Vinorelbine (VNR) and concurrent thoracic radiation therapy (TRT) in locally advanced non-small cell lung cancer (NSCLC)

Abstract

18507 Background: A retrospective analysis was performed to evaluate Therapeutic Index of VNR with concurrent TRT in pts with stage III unresectable NSCLC after induction therapy with platinum compounds, gemcitabine and/or vinorelbine. Methods: Multimodality treatment consisted of induction therapy with platinum (80 mg/m2/i.v.) or carboplatinum (AUC 5) plus gemcitabine (1,200 mg/m2/i.v.) (GP) or vinorelbine (25 mg/m2/i.v.) (VP) on days 1–8-21. Patients in complete remission (CR), partial remission (PR) and stable disease (SD) after induction therapy, concomitant chemo-radiotherapy were treated with VNR os (12 mg/m2) or i.v. (5 mg/m2) three-times weekly 2 hours before concurrent TRT (2 Gy/day for 6 wks). Results: From November 2002 to March 2007, 31 chemotherapy and radiotherapy-naive pts were treated (males/females 16/15); median age 60.0 years (range 18 to 77); median ECOG PS 0 (range 0–1); no weight loss > 10% in all pts; stage IIIA 6 pts (19.3%), IIIB 25 pts (80.7%). 21 Pts showed 6 WHO grade III toxic events (7.9%) and 1 WHO grade IV (1.3%) hematologic. After induction therapy we observed the following: 12 partial responses (38.7%) and 19 stable diseases (61.3%). After concurrent radio- chemotherapy clinical responses were as follows: 13 partial response (43.3%), 13 stable disease (43.3%) and 4 progressive disease (13.4%). Toxicity observed was as follows: 1 patient with dysphagia WHO grade III and 1 WHO grade IV, no toxic deaths have occurred. OS was 15.3 months (range 4.4 to +60.3), median TTP 10 months (range 3.7 to 26,1). By stratifying patients in stage IIIA and IIIB at diagnosis, in stage IIIA S was 21.6 months (range 13.5 to +39.2 months) and TTP was 13.9 months (range 11.5 to +19.4 months), in stage IIIB S 14.6 months (range 4.4 to +60.3 months) and TTP 9.1 months (range 3.7 to 26.1 months). After the multimodality treatment 5 patients (16.6%) were submitted to thoracic surgery: at the diagnosis 3 patients were stage IIIA and 2 patients IIIB. Actuarial survival curve shows that at 1 year the probability was 65% and at 2 years 35%. At this writing 9 pts (29%) were alive. Conclusions: Preliminary results of this multimodality treatment are promising as concern activity, local control of disease, median and overall survival. A larger accrual and a longer follow-up will be required to verify these data. No significant financial relationships to disclose.