SY3-3 - Significance of Consolidation Chemotherapy in Unresectable, Locally Advanced Non-Small Cell Lung Cancer

Abstract

Unresectable, locally advanced, non-small cell lung cancer (LA-NSCLC) is a curable disease. About 15-20% of LA-NSCLC patients treated with chemoradiotherapy lives longer than five years. Standard treatment consists of platinum doublet chemotherapy and concurrent thoracic radiotherapy. “Consolidation chemotherapy”means a subsequent chemotherapy after concurrent phase. A meta-analysis and several phase III studies showed that consolidation chemotherapy did not prolong overall survival compared with no consolidation treatment. However, consolidation chemotherapy is frequently adopted in daily practice.The main role of consolidation chemotherapy is to control distant failure. Recent phase III trial of chemoradiotherapy demonstrated that distant failure rate at 18 months reached over 40%. Thus, investigators believe that two courses of chemotherapy limited in the concurrent phase are not enough, and newer regimen should be developed. Among metastatic NSCLC, several agents including molecular targeted drugs have been developed. Introducing these drugs into LA-NSCLC may be beneficial because they can be safely administered at the full dose level concomitant with radiotherapy. In addition, histology is a key factor using these regimens. Their efficacy results were different between squamous and non-squamous cell lung cancer. With regard to LA-NSCLC, the pattern of relapse was different according to histology in the phase III trial (WJTOG 0105). Patients with non-squamous histology showed significantly higher rate of distant failure, while those with squamous histology developed loco-regional failure as a frequent site of initial relapse. Histology should be paid more attention even in LA-NSCLC, and these analyses will provide the new treatment strategy.In this session, I will review the recent advances of chemoradiotherapy in LA-NSCLC, and discuss the significance of consolidation chemotherapy.