Weekly administration of paclitaxel and carboplatin with concurrent thoracic radiation in previously untreated elderly patients with locally advanced non‑small‑cell lung cancer: A case series of 20 patients

Takeshita,Jumpei; Masago,Katsuhiro; Fujita,Shiro; Hata,Akito; Kaji,Reiko; Kawamura,Takahisa; Tamai,Koji; Matsumoto,Takeshi; Nagata,Kazuma; Otsuka,Kyoko; Nakagawa,Atsushi; Otsuka,Kojiro; Tomii,Keisuke; Shintani,Takashi; Takayama,Kenji; Kokubo,Masaki; Katakami,Nobuyuki

doi:10.3892/mco.2014.249

Weekly administration of paclitaxel and carboplatin with concurrent thoracic radiation in previously untreated elderly patients with locally advanced non‑small‑cell lung cancer: A case series of 20 patients

Authors:
- Jumpei Takeshita
- Katsuhiro Masago
- Shiro Fujita
- Akito Hata
- Reiko Kaji
- Takahisa Kawamura
- Koji Tamai
- Takeshi Matsumoto
- Kazuma Nagata
- Kyoko Otsuka
- Atsushi Nakagawa
- Kojiro Otsuka
- Keisuke Tomii
- Takashi Shintani
- Kenji Takayama
- Masaki Kokubo
- Nobuyuki Katakami
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Affiliations: Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe, Hyogo, Japan, Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan, Division of Radiation Oncology, Institute of Biomedical Research and Innovation, Kobe, Hyogo, Japan, Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Published online on: January 28, 2014 https://doi.org/10.3892/mco.2014.249
Pages: 454-460

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Abstract

Elderly patients with stage III non‑small‑cell lung cancer (NSCLC) are frequently underrepresented in clinical trials that evaluate chemoradiotherapy, due to their poor functional status, coexisting illnesses and limited life expectancy. The Japan Clinical Oncology Group 0301 trial (JCOG0301) was the first study to demonstrate that thoracic radiation therapy (TRT) with daily low‑dose carboplatin may improve the outcome of elderly patients with stage III NSCLC. However, the efficacy and safety profiles of chemoradiotherapy, including platinum doublets, have not been clearly determined in this patient population. We retrospectively assessed the efficacy and toxicity of weekly paclitaxel in combination with carboplatin and concurrent TRT in patients aged ≥75 years with previously untreated locally advanced NSCLC. Between February, 2004 and July, 2013, we collected the data of 20 patients treated with weekly paclitaxel and carboplatin for 6 weeks and concurrent TRT. The objective response rate was 90%, the disease control rate was 95%, the median progression‑free survival was 8.63 months [95% confidence interval (CI): 5.7‑16.7] and the median overall survival (OS) was 16.1 months (95% CI: 10.7‑41.6). There were no grade 4 hematological or non‑hematological toxicities and no reported treatment‑related deaths. Therefore, platinum doublet therapy in combination with TRT did not provide a clinically significant survival benefit in our population of elderly patients with locally advanced NSCLC. However, the present study demonstrated the good feasibility and safety of this regimen. Further prospective clinical trials are required to evaluate the efficacy and safety of platinum doublet with TRT in elderly patients.

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1.	Siegel R, Naishadham D and Jemal A: Cancer statistics, 2013. CA Cancer J Clin. 63:11–30. 2013. View Article : Google Scholar
2.	National Cancer Institute: SEER Stat fact sheets: Lung and bronchus cancer. http://seer.cancer.gov/statfacts/html/lungb.html. Accessed August 12, 2013.
3.	Furuse K, Fukuoka M, Kawahara M, et al: Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol. 17:2692–2699. 1999.PubMed/NCBI
4.	Curran WJ Jr, Paulus R, Langer CJ, et al: Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 103:1452–1460. 2011. View Article : Google Scholar : PubMed/NCBI
5.	Dillman RO, Herndon J, Seagren SL, Eaton WL Jr and Green MR: Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst. 88:1210–1215. 1996.PubMed/NCBI
6.	Sause W, Kolesar P, Taylor S IV, et al: Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest. 117:358–364. 2000. View Article : Google Scholar
7.	Edelman MJ, Tang M, Gardner JF, Mullins CD, Seal B and Davidoff AJ: Therapy (Tx) of locally advanced (LA) NSCLC in the elderly: Analysis of 6,325 patients from surveillance, epidemiology and end results (SEER)-Medicare. J Clin Oncol. 26(Suppl 15): 75492008.
8.	Atagi S, Kawahara M, Yokoyama A, et al Japan Clinical Oncology Group Lung Cancer Study Group: Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol. 13:671–678. 2012. View Article : Google Scholar
9.	Yamamoto N, Nakagawa K, Nishimura Y, et al: Phase III study comparing second- and third-generation regimens with concurrent thoracic radiotherapy in patients with unresectable stage III non-small-cell lung cancer: West Japan Thoracic Oncology Group WJTOG0105. J Clin Oncol. 28:3739–3745. 2010. View Article : Google Scholar
10.	Goldstraw P, Crowley J, Chansky K, et al International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions: The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2:706–714. 2007. View Article : Google Scholar
11.	Oken MM, Creech RH, Tormey DC, et al: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 5:649–655. 1982. View Article : Google Scholar : PubMed/NCBI
12.	Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 45:228–247. 2009. View Article : Google Scholar
13.	National Cancer Institute: Common Toxicity Criteria (NCI-CTC) version 4.0.3. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf. Accessed August 13, 2013.
14.	National Comprehensive Cancer Network: Clinical practice guidelines in oncology: non-small cell lung cancer, NCCN guidelines version 2 (2013). http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed August 13, 2013.
15.	Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr and Albain KS: Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 341:2061–2067. 1999.PubMed/NCBI
16.	De Ruysscher D, Botterweck A, Dirx M, et al: Eligibility for concurrent chemotherapy and radiotherapy of locally advanced lung cancer patients: a prospective, population-based study. Ann Oncol. 20:98–102. 2009.PubMed/NCBI
17.	Socinski MA, Zhang C, Herndon JE II, et al: Combined modality trials of the Cancer and Leukemia Group B in stage III non-small-cell lung cancer: analysis of factors influencing survival and toxicity. Ann Oncol. 15:1033–1041. 2004. View Article : Google Scholar : PubMed/NCBI
18.	Rocha Lima CM, Herndon JE II, Kosty M, Clamon G and Green MR: Therapy choices among older patients with lung carcinoma: an evaluation of two trials of the Cancer and Leukemia Group B. Cancer. 94:181–187. 2002.PubMed/NCBI
19.	Langer CJ, Hsu C, Curran WJ, et al: Elderly patients (pts) with locally advanced non-small cell lung cancer (LA-NSCLC) benefit from combined modality therapy: Secondary analysis of radiation therapy oncology group (RTOG) 94-10. In: Proceedings of the Annual Meeting of the American Society for Clinical Oncology 21 (abstract 1193); pp. 299a2002
20.	Schild SE, Stella PJ, Geyer SM, et al: The outcome of combined-modality therapy for stage III non-small-cell lung cancer in the elderly. J Clin Oncol. 21:3201–3206. 2003. View Article : Google Scholar : PubMed/NCBI
21.	Jalal SI, Riggs HD, Melnyk A, et al: Updated survival and outcomes for older adults with inoperable stage III non-small-cell lung cancer treated with cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel: analysis of a phase III trial from the Hoosier Oncology Group (HOG) and US Oncology. Ann Oncol. 23:1730–1738. 2012.
22.	Sgroi MM, Neubauer M, Ansari R, et al: An analysis of elderly patients (pts) treated on a phase III trial of cisplatin (P) plus etoposide (E) with concurrent radiotherapy (CRT) followed by docetaxel (D) vs observation (O) in pts with stage III non small cell lung cancer (NSCLC). J Clin Oncol. 25(Suppl 18): 90372007.
23.	Aupérin A, Le Péchoux C, Pignon JP, et al: Meta-Analysis of Cisplatin/carboplatin based Concomitant Chemotherapy in non-small cell Lung Cancer (MAC3-LC) Group: Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients. Ann Oncol. 17:473–483. 2006.
24.	Montazeri A, Milroy R, Hole D, McEwen J and Gillis CR: Quality of life in lung cancer patients: as an important prognostic factor. Lung Cancer. 31:233–240. 2001. View Article : Google Scholar : PubMed/NCBI
25.	Langendijk H, Aaronson NK, de Jong JM, ten Velde GP, Muller MJ and Wouters M: The prognostic impact of quality of life assessed with the EORTC QLQ-C30 in inoperable non-small cell lung carcinoma treated with radiotherapy. Radiother Oncol. 55:19–25. 2000. View Article : Google Scholar : PubMed/NCBI
26.	Efficace F, Bottomley A, Smit EF, et al: Is a patient’s self-reported health-related quality of life a prognostic factor for survival in non-small-cell lung cancer patients? A multivariate analysis of prognostic factors of EORTC study 08975. Ann Oncol. 17:1698–1704. 2006.
27.	Maione P, Perrone F, Gallo C, et al: Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multi-center Italian lung cancer in the elderly study. J Clin Oncol. 23:6865–6872. 2005.
28.	Herndon JE II, Fleishman S, Kornblith AB, Kosty M, Green MR and Holland J: Is quality of life predictive of the survival of patients with advanced nonsmall cell lung carcinoma? Cancer. 85:333–340. 1999. View Article : Google Scholar : PubMed/NCBI
29.	Brown J, Thorpe H, Napp V, et al: Assessment of quality of life in the supportive care setting of the big lung trial in non-small-cell lung cancer. J Clin Oncol. 23:7417–7427. 2005. View Article : Google Scholar : PubMed/NCBI
30.	Ganz PA, Lee JJ and Siau J: Quality of life assessment. An independent prognostic variable for survival in lung cancer. Cancer. 67:3131–3135. 1991. View Article : Google Scholar : PubMed/NCBI
31.	Eton DT, Fairclough DL, Cella D, Yount SE, Bonomi P and Johnson DH; Eastern Cooperative Oncology Group: Early change in patient-reported health during lung cancer chemotherapy predicts clinical outcomes beyond those predicted by baseline report: results from Eastern Cooperative Oncology Group Study 5592. J Clin Oncol. 21:1536–1543. 2003. View Article : Google Scholar
32.	Movsas B, Scott C, Langer C, et al: Randomized trial of amifostine in locally advanced non-small-cell lung cancer patients receiving chemotherapy and hyperfractionated radiation: Radiation Therapy Oncology Group Trial 98-01. J Clin Oncol. 23:2145–2154. 2005. View Article : Google Scholar