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Cancer Chemotherapy and Pharmacology

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01-02-2017 | Original Article

Single-center comparison of multiple chemotherapy regimens for concurrent chemoradiotherapy in unresectable stage III non-small-cell lung cancer

Authors: Samer Tabchi, Normand Blais, Marie-Pierre Campeau, Mustapha Tehfe

Published in: Cancer Chemotherapy and Pharmacology | Issue 2/2017

Abstract

Purpose

To date, the best chemotherapy regimen to combine with concurrent radiotherapy in stage III non-small-cell lung cancer remains undetermined. We compared the survival outcomes and toxicities in patients who were treated with etoposide–cisplatin (EP), paclitaxel–carboplatin (PC), or vinblastine–cisplatin (VP) in one large cancer referral center.

Methods

We enrolled patients who received concurrent chemoradiotherapy at our university-affiliated hospital between January 1, 2009 and December 31, 2013. Demographic and clinical characteristics were identified. Progression-free survival (PFS) and overall survival (OS) between the different treatment groups were compared using Kaplan–Meier and Cox proportional hazards regression models. Treatment-related toxicities were also compared.

Results

A total of 107 patients were treated with EP (31.8%), PC (32.7%) or VP (35.5%). Treatment with VP was significantly superior to PC, both in terms of median PFS [29.2 vs. 10.5 months; hazard ratio (HR) 0.43; 95% CI 0.21–0.85; p = 0.01] and in terms of median OS [40.7 vs. 17.8 months; (HR) 0.42; (0.21–0.84); p = 0.01]. However, there was no survival difference between EP and either one of the other regimens, but there was significantly more toxicities reported with the use of EP (73.5%) compared to PC (44.7%) or VP (37.1%); (p = 0.001). The most frequent non-hematologic toxicities for the entire cohort were esophagitis (28%), fatigue (22.4%), pneumonitis (14%), and nephrotoxicity (9.3%).

Conclusion

Although the present study is limited by its small cohort and its retrospective nature, the results suggest that VP might be superior to PC and is less toxic than EP.

Dose reductions in this arm are superior to the reported toxicities because vinblastine doses on days 8;15 and 22 tend to be omitted when the patient experiences asymptomatic hematologic toxicities. Tests are usually conducted at outpatient facility and results are sent directly to the pharmacy where a decision is made in regards to the upcoming dose depending on the complete blood count.

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Title: Single-center comparison of multiple chemotherapy regimens for concurrent chemoradiotherapy in unresectable stage III non-small-cell lung cancer
Authors: Samer Tabchi
Normand Blais
Marie-Pierre Campeau
Mustapha Tehfe
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: Cancer Chemotherapy and Pharmacology / Issue 2/2017
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI: https://doi.org/10.1007/s00280-016-3226-0

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