More patients with non-small cell lung cancer (NSCLC) that is locally advanced lived five years or longer when they had received radiation and chemotherapy at the same time (concurrently) than those who had received the treatment in sequence, the study found.
Walter J. Curran, Jr., MD, principal investigator of the study and executive director of Winship Cancer Institute
Traditional treatment protocols typically call for chemotherapy to be administered first for patients with locally advanced NSCLC. Patients then undergo radiation therapy.
In this study, however, more patients who received the therapies concurrently – during the same general time period — were still living after five years than those who received the therapies in sequence. The study was published online in the Sept. 8 Journal of the National Cancer Institute.
Walter J. Curran, Jr., MD, principal investigator of the study and executive director of Winship Cancer Institute, said the findings suggest a new treatment standard for this group of patients.
“The significant increase in five-year survival for patients receiving concurrent versus sequential treatment establishes a new treatment standard for this large population of lung cancer patients,” said Curran, who is also chair of the Radiation Therapy Oncology Group, which conducted the clinical trial. RTOG is a National Cancer Institute-supported group of cancer research centers that cooperatively conduct clinical trials.
The Phase III study enrolled 610 participants with stage III, NSCLC at 153 institutions across North America. Stage III, NSCLC is locally advanced disease that has not spread to other organs. Many who are diagnosed with the disease were never smokers.
The study participants were randomized into three arms. One arm received cisplatin-based chemotherapy and radiation therapy in sequence – that is, chemotherapy first, then radiation therapy. Another arm received radiation and chemotherapy concurrently once daily. The third arm received the therapies concurrently but twice daily.
The patients in the arm who received concurrent therapy once daily fared the best of the three arms. Of those patients, 16 percent were still living after five years. Those who received the therapies sequentially fared least well; 10 percent were still living after five years. Those who received concurrent therapy twice daily fared better than those who received the therapies sequentially, but not as well as those who received concurrent therapy once a day. Of those, 13 percent were still living after five years.
The news is important because lung cancer remains the nation’s number one cancer killer. Lung cancer is difficult to treat, in large part because it often is diagnosed in late stages. About 50,000 Americans are diagnosed each year with stage III NSCLC. This study advances the knowledge about how best to treat those patients. It also suggests new treatment strategies for further study. For example, RTOG is now evaluating the addition of another drug, cetuximab, to the regimen for patients with stage III, NSCLC.
The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.