Full-dose irinotecan plus platinum (IP) with concurrent thoracic radiotherapy (C-TRT) in unresectable locally advanced non-small cell lung cancer (LA-NSCLC).

Abstract

e17547 Background: Weekly paclitaxel-carboplatin or cisplatin-etoposide with C-TRT is the standard of care for unresectable LA-NSCLC, with median survival time (MST) of 16-24 months and 3 year overall survival (OS) of 17-27%. Irinotecan plus platinum with C-TRT has been studied in LA-NSCLC with similar outcomes and no undue toxicities (Langer et al J Thorac Oncol 2007; Bastos et al J Thorac Oncol 2010). We reviewed our multi-disciplinary thoracic oncology program experience of full dose IP with C-TRT in LA-NSCLC. Methods: All patients with unresectable LA-NSCLC treated between January 2007 and December 2011 were searched through our program database and included. 26 patients treated with definitive IP and C-TRT were identified. Treatment consisted of irinotecan 65mg/m2, plus cisplatin 30mg/m2 or carboplatin AUC 3, on days 1 and 8, every 21 days for four cycles. C-TRT started on day 22 at 2 Gy/day for 6-7 weeks. (Total 60-70Gy.) Survival curves were estimated by Kaplan-Meier analysis. Primary end point was OS. Secondary endpoints were overall response rate (ORR), progression free survival (PFS), and toxicities. Results: Patient characteristics: Median age 61 (range 44-82); 73% males; 50% squamous, 31% adenocarcinoma, 19% other histology; 30% Stage IIIA/ 62% IIIB/8% IIB. 1 patient died early without evaluation. ORR was 69%, 5 (19%) complete response, 13 (50%) partial response, 7 (27%) stable disease. Median PFS 10.1 months. MST 31.4 months. One year OS 67.8% (95% CI 52-89) and three year OS 35.7% (95%CI 15-87). 12 (46%) patients had G3/4 hematologic toxicities: 7 neutropenia, 6 thrombocytopenia, 6 anemia, 2 lymphopenia. 9 (34.6%) patients had G3/4 non-hematologic toxicities: 4 radiation esophagitis, 3 elevated creatinine, 2 pneumonia, 2 nausea/vomiting. 1 G5 radiation pneumonitis. Two patients died of pneumonia and sepsis. 18 (69%) patients completed 4 cycles IP with concurrent TRT. Conclusions: Definitive treatment with full dose Irinotecan plus platinum and concurrent thoracic radiotherapy is effective and tolerable for unresectable LA-NSCLC with an enhanced MST of 31 months and 3 year OS of 35%.