Hypofractionated/accelerated radiotherapy with cytoprotection (HypoARC) combined with vinorelbine and liposomal doxorubicin for locally advanced non-small cell lung cancer (NSCLC).

摘要

BACKGROUND: Combined radiochemotherapy is the gold standard for patients with locally advanced non-small cell lung cancer (LA-NSCLC). In the present study, the feasibility of hypofractionated accelerated radiotherapy with cytoprotection (HypoARC) in combination with vinorelbine and liposomal doxorubicin was evaluated. PATIENTS AND METHODS: Fourteen patients (pts) with LA-NSCLC (PS 0-2) were recruited. Patients received 15 fractions for 3.5 Gy within four consecutive weeks (1 week split after the 10th fraction), supported with subcutaneously administered amifostine (500-1000 mg/day). Pegylated liposomal doxorubicin was administered at a standard dose of 20 mg/m2 every two weeks, for 3 consecutive cycles. Vinorelbine was administered at 3 dose levels: a) 20 mg/m2 every week (5 pts), b) 25 mg/m2 thrice every two weeks (5 pts) and c) 30 mg/m2 thrice every two weeks (4 pts). RESULTS: Grade 3 neutropenia enforcing chemotherapy delays was noted in 2/5 and 2/4 patients in the groups b and c respectively. Fatigue was a common but not dose-defining feature. Radiation grade 2 esophagitis was noted in 6/14 patients. No case of severe radiation pneumonitis was noted. Partial response was documented in 9/14 patients, minimal response in 3/14 and stable disease in 2/14. The median local progression-free survival was 12 months and the median overall survival was 8 months. CONCLUSION: It is concluded that the administration of 25 mg/m2 of vinorelbine thrice a week together with liposomal doxorubicin and thoracic radiotherapy is feasible for patients with LA-NSCLC, providing high response rates. Further studies are required to better assess benefits in terms of local and distant control of the disease.