Induction chemotherapy followed by concurrent standard radiotherapy and daily low dose cisplatin in locally advanced non-small-cell lung cancer

Both induction chemotherapy and concurrent low-dose cisplatin have been sho wn to improve results of thoracic irradiation in the treatment of locally a dvanced non-small-cell lung cancer (NSCLC). This phase II study was designe d to investigate activity and feasibility of a novel chemoradiation regimen consisting of induction chemotherapy followed by standard radiotherapy and concurrent daily low-dose cisplatin. Previously untreated patients with hi stologically/cytologically proven unresectable stage IIIA/B NSCLC were elig ible. Induction chemotherapy consisted of vinblastine 5 mg m(-2) intravenou sly (i.v.) on days 1, 8, 15, 22 and 29, and cisplatin 100 mg m(-2) i.v. on days 1 and 22 followed by continuous radiotherapy (60 Gy in 30 fractions) g iven concurrently with daily cisplatin at a dose of 5 mg m(-2) i.v. Thirty- two patients were enrolled. Major toxicity during induction chemotherapy wa s haematological: grade III-IV leukopenia was observed in 31% and grade II anaemia in 16% of the patients. The most common severe toxicity during conc urrent chemoradiation consisted of grade III leukopenia (21% of the patient s); grade III oesophagitis occurred in only two patients and pulmonary toxi city in one patient who died of this complication. Eighteen of 32 patients (56%, 95% CI 38-73%) had a major response (11 partial response, seven compl ete response). With a median follow-up of 38.4 months, the median survival was 12.5 months and the actuarial survival rates at 1, 2 and 3 years were 5 2%, 26% and 19% respectively. The median event-free survival was 8.3 months with a probability of 40%, 23% and 20% at 1, 2 and 3 years respectively. I nduction chemotherapy followed by concurrent daily low-dose cisplatin and t horacic irradiation, in patients with locally advanced NSCLC, is active and feasible with minimal non-haematological toxicity. Long-term survival resu lts are promising and appear to be similar to those of more toxic chemoradi ation regimens, warranting further testing of this novel chemoradiation str ategy, (C) 1999 Cancer Research Campaign.