Addition of S-1 to cisplatin plus radiotherapy ‘favourable’ in NSCLC

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By Shreeya Nanda, Senior medwireNews Reporter

Research suggests that treatment with cisplatin plus S-1 together with thoracic radiotherapy is relatively efficacious and tolerable in patients with locally advanced non-small-cell lung cancer (NSCLC).

Although cisplatin-based chemotherapy with thoracic radiotherapy is a standard treatment for unresectable, locally advanced NSCLC, the outcomes are not satisfactory, explain Katsuyuki Hotta, from Okayama University Hospital in Japan, and colleagues. They investigated the effect of adding the 5-fluorouracil derivative S-1 to the standard treatment in a phase II trial, the primary endpoint of which was the response rate.

A total of 48 patients with stage III NSCLC received cisplatin plus S-1 (at a dose of 40 mg/m2 twice daily from days 1–14 and 29–42 of treatment) with concurrent thoracic irradiation, of whom 37 had a partial response, giving an overall response rate (ORR) of 77%.

Participants were followed up for a median of 54 months. Median progression-free survival and median survival time were 9.3 months and 31.3 months, respectively.

When patients were stratified by various clinical factors, the ORRs and survival data did not vary significantly by age, gender or tumour histology, among other variables. However, participants with T1 or T2 malignancies had a significantly prolonged median survival time compared with those with T3 or T4 tumours (not reached vs 16.4 months).

Distant metastasis occurred in 15 study participants, loco-regional disease in 17 and two developed both distant metastases and loco-regional disease.

The most common grade 3 or 4 adverse event was neutropenia, which occurred in 42% of participants. Grade 3 or 4 pneumonitis and esophagitis, “the principal toxicities that would lead to the interruption of [thoracic radiotherapy]”, occurred respectively in 4% and 0% of patients, notes the team. Febrile neutropenia was observed in 8% of the study population.

The researchers conclude in Lung Cancer: “Overall, in terms of safety and efficacy, the combination of [cisplatin-based chemotherapy] and S1 would need to be further investigated in the locally advanced setting.”

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