Optimal Treatment of Unresectable Locally Advanced NSCLC. Sponsored by a Grant from the Bonnie J. Addario Lung Cancer Foundation

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1 Optimal Treatment of Unresectable Locally dvanced SCLC Howard (Jack) West, M Medical Oncologist Medical irector, Thoracic Oncology Program Swedish Cancer Institute Seattle, W February, 2009 President & CEO GCE Sponsored by a Grant from the Bonnie J. ddario Lung Cancer Foundation Working to eradicate lung cancer through research, early detection, education, prevention, and treatment. For information about sponsoring a presentation about a topic important to you, please info@cancergrace.org

2 isclaimers The information provided here includes views of the presenter that do not necessarily represent those of the Global esource for dvancing Cancer Education (GCE) in general, nor those of Swedish Cancer Institute. The contents of this program do not constitute medical advice and is intended to supplement but not replace input from an individual patient s own medical team. Stage III/Locally dvanced SCLC pproximately 40-45% of new presentations of SCLC

3 Efficacy esults: Sequential vs. Concurrent Chemoradiotherapy, Two Major Trials West Japan TOG 9410 MVP* T x2 56 Gy St III SCLC = MVP* x 2 Concurrent T 56 Gy (split course) MVP* = mitomycin C, vinblastine, cisplatin St III SCLC = Cis/ VBL x2 T 63 Gy Cis/VBL x2 concurrent T daily Cis/Etop (PO) x2 concurrent 2x/d T 5-year OS (%) % 9% Seq Conc Furuse, JCO 17: , year OS (%) % 17% 12% Seq Conc HyperFx Curran, PSCO 22:621. #2499, 2003 Survival Comparison between Sequential and Concurrent CT/T (n=709) WJLCG GLOT (n=716) CZECH LMP TOG 9410 BOCT 10 Sequential Concurrent Choy, SCO 2003 P < 0.05 (Kruskal-Wallis Test)

4 Early Toxicity Comparison between Sequential and Concurrent CT/T % WJLCG GLOT CZECH LMP % TOG 9410 BOCT 0 Sequential Concurrent SWOG 9504: Consolidation Taxotere (ocetaxel) after efinitive Chemoradiation =83 evaluable, stage IIIB SCLC Overall Survival Cisplatin/Etoposide x2 cycles with concurrent T 61Gy Progression-FreeSurvival Taxotere every three weeks x3 cycles, consolidation chemo Gandara, J Clin Oncol, 2003 Failure in brain 33%

5 Hoosier Oncology Group (HOG) Trial: irect Test of Consolidation Taxotere (ocetaxel) Unresectable Stage III SCLC Cisplatin/etoposide x2 w/concurrent XT to 61 Gy o P PS 0-2 Consolidation Taxotere every 3 weeks x 3 cycles Observation ccrued: 203 pts 147 pts (68%) Hanna, J Clin Oncol 2008 HOG Trial: Overall Survival Hanna, J Clin Oncol 2008

6 HOG Trial: Side Effects and Treatment-elated eaths Hanna, J Clin Oncol 2008 Chemo/adiation Consolidation Taxotere (ocetaxel) Maintenance Iressa (Gefitinib) vs. Placebo Unresectable Stage III/IIIB Cisplatin/ etoposide x2 w/concurrent XT 61 Gy Taxotere (ocetaxel) 75 mg/m2 x 3 cycles Iressa (Gefitinib) 500/250 mg PO daily Placebo PO daily ccrued: 620 pts 574 pts (74%) 263 pts (42%) Eligible: 575 pts 412 pts (72%) 255 pts (44%) Kelly, J Clin Oncol 2008

7 SWOG 0023: Efficacy Progression-Free Survival Overall Survival Kelly, J Clin Oncol 2008 TOG/Intergroup Trial of Chemo/adiation to Either 60 or 74 Gray, +/- Erbitux (Cetuximab) Primary Endpoint: Overall Survival Unresectable Stage III SCLC, = 512 = 512 T to 60 Gy T to 74 Gy Concurrent Chemo/adiation weekly adiation to 60 Gy + Erbitux (cetuximab) weekly weekly adiation to 60 Gy weekly adiation to 74 Gy + Erbitux (cetuximab) weekly weekly adiation to 74 Gy Consolidation every 3 wks every 3 wks every 3 wks every 3 wks

8 Eli Lilly-Sponsored Phase III Trial in Stage III Unresectable SCLC Concurrent Chemo/adiation Consolidation Unresectable Stage III SCLC, on-squamous = 600 O M I Z E Cisplatin IV d1 limta IV d1 every weeks x 3 adiation 66 Gy/33 Fx Cisplatin d1,8 Etoposide d1-5 Q4 weeks x 2 adiation 66 Gy/33 Fx limta IV d1 x3 cycles Cis/Etoposide or Cis/avelbine or Primary Endpoint: Overall Survival (superiority) Conclusions: Optimal Therapy for Stage III Unresectable SCLC, Today Concurrent chemo/t consistently superior to sequential chemo/t espite encouraging results from SWOG phase II S9504 trial, neither HOG trial nor SWOG 0023 trial demonstrates benefit with consolidation Maintenance EGF inhibitor after chemo/t and consolidation chemo was significantly detrimental in unselected population Current controversies/questions: Is 6-7 weeks of plat-based CT with T to Gy is enough?! We don t have compelling evidence that more chemo is better Many oncologists still feel additional chemo is likely beneficial ew trials exploring alimta (non-squamous patients only) and erbitux, higher radiation doses, and other agents

9 Questions and Comments? Posts with additional detail on these topics are available at GCE members can leave comments and questions at

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