Phase I trial of concurrent thoracic radiation and continuous infusion cisplatin and etoposide in stage III non-small cell lung cancer

Objective: Although combined modality therapy appears to be superior to rad iotherapy alone for the treatment of locally advanced non-small cell lung c ancer (NSCLC), the optimal treatment regimen has not been determined. We de signed this trial to determine the maximal tolerated doses (MTD) of continu ous intravenous infusion (CI) cisplatin and etoposide that could be adminis tered concurrently with thoracic irradiation. Methods: 19 patients with sta ge IIIA or IIIB NSCLC were treated at three different dose levels of CI cis platin and etoposide with concurrent single daily fraction thoracic radioth erapy to 4500 cGy. This chemoradiotherapy phase of treatment was followed b y a 1500-2000 cGy radiotherapy boost and three cycles of standard intermitt ent bolus cisplalin 80 mg/m(2) IV on day 1 and etoposide 80 mg/m(2) IV on d ays 1, 2 and 3. Results: The MTD of CI chemotherapy was determined to be ci splatin 5 mg/m(2)/day plus etoposide 18 mg/m(2)/day for 5 days per week ove r 5 weeks along with thoracic irradiation. Overall, 37% of patients require d breaks in the chemoradiotherapy course and 32% required attenuation of th e planned duration of CI chemotherapy. Only 42% of patients received all th ree planned cycles of bolus chemotherapy and 16% received < 6000 cGy of tho racic irradiation. The major toxicities during concurrent chemoradiotherapy were grade 3-4 esophagitis (42%) and myelosuppression (47%). Subsequent ch emotherapy was complicated by grade 3-4 myelosuppression in 38% of patients . An objective response was documented in 58% of patients (CR 11%, PR 47%). Median survival was 18 months with 2- and 5-year survival rates of 42 and 11%, respectively. Conclusions: These results demonstrate that CI cisplatin and etoposide can be administered safely to patients with locally advanced NSCLC, and that such potentially radiosensitizing strategies deserve furth er evaluation in this setting. (C) 1999 Elsevier Science Ireland Ltd. All r ights reserved.