Post-surgery Chemotherapy Based on BRCA1 Levels Fails To Improve Survival in NSCLC
One-hundred and eight patients received cisplatin plus docetaxel in the control arm; 392 patients in the experimental arm received varying treatments according to BRCA1 mRNA expression levels.
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Post-resection chemotherapy tailored to mRNA BRCA1 levels did not significantly improve survival among patients with non–small cell lung cancer (NSCLC) with lymph node involvement compared with the control chemotherapy regimen, according to a plenary presentation at the International Association for the Study of Lung Cancer (IASLC) 18th Annual World Conference on Lung Cancer (WCLC) in Yokohama, Japan.1
For the phase 3 GECP-SCAT study (ClinicalTrials.gov Identifier: NCT00478699), researchers randomly assigned 500 patients with completely resected NSCLC to 2 cohorts. One-hundred and eight patients received cisplatin plus docetaxel in the control arm; 392 patients in the experimental arm received varying treatments according to BRCA1 mRNA expression levels. Patients with low levels of expression received cisplatin plus gemcitabine, those with intermediate levels received cisplatin plus docetaxel, and those with high levels received docetaxel alone.
The median mRNA BRCA1 level was 15.78. Patients with adenocarcinoma had median BRCA1 levels of 6.95; patients with squamous histology had median levels of 20.29 (P < .001).
Median progression-free survival was 38.7 months in the control arm, 32.2 months the cisplatin plus gemcitabine arm, 34.3 months for the cisplatin plus docetaxel arm, and 41 months in the docetaxel alone arm.
At the 5-year follow-up, the event free–rate was 54% in the control arm vs 56% in the experimental arm. No significant differences in median overall survival (OS) were observed; median OS was 73.3 months in the control arm compared with 77.5 months in the experimental arm (P = .75). In the experimental cohort, median OS was 80.2 months in the docetaxel alone arm, 80.5 months in the cisplatin plus docetaxel arm, and 74 months in the cisplatin plus gemcitabine arm.
Patients in the experimental arm had higher levels of compliance to chemotherapy and had fewer dose reductions regardless of the extent of surgery. Patients who were 70 or older had lower rates of compliance.
The authors concluded that while no OS improvement was seen in the experimental arm, if patients have high BRCA levels, “[chemotherapy] treatment without cisplatin is not detrimental.”
Read more of Cancer Therapy Advisor's coverage of the IASLC 18th World Conference on Lung Cancer (WCLC) by visiting the conference page.
- Massuti B, Dols MC, Rodriguez-Paniagua M, et al. SCAT ph III trial: adjuvant CT based on BRCA1 levels in NSCLC N+ resected patients. Final survival results a Spanish Lung Cancer Group trial. Presented at: International Association for the Study of Lung Cancer 18th World Conference on Lung Cancer; Yokohama, Japan: October 15-18, 2017. Abstract PL 02.04.