Eh. Tan et al., Induction chemotherapy followed by concurrent chemoradiotherapy in stage III unresectable non-small cell lung cancer, ACTA ONCOL, 38(8), 1999, pp. 1005-1009
The favourable experience with the combination regimen of vinorelbine, ifos
famide and cisplatin (NIP) in patients with metastatic non-small cell lung
cancer (NSCLC) has led to a protocol assessing this regimen as an induction
treatment in patients with stage III unresectable NSCLC. followed by thora
cic radiotherapy with concurrent daily cisplatin as a radiosensitizer. Two
cycles of NIP were administered 21 days apart; each cycle comprised i.v. vi
norelbine 25 mg/m(2) on days 1 and 8, i.v. ifosfamide 3 g/m(2) on day 1 wit
h MESNA as uroprotection, and i.v. cisplatin 50 mg/m(2) on day 1. Radical t
horacic radiotherapy commenced on day 43 to a total dose of 64 Gy and i.v.
cisplatin 6 mg/m(2) was given concurrently prior to each fraction of radiat
ion as a sensitiser. Two more cycles of NIP were given to patients who resp
onded favourably to the induction treatment about 2 weeks after completion
of radiation. Between July 1995 and July 1997, 44 patients were treated wit
h this protocol. This treatment schedule was generally well tolerated. Grad
e 3-4 neutropenia occurred in 50% of the patients and neutropenic sepsis wa
s seen in 8. Grade 3-4 oesophagitis was uncommon. Most of the patients were
able to complete the induction and concurrent chemoradiotherapy phase. Maj
or response occurred in 75% of the patients with 2 (4.5%) complete response
s (CR). A total of 6 patients achieved CR after chemoradiotherapy. At a med
ian follow-up of 35 months, the median overall survival for all patients wa
s 15 months with a 3-year survival rats of 24%. The median overall survival
for stage IIIA patients was 19 months with a 3-year survival rate of 39% i
n contrast to 13 months' median overall survival and only 15% 3-year surviv
al rate for stage IIIB. The NIF regimen results in a high response rate in
NSCLC and this treatment programme seems to benefit selected patients with
stage III disease.