Can the use of amifostine improve cure rates for patients with advanced non-small cell lung cancer?

Abstract

Concurrent chemoradiation, probably plus systemic chemotherapy, currently offers the best treatment strategy in stage IIIA/IIIB non-small cell lung cancer. However, such approaches do not control local disease well, perhaps because of inadequate radiation dose. While few studies have explored higher than standard radiation doses (ie, 60 Gy), the major fear is that higher doses increase patient morbidity without improving cure rates. A University of North Carolina (Chapel Hill, NC) phase I/II trial suggests that at least 74 Gy can be given safely to patients with cytotoxic drugs, with a suggestion of improved survival. Moreover, other trial data have suggested that the cytoprotective and radioprotective agent amifostine can be used to reduce esophagitis and possibly pneumonitis in patients treated with conventional radiation doses. We describe herein a proposed clinical trial designed to test: (1) the hypothesis that higher radiation doses can lead to a survival advantage in patients with non-small cell lung cancer, and (2) the value of amifostine as a cytoprotective agent in the high-radiation dose range.