Combo Therapy Better for Lung Cancer

While it has been known for some time that combining chemotherapy with radiation is better than radiation alone for treating non-small cell lung cancer, the right combination of chemotherapy and the best timing of treatment have been problematical with patients with locally advanced disease (cancer confined to the lungs).

A new study led by lung cancer specialists at Jefferson Medical College at Thomas Jefferson University (Philadelphia, PA, USA) adds to growing evidence that giving patients both chemotherapy and radiation at the start of treatment may help patients live longer. Non-small-cell lung cancer accounts for approximately 80% of all cases of lung cancer.

"This is a further step in looking at what is the best combination of two chemotherapy agents with radiation, which will enable us to move forward and study it more systematically,” noted Walter J. Curran Jr., M.D., professor and chair of radiation oncology at Jefferson Medical College at Thomas Jefferson University, who led the study. "There are new biologic agents we want to test with chemotherapy, with radiation and with both. Finding the best combination of chemotherapy and radiation provides a template by which we can test these agents.”

The findings were published in the September 1, 2005 in the Journal of Clinical Oncology. In the multicenter, randomized phase II trial, investigators compared three different approaches to treating inoperable non-small-cell lung cancer that had not metastasized beyond the lungs. They divided more than 250 patients into three treatment arms. One group received chemotherapy before radiation. The second group had chemotherapy before and during radiation. Patients in the third group received chemotherapy and radiation at the same time, then a little more chemotherapy was added afterward. Each group had the same schedule of radiation and was given the same two standard chemotherapy agents, carboplatin and paclitaxel.

Dr. Curran and coworkers discovered that the patients in the third group did the best, living several months more on average when compared against the standard treatment. "That's in keeping with the observed results of other studies,” Dr. Curran stated. "Giving radiation and chemotherapy from day one appears to be the best approach for these patients,” although side effects can at first appear to be worse. "Researchers are already looking at targeted agents such as bevacizumab, cetuximab, and other agents with chemotherapy and radiation in lung cancer. This kind of study will help guide us as to which schedule to use.”