Comparison of concurrent use of carboplatin-Paclitaxel versus cisplatin-etoposide with thoracic radiation for stage III NSCLC patients: A systematic review.

Authors

null

Conor Ernst Steuer

Emory Univ, Atlanta, GA

Conor Ernst Steuer , Madhusmita Behera , Kristin Ann Higgins , Nabil F. Saba , Dong Moon Shin , Suchita Pakkala , Rathi Narayana Pillai , Taofeek Kunle Owonikoko , Walter John Curran Jr., Chandra Prakash Belani , Fadlo Raja Khuri , Suresh S. Ramalingam

Organizations

Emory Univ, Atlanta, GA, Winship Cancer Inst Emory Univ, Acworth, GA, Winship Cancer Inst of Emory Univ, Atlanta, GA, Winship Cancer Inst Emory Univ, Atlanta, GA, Winship Cancer Inst At Emory Univ, Atlanta, GA, Winship Cancer Inst Emory Univ, Atlanta, GA, NRG Oncology/RTOG, and Emory University, Atlanta, GA, Penn State Hershey Cancer Institute, Hershey, PA, Winship Cancer Inst, Atlanta, GA, The Winship Cancer Institute of Emory University, Atlanta, GA

Research Funding

No funding sources reported

Background: The two most commonly used chemotherapy regimens deployed concurrently with thoracic radiation (RT) for patients with unresectable IIIA and IIIB non-small cell lung cancer (NSCLC) are carboplatin/paclitaxel (CP) and cisplatin/etoposide (CE). Because there are no prospective comparisons of these two regimens in this setting, we conducted a systematic review of published trials to compare outcomes and toxicities between CE and CP. Methods: Studies which enrolled stage III patients receiving RT with CP or CE were identified using electronic databases (MEDLINE, EMBASE, and Cochrane library) and meeting abstracts. Trials were excluded if they were phase I, enrolled less than 10 pts, or included surgical resection. A systematic analysis of extracted data was performed using Comprehensive Meta Analysis (Version 2.2) software using random and fixed effect models. Clinical outcomes were compared using point estimates for weighted values of median overall survival (OS), progression free survival (PFS), response rate (RR) and toxicities. Two-tailed T-test with a significance level of 0.05 was used for all comparisons. Results: 3194 patients were included from 32 studies in the CE arm, and 3789 patients from 51 studies in CP. Baseline characteristics of patients on the CE arm versus CP arm were: median age 61 vs. 63 years, male 67.6% vs. 78%, squamous histology 39% vs. 40%, and median radiation dose 62 Gy vs. 63 Gy. There was no significant difference in response rates between CE and CP (65% vs. 56%, p = 0.6), respectively. There was no significant difference in median progression free survival (11.5m vs. 9.3m p = 0.2), overall survival (19.8m vs. 18.4m, p = 0.48), or 3-year survival rate (31% vs. 25%, p = 0.4) for CE vs. CP. CE was associated with higher grade 3/4 hematological toxicities than CP, such as neutropenia (53% vs. 23% p < 0.0001), as well as grade 3/4 nausea/vomiting (20% vs. 9% p = 0.018), while rates of grade 3/4 pneumonitis and esophagitis were similar. Conclusions: CE and CP regimens were associated with comparable efficacy when used with concurrent radiotherapy for stage III unresectable NSCLC pts. The toxicity profile favored the CP regimen.

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Abstract Details

Meeting

2015 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Local-Regional Non–Small Cell Lung Cancer

Citation

J Clin Oncol 33, 2015 (suppl; abstr 7536)

DOI

10.1200/jco.2015.33.15_suppl.7536

Abstract #

7536

Poster Bd #

283

Abstract Disclosures