Greco F A, Stroup S L, Gray J R, Hainsworth J D
Department of Medical Oncology, Sarah Cannon-Minnie Pearl Center, Nashville, TN 37203-1632, USA.
J Clin Oncol. 1996 May;14(5):1642-8. doi: 10.1200/JCO.1996.14.5.1642.
The addition of combination chemotherapy to standard radiation therapy has improved treatment for locally unresectable non-small-cell lung cancer. In this phase II study, we evaluated the toxicity and efficacy of a novel chemotherapy regimen that included paclitaxel, cisplatin, and etoposide plus concurrent radiation therapy in this group of patients.
Thirty-three patients with previously untreated, unresectable stage III non-small-cell lung cancer (stage IIIA, 11 patients; stage IIIB, 22 patients) initially received two courses of chemotherapy, which included paclitaxel 135 mg/m2 by 1-hour infusion on day 1, cisplatin 60 mg/m/ intravenously (i.v.) on day 2, and etoposide 100 mg/m2 i.v. on days 1, 2 and 3. On week 6, radiation therapy (60 Gy in 30 fractions) was initiated in conjunction with two additional courses of chemotherapy: paclitaxel 135 mg/m2 i.v. by 1-hour infusion on day 1, cisplatin 5 mg/m2 i.v. on days 2- to 10, and etoposide 25 mg/m2 on days 1 to 10.
This combined modality program was feasible and well tolerated by most patients. During the two courses of induction chemotherapy, grade 3 or 4 myelosuppression occurred in only six patients (18%). Esophagitis was common during combined modality therapy (grade 3, 10 patients; grade 4 five patients). Forty-two percent of patients had partial response after two courses of induction therapy, and 82% of patients had an objective response at completion of therapy. Twelve patients (36%) had a complete response. Nineteen patients remain progression-free at a median of 8 months; the median survival time has not been reached.
This paclitaxel-containing combined modality therapy is feasible and highly active in patients with inoperable stage III lung cancer. Esophagitis is the most common severe toxicity with this program. Further studies with paclitaxel-containing combination regimens in patients with stage III non-small-cell lung cancer are indicated.
在标准放疗基础上加用联合化疗已改善了局部不可切除非小细胞肺癌的治疗。在这项II期研究中，我们评估了一种新型化疗方案（包括紫杉醇、顺铂和依托泊苷加同步放疗）在这类患者中的毒性和疗效。
33例先前未接受过治疗、不可切除的III期非小细胞肺癌患者（IIIA期11例；IIIB期22例）最初接受两个疗程的化疗，其中包括第1天静脉滴注1小时给予紫杉醇135mg/m²，第2天静脉注射顺铂60mg/m²，第1、2和3天静脉注射依托泊苷100mg/m²。在第6周，开始放疗（30次分割，共60Gy）并联合另外两个疗程的化疗：第1天静脉滴注1小时给予紫杉醇135mg/m²，第2至10天静脉注射顺铂5mg/m²，第1至10天静脉注射依托泊苷25mg/m²。
这种联合治疗方案可行，大多数患者耐受性良好。在两个疗程的诱导化疗期间，仅6例患者（18%）出现3或4级骨髓抑制。食管炎在联合治疗期间很常见（3级10例患者；4级5例患者）。42%的患者在两个疗程的诱导治疗后出现部分缓解，82%的患者在治疗结束时出现客观缓解。12例患者（36%）完全缓解。19例患者在中位8个月时仍无进展；中位生存时间尚未达到。
这种含紫杉醇的联合治疗方案在不可手术的III期肺癌患者中可行且活性高。食管炎是该方案最常见的严重毒性。有必要对III期非小细胞肺癌患者采用含紫杉醇的联合方案进行进一步研究。
