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K. Watanabe
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-085 - Randomized Phase II Study of Docetaxel plus Bevacizumab or Pemetrexed plus Bevacizumab for Elderly Non-Squamous NSCLC (TORG1323) (ID 1742)
09:30 - 09:30 | Author(s): K. Watanabe
- Abstract
Background:
A randomized study comparing carboplatin plus weekly paclitaxel versus single-agent chemotherapy in elderly patients with non-small cell lung cancer (NSCLC) demonstrated a survival advantage for combination therapy, however, increased toxicity and treatment-related deaths were also observed. Thus, single agent approaches remain the standard of care and the improvement of treatment remains a challenge in elderly patients. The combination of bevacizumab and other platinum-based chemotherapies is the standard of care in non-elderly patients with non-squamous NSCLC. Additionally, a randomized phase II study suggested the improvement of efficacy for the combination of B plus single-agent pemetrexed or docetaxel compared with single-agent alone. Even in elderly patients, two prospective studies which we conducted demonstrated the feasibility of the combination of bevacizumab and single agent pemetrexed or docetaxel. Thus we plan this randomized phase II study (TORG1323) to select the optimal regimen for experimental arm of the future phase III study in elderly patients.
Methods:
TORG1323 is an open label multicenter randomized phase II study to compare docetaxel plus bevacizumab (DB) with pemetrexed plus bevacizumab (PB). The primary endpoint is progression free survival (PFS, assessed by independent review committee). The secondary endpoints are safety, PFS (assessed by investigators), objective response rate, overall survival, time to treatment failure and quality of life. Eligible patients are 75 years or older, have histologically or cytologically documented stage IIIb, IV or recurrent non-squamous NSCLC for which they had no received chemotherapy, ECOG performance status 0 or 1, and adequate organ function. Patients are randomly assigned to PB and DB arm (1:1). Bevacizumab is administered 15 mg/kg, pemetrexed is 500 mg/m[2] and docetaxel is 50 mg/m[2] every 3 weeks until disease progression or unacceptable toxicity. Selection design is adopted for this study. The planned sample size is 120 patients to yield 80 % power to select an optimal regimen correctly. Enrollment time is 2 years 8 months and follow-up time is 1 year. The first patient on this clinical trial was enrolled in April 2014. Further details can be found on UMIN Clinical Trials Registry (UMIN000012786). Figure 1
Results:
not applicable
Conclusion:
not applicable
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P3.07 - Poster Session/ Small Cell Lung Cancer (ID 223)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.07-015 - Final Report of Phase I/II Study of Induction Carboplatin and Irinotecan Followed by TRT for Elderly Patients with LD-SCLC: TORG 0604 (ID 3232)
09:30 - 09:30 | Author(s): K. Watanabe
- Abstract
Background:
In elderly patients with LD-SCLC, the role of irinotecan has been unclear and the timing of TRT combined with chemo-therapy has not been fully evaluated. Furthermore, no standard treatment has been established for them. We report a phase I/II trial of induction chemotherapy of carboplatin and irinotecan followed by sequential TRT in this population.
Methods:
Patients with untreated, measurable LD-SCLC >70 years with performance status (PS) 0 to 2 and adequate organ function were eligible. Treatment consisted of induction with carboplatin on day 1 and irinotecan on days 1 and 8 every 21 days for four cycles. TRT of 54Gy in 27 fractions was then administered sequentially. Carboplatin dose was escalated from AUC of 4 to 5 (Levels 1 and 2, respectively) with a fixed dose of irinotecan at 50 mg/m[2]. The primary objective of the phase II portion was evaluation of efficacy.
Results:
A total of 41 patients were enrolled [median age 75 years, range 70-86 years; 31 male, 10 female; PS 0/1/2: 22/18/1]. At Level 1 (n=6), one patient experienced dose-limiting toxicity (DLT) as Grade 3 hypertension. At Level 2 (n=6), two patients experienced DLT as Grade 4 thrombocytopenia. Therefore, level 1 was chosen as the recommended dose. The phase II trial was then expanded by 35 patients in the level 1 based on the Simon minimax design. In all cohorts, the median chemotherapy cycle was 4 (1/2/3/4 courses administered as 4/2/2/33); median radiation dose was 54Gy (range 36-60). Toxicities were generally mild, as expected. Gr 3/4 leukopenia and thrombocytopenia were both observed in six (15%) patients. No Gr 3/4 diarrhea or esophagitis was noted. Although Gr 3 febrile neutropenia and Gr 3 pneumonitis were seen in two patients each, no treatment-related deaths occurred. There were five complete responses and 32 partial responses, for a response rate of 90%. With median follow-up of 80.4 months (n=41), median progression-free and overall survival times were 11.2 and 27.1 months, respectively.
Conclusion:
Induction chemotherapy with carboplatin plus irinotecan followed by sequential TRT was well tolerated and highly effective in elderly patients with LD-SCLC. Further confirmatory studies are warranted.
