MD Conference Express - ELCC 2015 - (Page 21)

Table 1. RCTs of Neoadjuvant or Adjuvant RT in Patients With Stage III NSCLC Study Intervention No. of Patients, Stage/TNM Status Outcome Neoadjuvant RT Lung Intergroup 0139 [Albain KS et al. Lancet. 2009] CRT followed by surgery vs CRT alone 429, IIIA (N2) 5-y survival: CRT + surgery, 27%; CRT alone, 20%; P = .10 German Lung Cancer Cooperative Group [Thomas M et al. Lancet Oncol. 2008] IND-Ctx followed by CRT and surgery vs IND-Ctx alone followed by surgery 558, III (A + B) 5-y OS in patients undergoing tumor resection: Ctx + CRT + surgery, 45%; Ctx + surgery, 42%; P = .82 SAKK 16/00 [Pless M et al. Ann Oncol. 2014] CRT followed by surgery vs Ctx alone followed by surgery 232, IIIA/N2 Median OS: CRT, 37.1 mo (95% CI, 22.6 to 50); Ctx, 26.1 mo (95% CI, 26.1 to 52.1); P = .938 ESPATUE [Eberhardt et al. J Clin Oncol. 2014] IND-Ctx + CRT followed by surgery (arm B) vs INDCtx + CRT followed by CRT (arm A) 246, resectable stage IIIA (N2), selected stage IIIB 5-y survival: arm B, 44.2%; arm A, 40.6%; log-rank P = .31 Adjuvant RT in postoperative setting ECOG [Keller SM et al. N Engl J Med. 2000] RT alone vs CRT 488, resected stage II (T2N1M0) or stage IIIa (T1-2N2M0 or T3N1-2M0) Median OS: RT alone, 39 mo; CRT, 38 mo; log-rank P = .56 ANITA [Douillard JY et al. Lancet Oncol. 2006] Adjuvant Ctx vs observation; PORT optional per each center's policy 840, IB-IIIA 5-y OS with Ctx improved by 8.6%; adjusted risk for death was significantly reduced for Ctx vs observation; P = .017 CRT, chemoradiation therapy; Ctx, chemotherapy; IND-Ctx, induction chemotherapy; NSCLC, non-small cell lung cancer; OS, overall survival; PORT, postoperative radiation therapy; RCT, randomized clinical trial; RT, radiation therapy; TNM, tumor, node, and metastasis. upfront stratification of tumors-as resectable, potentially resectable with an increased risk of incomplete resection, or unresectable-is crucial, he said. According to Prof De Leyn, good survival rates and acceptable morbidity and mortality have been achieved with induction chemotherapy or chemoradiotherapy in selected patients with potentially resectable tumors with an increased risk of incomplete resection. Prof De Leyn reviewed the evidence from several studies involving patients with potentially resectable N2 disease and one study of patients with unresectable disease, all of whom underwent surgery following induction chemotherapy or chemoradiation therapy (CRT; Table 2). In the German Lung Cancer Cooperative Group study [Thomas M et al. Lancet Oncol. 2008], preoperative CRT increased postsurgical mortality compared with preoperative chemotherapy, primarily due to increased rates of empyema and bronchial insufficiency. The evidence does not support a role for induction CRT for N2 disease, Prof De Leyn said. For Pancoast tumors, however, induction CRT is the standard of care. For stage III tumors deemed unresectable at baseline assessment, the EORTC 8947 trial [van Meerbeeck JP et al. J Natl Cancer Inst. 2007] demonstrated that induction chemotherapy will not render an unresectable tumor resectable, Prof De Leyn said. He recommended that patients whose tumors are deemed unresectable should receive immediate CRT. Both types of surgery and hospital surgical volume have been shown to influence outcomes. In a systematic review and meta-analysis of 27 studies published between 1990 and 2010, right pneumonectomy following neoadjuvant therapy was associated with significantly higher 30-day (P = .02) and 90-day (P = .03) mortality Peer-Reviewed Highlights From the European Society for Medical Oncology 2015 European Lung Cancer Conference 21

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MD Conference Express - ELCC 2015