NSCLC: Etoposide/Cisplatin May Be Superior to Carboplatin/Paclitaxel With Radiation

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Chemoradiotherapy with etoposide plus cisplatin may improve overall survival over weekly paclitaxel plus carboplatin.
Chemoradiotherapy with etoposide plus cisplatin may improve overall survival over weekly paclitaxel plus carboplatin.

Chemoradiotherapy with etoposide plus cisplatin may improve overall survival over weekly paclitaxel plus carboplatin for patients with unresectable stage III non-small cell lung cancer (NSCLC), according to a study published in the Annals of Oncology.1

Cisplatin-based combination chemotherapy given concurrently with radiotherapy is the established standard of care for patients with inoperable stage III NSCLC. The optimal chemotherapy regimen in this setting is, however, unknown.

Researchers compared the efficacy of concurrent thoracic radiotherapy with etoposide plus cisplatin or carboplatin plus paclitaxel in patients with stage III NSCLC in an open-label, phase 3 trial (ClinicalTrials.gov Identifier: NCT01494558).

Investigators enrolled 200 patients and randomly assigned them to receive etoposide plus cisplatin every 4 weeks for 2 cycles or paclitaxel plus carboplatin weekly, given concurrently with 60 to 66 Gy of radiation.

At a median follow-up of 73 months, investigators estimated that 15.0% (95% CI, 2.0-28.0) more patients in the etoposide-cisplatin arm would be alive at 3 years than the carboplatin-paclitaxel arm (P = .024).

There was, however, no significant difference in median overall survival between the 2 treatment arms (hazard ratio, 0.76; 95% CI, 0.55-1.05; P = .095). Median overall survival was 23.3 months with etoposide plus cisplatin vs 20.7 months with paclitaxel plus carboplatin.

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The incidence of grade 2 or worse radiation pneumonitis was significantly higher in the paclitaxel-carboplatin group (33.3% vs 18.9%; P = .036), whereas the incidence of grade 3 or worse esophagitis was significantly higher in the etoposide-cisplatin group (20.0% vs 6.3%; P = .009).

Reference

  1. Liang J, Bi N, Wu S, et al. Etoposide and cisplatin vs paclitaxel and carboplatin with concurrent thoracic radiotherapy in unresectable stage III non–small cell lung cancer: A multicenter randomized phase III trial. Ann Oncol. 2017 Jan 30. doi: 10.1093/annonc/mdx009 [Epub ahead of print]

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