Standard-Dose vs. High-Dose Chemoradiotherapy With, Without Cetuximab for Lung Cancer

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According to a new study published in the journal The Lancet Oncology, researchers have found that high-dose conformal radiotherapy with concurrent chemotherapy was not better than standard-dose radiotherapy with concurrent radiotherapy for the treatment of patients with stage 3 non-small cell lung cancer (NSCLC), and might actually be harmful to patients.

For the international, open-label, two-by-two factorial phase 3 study, researchers randomly assigned 166 patients to receive standard-dose radiation plus carboplatin and paclitaxel, 121 to high-dose radiation plus chemotherapy, 147 to standard-dose radiotherapy with chemotherapy and cetuximab, and 110 patients to high-dose chemoradiotherapy plus cetuximab.

Results showed a median overall survival of 28.7 months (95% CI: 24.1 - 36.9) for the standard-dose radiotherapy group compared with 20.3 months (95% CI: 17.7 - 25.0) for the high-dose radiotherapy group (HR = 1.38; 95% CI: 1.09 - 1.76; P = 0.004).

Median overall survival for those who received chemoradiotherapy plus cetuximab was 25.0 (95% CI: 20.2 - 30.5) versus 24.0 months (95% CI: 19.8 - 28.6) for those who did not receive cetuximab (HR = 1.07; 95% CI: 0.84 - 1.35).

In regard to safety, there were more treatment-related deaths in the high-dose radiation plus chemotherapy and cetuximab groups, and cetuximab treatment was associated with a higher incidence of severe adverse events (P < 0.0001).

The findings suggest that high-dose chemoradiotherapy is no better than standard-dose for patients with stage 3 NSCLC, and the addition of cetuximab to chemoradiotherapy provides no benefit in overall survival.

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High-dose radiotherapy was not better than standard-dose for NSCLC.
The authors aimed to compare overall survival after standard-dose versus high-dose conformal radiotherapy with concurrent chemotherapy and the addition of cetuximab to concurrent chemoradiation for patients with inoperable stage III non-small-cell lung cancer.
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