Concurrent Chemoradiation Therapy with Cisplatin and Oral Etoposide for Locally Advanced Non-small Cell Lung Cancer / 대한암학회지

PURPOSE: Prognosis of locally advanced inoperable non-small cell lung cancer (NSCLC) treated with radiation therapy alone has been disappointing. In recent years, concurrent chemoradiation therapy has potential of improving both local and metastatic disease-free survival. This phase II study was undertaken to determine the feasibility, toxicity, response rate, local control rate, and survival duration of locally advanced NSCL patients treated with concurrent chemoradiation using cisplatin and oral etoposide. MATERIAL AND METHODS: Forty-seven patients were enrolled and forty-one patients were evaluable. Chemotheray consisted of cisplatin 50 mg/m2/IV on days 1 and 8 and oral etoposide 100 mg/day on days 1 to 5 and 8 to 12 which was repeated, every 4 weeks for two cycles during radiation therapy. Radiation therapy was administered to a total dose of 6300 cGY. RESULTS: Among 41 evaluable patients, six patients achieved complete response, and twenty had partial response, for an overall response rate of 63.4% (95% confidence interval; 48.4% to 75.4%). Stable disease was reported in 10 patients (24.4%) and another 5 (12.2%) showed disease pro gression. Overall survival rate was 76% at 1 year, 34% at 2 years. Median survival duration was 17 months (range; 3 to 41 ). Eighty-three percents of patients had radiation pneumonitis but only one patients needed medical treatment. CONCLUSION: Concurrent chemoradiation therapy with cisplatin and oral etoposide at this level is a well tolerated and feasible.

Clinical Efficacy of Combination Chemotherapy with Cisplatin , Ifosfamide , and Oral Etoposide ( PIE ) in Advanced Non - Small Cell Lung Cancer / 대한암학회지

PURPOSE: A prolonged administration of etoposide increases its effectiveness on the suggestion that pralonged maintenance of low levels is an important factor in determining its activity. Many studies have been tried to define the efficacy of combination of oral etoposide with other chemotherapeutic drugs such as cisplatin, 5-FU, and ifosfamide in patients with advanced non-small cell lung cancer (NSCLC). In this study, we evaluated the effectiveness and toxicities of combination chemotherapy of oral etoposide with intravenous cisplatin and ifosfamide in advanced NSCLC patients. MATERIALS AND METHODS: Thirty-three patients with inoperable NSCLC who had measurable diseases and had not been treated with chemotherapeutic drug, were enrolled in this study (from May 1995 to April 1998). Treatment consisted of intravenous cisplatin (20 mg/m(2)/day, Day 1-3) and ifosfamide (1,800 mg/m(2)/day, Days 1-3) with Mesna (1,100 mg/m(2)/day, Days 1-3), and oral etoposide (50 mg/m(2)/day, Days 4-17). This treatment was repeated every 4 weeks. Patients showing stable disease or a better response were continued on treatment with the range of one to nine cycles (medium: 3 cycles). All patients were evaluated for the response, survival, and toxicity of this combination chemotherapy. RESULTS: Eleven patients showed either complete responses [CR, 3 (9%)] or partial responses [PR, 8 (24%)]. The median number of treatment cycles were 5 (range, 3-9) for responders and 2 (range, 1-7) for non-responders. The responders had median response duration of 10 months and the overall survival of 12 months. The overall survival of responders were longer than that of non-responders (median 19 vs 5 months, p 0.0232). The toxicities of this treatment were tolerable without treatment related death. Limiting toxicities were myelosuppression and oral mucbsities, Grade 3 or 4 leukopenia and oral mucosities were observed in 34% and 9%, respectively. CONCLUSION: The combination of cisplatin, ifosfamide, and oral etoposide produced encouraging response rates and median survival duration in patients with response. Further study of this combination is warranted in comparison with standard cisplatin+etoposide regimen or intravenous etoposide, cisplatin and ifosfamide regimen.

Combination Chemotherapy with Cisplatin , Etoposide , and Ifosfamide ( PIE ) in the Advanced Non - Small Cell Lung Cancer / 대한암학회지

PURPOSE: Combination chemotherapy with cisplatin and etoposide have been considered as one of the chemotherpy regimen for non small cell lung cacer(NSCLC) with the response rate of 20~40%. Ifosfamide is one of the most active agent against NSCLC. And so, we initiated a phase II trial for advanced NSCLC to determine the effect of PIE(cisplatin, ifosfamide, etoposide) regimen. MATERIALS AND METHODS: 36 patients with inoperable non-small cell lung cancer who had no prior systemic chemotherapy were treated with combined ifosfamide (1,800 mg/m2 plus mesna 1,100 mg/m2 by intravenous continuous infusion daily for 3 days) with cisplatin (20 mg/m2 intravenous for 3 days) and etoposide (80 mg/m2 intravenous for 3 days). We evaluated the response rate, survival and toxicities of these patients. RESULTS: The objective response rate was 28%(CR; 2/36, 6%, PR; 8/36, 22%). Among 10 responders, 7 patients were in good ECOG performance status(0~1). The mean survival of all these patients were 43 weeks(8~141 weeks); the responding patients survived longer than the non-responders(median survival; 59 weeks vs 28 weeks, p<0.05). The toxicities of this regimen were acceptable without treatment related toxic death. CONCLUSION: We concluded that PIE regimen is effective in the treatment of advanced non-small cell lung cancer with acceptable toxicities and long-term follow up is warranted.