A phase II study of induction chemotherapy followed by concurrent chemoradiotherapy in elderly patients with locally advanced non-small-cell lung cancer

The optimal management of unresectable locally advancednon-small-cell lung cancer in older patients has not beendefined to date. The present phase II study was planned toevaluate the activity and safety of platinum-based inductionchemotherapy followed by concurrent chemoradiotherapyin elderly patients with locally advanced non-small-cell lungcancer. Patients received two cycles of paclitaxel(175mg/m2) and carboplatin (area under the curve: 5) day1, every 3 weeks. Chemoradiotherapy (thoracic radiationtherapy) was initiated on day 42 and consisted of 1.8 Gydaily, five times per week over 5 weeks (45.0 Gy targetdose) followed by 10 2.0 Gy daily fractions. Concomitantchemotherapy was weekly paclitaxel 50 mg/mq followedby weekly carboplatin at an area under the curve of 2. Theeligibility for patients: age 70 or older and histologicallydocumented untreated non-small-cell lung cancer, locallyadvanced, unresectable, stage III A N2 bulky or III B. Thirtyconsecutive patients were enrolled onto the study. Themedian age was 73 (range 70–76). According to theintention-to-treat analysis, 1 month after the end ofcombined chemoradiotherapy, we observed complete andpartial responses in one and 19 of the 30 patients,respectively, for an overall response rate of 66% (95%confidence interval, 45–76%). Median progression-freesurvival was 8.7 months (95% confidence interval, 3.4–37.8)and median survival was 15 months (95% confidenceinterval, 4.2–52.1). During the treatment, 12 patients(40.0%) experienced grade 3–4 neutropenia, two patientsneutropenic fever, and three patients grade 3 anaemia and grade 3 thrombocytopenia, respectively. Grade 3oesophagitis, during concomitant radiotherapy, wasobserved in six patients (20.0%). No treatment-relatedmortality was reported. The investigated sequentialapproach including induction chemotherapy followed byconcurrent chemoradiotherapy appears safe and seems areasonable chance for the treatment of locally advancednon-small-cell lung cancer in the elderly population.