PACLITAXEL IN COMBINATION CHEMOTHERAPY WITH RADIOTHERAPY IN PATIENTS WITH UNRESECTABLE STAGE-III NON-SMALL-CELL LUNG-CANCER

Purpose: The addition of combination chemotherapy to standard radiatio n therapy has improved treatment for locally unresectable non-small-ce ll lung cancer. In this phase II study, we evaluated the toxicity and efficacy of a novel chemotherapy regimen that included paclitaxel, cis platin, and etoposide plus concurrent radiation therapy in this group of patients. patients and Patients and Methods: Thirty-three patients with previously untreated, unresectable stage III non-small-cell lung cancer (stage IIIA, 11 patients; stage IIIB, 22 patients) initially re ceived two courses of chemotherapy, which included paclitaxel 135 mg/m (2) by 1-hour infusion on day 1, cisplatin 60 mg/m(2) intravenously (I V) on day 2, and etoposide 100 mg/m(2) IV on days 1, 2, and 3. On week 6, radiation therapy (60 Gy in 30 fractions) was initiated in conjunc tion with two additional courses of chemotherapy: paclitaxel 135 mg/m( 2) IV by 1-hour infusion on day 1. cisplatin 5 mg/m(2) IV on days 2- t o 10, and etoposide 25 mg/m(2) on days 1 to 10. Results: This combined modality program was feasible and well tolerated by most patients. Du ring the two courses of induction chemotherapy, grade 3 or 4 myelosupp ression occurred in only six patients (18%). Esophagitis was common du ring combined modality therapy (grade 3, 10 patients; grade 4, five pa tients). Forty-two percent of patients had a partial response after tw o courses of induction therapy, and 82% of patients had an objective r esponse at completion of therapy. Twelve patients (36%) had a complete response. Nineteen patients remain progression free at a median of 8 months; the median survival rime has not been reached. Conclusion: Thi s paclitaxel-containing combined modality therapy is feasible and high ly active in patients with inoperable stage III lung cancer. Esophagit is is the most common severe toxicity with this program. Further studi es with paclitaxel-containing combination regimens in patients with st age III non-small-cell lung cancer are indicated. (C) 1996 by American Society of Clinical Oncology.