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Lung Cancer. 2014 Sep;85(3):395-400. doi: 10.1016/j.lungcan.2014.06.019. Epub 2014 Jul 3.

Multicenter phase II study evaluating docetaxel and cisplatin as neoadjuvant induction regimen prior to surgery or radiochemotherapy with docetaxel, followed by adjuvant docetaxel therapy in chemonaive patients with NSCLC stage II, IIIA and IIIB (TAX-AT 1.203 Trial).

Author information

1
Department of Hematology and Oncology, Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria. Electronic address: florian.kocher@i-med.ac.at.
2
Department of Hematology and Oncology, Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria.
3
Department of Pulmonary Medicine II, SMZ Otto Wagner Hospital, Vienna, Austria.
4
Department of Internal Medicine III, Paracelsus Medical University Hospital, Salzburg, Austria.
5
Department of Pneumology, General Hospital of Linz, Linz, Austria.
6
Department of Pneumology, General Hospital Wels, Wels, Austria.
7
Department of Visceral and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.

Abstract

OBJECTIVES:

Neoadjuvant therapy with a platinum based doublet is an option in NSCLC patients with upfront resectable disease. However, the role of neoadjuvant induction in stages IIIA and IIIB and in initially not resectable patients is unclear.

PATIENTS AND METHODS:

In this phase II trial, 78 patients with locally advanced NSCLC, of whom 56 were considered not resectable at initial diagnosis, were treated with three neoadjuvant cycles of docetaxel and cisplatin and subjected to radical surgery if resectable. Definitive radiochemotherapy (RCT) using weekly docetaxel was the prespecified alternative if patients were not resectable at restaging. The primary objective was response to neoadjuvant induction.

RESULTS:

After induction, 36 (46%) were radically operated and 24 (31%) were treated with RCT. Overall, 32 patients (41%) completed the entire study plan. Partial response to induction therapy was observed in 43 patients (55%); furthermore, 19 of 56 initially not resectable cases (34%) became resectable upon induction. Median progression-free (PFS) and overall survival (OS) were 8.5 and 16.4 months for the whole cohort. Encouragingly, conversion to resectability was predictive for favorable outcome. On the other hand, patients who were not resectable at restaging and received RCT were characterized by a rather unfavorable prognosis (5-year and 10-year OS, whole cohort: 20% and 12%; RCT: 8% and 0%; surgery: 37% and 24%, respectively).

CONCLUSION:

Neoadjuvant induction with the doublet docetaxel/cisplatin and subsequent radical resection resulted in favorable survival. Of note, conversion to resectability was mandatory for the chance of cure in patients considered initially not resectable.

KEYWORDS:

Cisplatin; Docetaxel; Induction; Neoadjuvant; Non-small cell lung cancer (NSCLC); Radiochemotherapy; Surgery

PMID:
25043642
DOI:
10.1016/j.lungcan.2014.06.019
[Indexed for MEDLINE]

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