Findings may change treatment for thousands
Non-small cell lung cancer - the kind related mostly to smoking - is terribly difficult to treat. Now, researchers at Jefferson Medical College have preliminary clinical trial results showing that giving advanced lung cancer patients a common chemotherapy drug at the same time they receive daily radiation may help them live longer than by taking one treatment at a time. The new findings promise to change the way thousands of lung cancer patients are treated.
Walter J. Curran, Jr., M.D., clinical director of the Kimmel Cancer Center and professor and chair of radiation oncology at Jefferson Medical College of Thomas Jefferson University in Philadelphia, along with colleagues at Fox Chase Cancer Center in Philadelphia, M.D. Anderson Cancer Center in Houston and several other centers, examined the results of 597 patients treated with concurrent chemotherapy and daily chest radiation. They found that on average, patients who received the concurrent treatment lived 17 months. Those treated sequentially lived an average of 14.6 months.
Dr. Curran, who is chairman of the Radiation Therapy Oncology Group, a federally funded cancer clinical trials group which carries out multi-disciplinary research nationwide and which conducted the trial, presents his team's findings May 23 at the annual meeting of the American Society of Clinical Oncology in New Orleans.
Locally advanced non-small cell lung cancer is diagnosed annually in approximately 50,000 Americans. Nearly all NSCLC cases - which makes up approximately 75 percent of lung cancer - are smoking-related.
NSCLC tends to spread to adjacent lymph nodes. Surgery offers little to such patients, leaving radiation and chemotherapy.
Patients in the current study were assigned to one of three arms. Patients in arm one received the standard sequential chemotherapy and chest radiation. Those in arm two received daily radiation along with two drugs - cisplatin and vinblastine - at different times in the therapy. In arm three, patients were given a slightly different schedule of the same chemotherapy drugs, along with radiation therapy twice daily.
"We conclude that there may be an advantage to concurrent therapy, but there doesn't appear to be an advantage with twice a day radiation," he says. "This study provides strong support for continuing to investigate chemotherapy and radiation delivered concurrently." While the results are encouraging, it is too early to tell about long-term survival, Dr. Curran says. Patients did experience an increase in side effects, such as difficulty swallowing and bone marrow suppression and anemia.
This is the second major study in the world to look at this issue. A Japanese study also showed 14 months survival with sequential therapy and 17 months with concurrent treatment, says Dr. Curran.
"Previous studies have shown a five-year survival rate of 5 percent patients with locally advanced NSCLC," he explains. Today, with combining chemotherapy and radiation treatments, closer to 10 to 12 percent of patients may live five years.
"Over the past decade, we've seen an increase in median survival time from less than a year to about a year and a half - about a 50 percent increase," Dr. Curran says. "This is a much greater increase in survival time, percentage-wise, than in other major cancers."
He points out that over the last 12-years, researchers have been able to help patients live an average of almost twice as long. "We also hope we'll see a doubling in the three to five-year long-term survival rates," since the short-term improvements frequently portend for the long term, he says. "When you consider what a common disease this is, doubling the five-year survival rate is a substantial benefit."
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Editors: This information is embargoed for release May 23 at 1 p.m. EST at the American Society of Clinical Oncology meeting in New Orleans