While researchers have learned in the last decade thatcombining chemotherapy with radiation is better than radiation alonefor treating non-small cell lung cancer patients with locally advanceddisease – cancer confined to the lungs – finding the right combinationof drugs – and the best timing of treatment – has been tricky.
Anew study led by lung cancer specialists at Jefferson Medical Collegeadds to growing evidence that giving patients both chemotherapy andradiation in the beginning of treatment may help patients live longer.Non-small-cell lung cancer accounts for about 80 percent of all casesof lung cancer. An estimated 40,000 Americans are diagnosed each yearwith locally advanced disease.
“This is a further step in lookingat what is the best combination of two chemotherapy agents withradiation, which will enable us to move forward and study it moresystematically,” says Walter J. Curran Jr., M.D., professor and chairof radiation oncology at Jefferson Medical College at Thomas JeffersonUniversity in Philadelphia and clinical director of Jefferson’s KimmelCancer Center, who led the research.
“There are new biologicagents we want to test with chemotherapy, with radiation and withboth,” he notes. “Finding the best combination of chemotherapy andradiation provides a template by which we can test these agents.”
The results appear September 1, 2005 in the Journal of Clinical Oncology.
Inthe multicenter, randomized phase 2 trial, researchers compared threedifferent approaches to treating inoperable non-small-cell lung cancerthat had not spread beyond the lungs. They divided more than 250patients into three treatment arms. One group received chemotherapybefore radiation. A second group had chemotherapy before and duringradiation. Patients in the third arm received chemotherapy andradiation at the same time, then added a little more chemotherapyafter. Each arm had the same schedule of radiation and were given thesame two standard chemotherapy agents, carboplatin and paclitaxel.
Dr.Curran and his colleagues found that the patients in the third arm didbest, living several months more on average when compared against thestandard treatment.
“That’s in keeping with the observedresults of other studies,” Dr. Curran says. “Giving radiation andchemotherapy from day one appears to be the best approach for thesepatients,” though side effects can at first appear to be worse.
“Researchersare already looking at targeted agents such as bevacizumab, cetuximaband other agents with chemotherapy and radiation in lung cancer,” hesays. “This kind of study will help guide us as to which schedule touse.”
Some other institutions that participated in the trialinclude medical centers at the University of Pittsburgh and VanderbiltUniversity and Rush University Medical Center.
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