mg/m² initial dose) started 4–6 weeks after completion of chemotherapy.
Concurrent chemotherapy was generally well tolerated, with a low level of radiationrelated esophagitis; 2 patients died from pneumonitis. Grade 3/4 neutropenia during consolidation docetaxel was common. At a median follow-up of 71 months, median progression-free survival was 16 months; median survival 26 months; and 3-, 4-, and 5-year survival rates were 40%, 29%, and 29%, respectively. Brain metastasis was the most common site of failure. In the predecessor trial S9019, median survival was 15 months, and 3-, 4-, and 5-year survival rates were 17%, 17%, and 17%, respectively.
The 5-year survival rate in S9540 of 29% compares favorably with the predecessor trial S9019 and other treatment approaches currently used in this patient population. A phase III trial designed to validate the concept of consolidation docetaxel is presently under way.
A phase i trial of concurrent chemoradiotherapy with non-split administration of docetaxel and cisplatin for dry stage III non-small-cell lung cancer (JCOG9901DI)
2012, Cancer Chemotherapy and Pharmacology
Phase III trial comparing docetaxel and cisplatin combination chemotherapy with mitomycin, vindesine, and cisplatin combination chemotherapy with concurrent thoracic radiotherapy in locally advanced non-small-cell lung cancer: OLCSG 0007
2010, Journal of Clinical Oncology
Multimodality therapy for stage III NSCLC: Controversies, advances, and evolving approaches
2006, Advanced Studies in Medicine

Electronic forwarding or copying is a violation of US and International Copyright Laws.

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Cancer Information Group, ISSN #1525-7304, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA 978-750-8400.

View full text

Therapeutic Strategies for Combined-Modality Therapy of Locally Advanced-Stage Non–Small-Cell Lung Cancer: Rationale for Consolidation Docetaxel Therapy

Abstract

Lung Cancer

J Thorac Cardiovasc Surg

Lung Cancer

Improved survival in stage III non-smallcell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial

J Natl Cancer Inst

Radiotherapy alone versus combined chemotherapy and radiotherapy in non-resectable non-small cell lung cancer: first analysis of a randomized trial of 353 patients

J Natl Cancer Inst

Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized clinical trials

Br Med J

A randomized trial comparing pre-operative chemotherapy plus surgery with surgery alone in patients with non-small cell lung cancer

N Engl J Med

A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small cell lung cancer

J Natl Cancer Inst

Integration of novel therapeutics into combined modality therapy of locally advanced non-small cell lung cancer

Clin Cancer Res

Combined-Modality Treatment of Non-Small Cell Lung Cancer

Activity of docetaxel in platinum-treated nonsmall cell lung cancer: results of a phase II multicenter trial

J Clin Oncol

Prospective randomized trial of docetaxel versus best supportive care in patients with non-small cell lung cancer previously treated with platinum-based chemotherapy

J Clin Oncol

p53-independent apoptosis induced by paclitaxel through an indirect mechanism

Proc Natl Acad Sci U S A

Bcl-2 phosphorylation and p27 induction as potential p53-independent mechanisms of apoptotic response to taxanes in nonsmall cell lung carcinoma

Proc Am Assoc Cancer Res

Aberrant p53 expression predicts clinical resistance to cisplatin-based chemotherapy in locally advanced non-small cell lung cancer

Cancer Res