Concomitant Cisplatin, Vinorelbine, and Radiation in Advanced Chest Malignancies
Newer chemotherapy drugs have shown encouraging activity in advanced non-small-cell lung cancer. Based on these improved outcomes, as well as the high rate of distant relapse in patients with locally advanced disease, several recent studies have evaluated the use of systemic therapy in patients with earlier-stage disease.
ABSTRACT: Newer chemotherapy drugs have shown encouraging activity in advanced non-small-cell lung cancer. Based on these improved outcomes, as well as the high rate of distant relapse in patients with locally advanced disease, several recent studies have evaluated the use of systemic therapy in patients with earlier-stage disease. Chemotherapy has prolonged survival when given in addition to radiation therapy or used as induction therapy in patients with locally advanced, resectable non-small-cell lung cancer. Other work has shown improved survival when chemotherapy has been added to radiation therapy in patients with locally advanced, unresectable disease. Evaluations of the optimal sequencing of these two modalities have established the feasibility of delivering systemically active doses of chemotherapy concurrently with thoracic radiation. The mechanism of benefit is likely related in part to the radiosensitizing properties of certain chemotherapeutic agents, such as vinorelbine (Navelbine) and cisplatin (Platinol). To further evaluate the use of concomitant chemoradiation, our group designed a phase I, dose-escalation study of vinorelbine plus cisplatin and standard thoracic irradiation in patients with advanced chest neoplasms. Data from 37 patients showed that myelosuppression was the acute dose-limiting toxicity of this regimen. Early responses have been observed, and future analyses will document response rates both inside and outside the radiation field. [ONCOLOGY 11(Suppl 12)39-43, 1997]
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