Author of

• 12573

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  P3.09 - Poster Session 3 - Combined Modality (ID 214)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Combined Modality
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12590

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    P3.09-017 - Concurrent Chemoradiotherapy (ConCRT) using Cisplatin-Vinorelbine in Locally Advanced (LA) Non-small Cell Lung Cancer (NSCLC) (ID 3274)

    09:30 - 09:30  |  Author(s): M. Maimaris
    • Abstract

    Background
    ConCRT is considered to be the standard of care in LA NSCLC. We adopted ConCRT as our standard of care for appropriately selected patients since 2005. This is an analysis of a register of all patients consecutively assigned ConCRT since 2005 (in an intent to treat analysis).

    Methods
    From Feb 2005 to Feb 2013 we assigned ConCRT for 56 consecutive patients with LA NSCLC, who were deemed unresectable; this included T4/N3/ “bulky” N2 disease or locally recurrent disease after initial surgery. Patients had ECOG performance status (PS) 0-2 and were treated with Cisplatin 75mg/m2 d1 and Vinorelbine 30mg/m2 d1-8, 3-weekly during the induction chemotherapy phase (i.e. full doses for the first 1-2 cycles) whilst with the addition of radical RT delivered concurrently with subsequent chemotherapy cycles, Vinorelbine was reduced to 12.5mg/m2 d1-8. After ensuring acceptable toxicity with the first 11 patients treated, subsequent patients received Vinorelbine at 15mg/m2 d1-8 during ConCRT and the number of treatment cycles was escalated to a maximum of 6. Patients received definitive CRT (59.4-64.8 Gy) unless surgery was planned, in which case restaging evaluation for potentially resectable patients was performed at 45-50.4 Gy. PET staging was only available in a minority of these patients, since 2011.

    Results
    56 patients: 51 men and 5 women. Median age was 63 (43-81); PS 0-1 n=47, PS 2 n=9. Radiological stage IIIB n=34 (61%), IIIA n=16 (29%), IIB n=6 (11%). Histology, squamous n=31, adenocarcinoma n=13, unspecified/other NSCLC n=12. Treatment delivered: median 4 cycles of chemotherapy (range 1-6) delivered. 50 patients (89%) completed ConCRT. Radiological response rates: Objective responses n=34 (29 partial, 5 complete) yielding a response rate of 61%; stable disease (SD) n=7; progressive disease (PD) n=7; of the remaining 8 non-evaluable patients, 6 patients did not complete ConCRT, either due to toxicity/death or disease progression. 7/50 patients who received ConCRT underwent surgery (5 lobectomies, 2 pneumonectomies). 6 of these 7 patients had a complete pathologic response (pCR) and 1 a near pCR. Kaplan Meier survival figures: median progression-free survival (PFS) 12.2 months (95% C.I. 8.8-15.6) and median overall survival (OS) 17.2 months (95% C.I. 11.8-22.6). There were 2 toxic deaths from neutropenic sepsis. The incidence of grade 3-4 oesophagitis or pneumonitis was < 10% and manageable. Detailed toxicity data will be presented in the full publication.

    Conclusion
    This regimen has produced encouraging results in a patient cohort with predominantly IIIB disease and with a significant minority of poor PS=2 patients, with close to 90% being able to complete the treatment. The 17.2 month median OS achieved in this cohort is similar to that reported previously from larger randomized phase III studies of ConCRT. Finally 11% of patients had pathological pCR, whist it appears that about 35% patients treated with this regime can achieve long-term survival.