CANCER DE PULMON DE CELULA NO PEQUEÑA: TRATAMIENTO DEL ESTADIO

III

Nuria ViñolasPOSTMUNDIAL DE PULMON8 de octubre 2015Madrid

1.Papel de la cirugia

2. Radioterapia: dosis y técnica

3. Tipos de quimioterapia: eficacia y toxicidad

4. Pacientes ancianos

5. Terapias moleculares

apel de la cirugia

ORAL05.05: Trimodality Therapy in the Treatment of Stage IIIA Non-Small Cell Lung Cancer (NSCLC): A National Cancer Database Analysis – Behera M et al

Study objective

• To compare the outcomes and predictors associated with trimodality therapy vs. chemoradiotherapy alone in patients with NSCLC from the National Cancer Database

Behera et al. J Thorac Oncol 2015; 10 (suppl 2): ORAL05.05

Primary endpoint

• OS

CRT + pneumonectomy

CRT alone

CRT + lobectomy

Key patient inclusion criteria

• Stage IIIA-N2

(n=29,584)

PD

PD

PD

2. Radioterapia: dosis y técnica

ORAL20.03: Radiation Dose Escalation in Patients with Locally Advanced Non-Small Cell Lung Cancer; 60 Month Follow-Up of a Randomized Phase II Trial – Walraven I* et al

Study objective

• To evaluate the efficacy of dose escalation with hypofractionation in patients with locally advanced NSCLC treated with concurrent cisplatin ± cetuximab

*Presented by Belderbos JWalraven et al. J Thorac Oncol 2015; 10 (suppl 2): ORAL20.03*6 mg/m2 qd; †400 mg/m2 loading dose then 250 mg/m2 qw

Primary endpoint

• OS

R

PD

PD

Key patient inclusion criteria

• Inoperable stage II and IIIA/B NSCLC

• WHO PS 0–1

(n=102)RT (24 x 2.75 Gy) +

cisplatin* + cetuximab†

(n=51)

RT (24 x 2.75 Gy) + cisplatin*(n=51)

3. Tipos de quimioterapia:eficacia y toxicidad

ORAL20.01: A Systematic Review of Carboplatin-Paclitaxel versus Cisplatin-Etoposide Concurrent with Thoracic Radiation for Stage III NSCLC Patients– Steuer C et al

• Key results

– Anaemia (8% vs. 16%; p=0.06), thrombocytopenia (6% vs. 14%; p=0.001) and neutropenia (23% vs. 54%; p<0.0001) were all lower in the CP vs. CE arm

• Conclusions

– There were no differences in efficacy between the CP and CE arms

– Prospective data are required to establish the optimum regimen

Steuer et al. J Thorac Oncol 2015; 10 (suppl 2): ORAL20.01

Carboplatin-paclitaxel Cisplatin-etoposide p-value

ORR, % 56 58 0.28

PFS, months 9.3 11.2 0.15

3-year survival, % 25 30 0.5

OS, months 18.4 19.4 0.35

4. Pacientes ancianos y frágiles

5. Terapias moleculares

ORAL20.03: Radiation Dose Escalation in Patients with Locally Advanced Non-Small Cell Lung Cancer; 60 Month Follow-Up of a Randomized Phase II Trial – Walraven I* et al

Study objective

• To evaluate the efficacy of dose escalation with hypofractionation in patients with locally advanced NSCLC treated with concurrent cisplatin ± cetuximab

*Presented by Belderbos JWalraven et al. J Thorac Oncol 2015; 10 (suppl 2): ORAL20.03*6 mg/m2 qd; †400 mg/m2 loading dose then 250 mg/m2 qw

Primary endpoint

• OS

R

PD

PD

Key patient inclusion criteria

• Inoperable stage II and IIIA/B NSCLC

• WHO PS 0–1

(n=102)RT (24 x 2.75 Gy) +

cisplatin* + cetuximab†

(n=51)

RT (24 x 2.75 Gy) + cisplatin*(n=51)

CONCLUSIONES

1. La cirugía debe considerarse en algunos pacientes con estadio IIIA en el contexto de un tratamiento multimodal

2 Se siguen investigando nuevas estrategias para mejorar la eficacia de la RT

3. No diferencias de actividad entre diferentes regímenes de quimioterapia pero si diferencias en la toxicidad

4. Los pacientes ancianos también se benefician de tratamiento con quimio y radioterapia concomitante

5. No beneficio de la adición de terapias moleculares al tratamiento con quimioterapia y radioterapia radical

Referencias (I)Behera M, Steuer C, Fernandez F, Liu Y, Chao F, Gillespie T, Higgins K, Saba N, Pillai R, Force S, Pakkala S, Shin D, Owonikoko T, Belani Ch, Curran W, Khuri F, Ramalingam S. Trimodality therapy in the treatment of stage IIIA non-small cell Lung cancer (NSCLC): a national cancer database analysis.Abstract #2962

Walraven M, Heuvel M, van Diessen H, Shaake E, Uyterlinde W, Aerts J, Koppe F, Codrington H, Kunst P, Dieleman E, van de Vaart P, Verheij M.Long-term follow-up of patients with locally advanced NSCLC receiving concurrent hypofractionated chemoradiotherapy with or without cetuximab.Abstract #1190

Hu CH, Choy H, Komaki R, Timmerman R, Schild S, Bogart J, Dobelbower M, Bosch W, Galvin J, Kavadi V, Narayan S, Iyengar P, Robinson C, Wynn R, Raben A, Augspurger M, MacRae R, Paulus R, Bradley J.Outcomes of intensity modulated and 3D-conformal radiotherapy for stage III non-small cell lung cancer in NRG oncology/RTOG 0617.Abstract #938

Sun X, Deng Q, Yu X, Ji Y, Zheng Y, Jiang H, Xu Y, Ma S.A phase II study of endostatin in combination with paclitaxel, carboplatin, and radiotherapy in patients wiht unresectable locally advanced non-small cell lung cancer (NCT01158144).Abstract #2830

Referencias (II)Steuer C, Behera M, Higgins K, Saba N, Shin D, Pakkala S, Pillai R, Owonikoko T, Curran W, Belani Ch, Khuri F, Ramalingam S.A systematic review of carboplatin-paclitaxel versus cisplatin-etoposide concurrent with thoracic radiation for stage III NSCLC patients.Abstract # 600

Shimizu J, Seto T, Sasaki T, Yamanaka T, Kodaira T, Kunitake N, Nishio M, Kozuka T, Takahashi T, Harada H, Yoshimura N, Tsutnami S, Kitajima H, Kataoka M, Nakagawa k, Nishimura Y, Nakanishi Y.A randomized phase II study of S-1 and cisplatin vs vinorelbine and cisplatin with concurrent thoracic radiotherapy for locally advanced NSCLC: WJOG5008L.Abstract #544

Dawe D, Christiansen D, Zarychanski R, Abou-Setta A, Ellis P, Swaminath A, Rothney J, Rabbani R, Mahmud S.MINI07,02-Chemotherapy versus radiotherapy alone in elderly patients with stage III non-small cell lung cancer: a systematic review.Abstract #3163

Lee J, Moon S, Lim K, Nam B, Kook G, Lee Y, Kim H, Yun T, Cho K, Yoon S, Han J.Incorporating erlotinib into chemoradiation therapy for unresectable stage IIIA/B NSCLC.Abstract # 1761