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Does Adding Cetuximab to Radiotherapy Improve Survival in Unresectable Lung Cancer?

By: Sarah Campen, PharmD
Posted: Tuesday, February 18, 2020

A 60-Gy radiation dose with concurrent chemotherapy should remain the standard of care for patients with unresectable stage III non–small cell lung cancer (NSCLC), according to Jeffrey D. Bradley, MD, of Emory University School of Medicine, Atlanta, and colleagues. Long-term results of the RTOG 0617 study, published in the Journal of Clinical Oncology, also showed that the addition of cetuximab did not confer a survival benefit and increased toxicity.

The 5-year overall survival estimate for the 60-Gy radiation arm was a “new landmark” at 32.1%. “This is among the highest [overall survival] results of any phase III trial for patients with stage III NSCLC,” stated the authors.

The RTOG 0617 study compared standard-dose (60 Gy) versus high-dose (74 Gy) radiation with concurrent chemotherapy in 496 patients with stage III NSCLC, as well as the addition of cetuximab to treatment. After a median follow-up of 5.1 years, overall survival in the standard-dose arm compared with the high-dose arm was 28.7 versus 20.3 months (P = .0072), respectively. The 5-year overall survival rates were 32.1% and 23% in the standard-dose and high-dose arms, and progression-free survival rates were 18.3% and 13%, respectively.

As for toxicity, three grade 5 adverse events were reported with standard-dose radiotherapy and nine, with high-dose therapy. Treatment-related grade 3 or 4 dysphagia and esophagitis were reported in 3.2% and 5.0% of patients in the standard-dose arm versus 12.1% and 17.4% in the high-dose arm, respectively. Rates of pulmonary toxicity were similar between the treatment arms.

These results argue strongly that the current standard-of-care radiation dose should be 60 Gy given in 2-Gy daily fractions to a target volume directed at tumor plus margin,” concluded the authors. And, they noted, “the use of cetuximab conferred no benefit or harm.”

Disclosure: For full disclosures of the study authors, visit ascopubs.org.



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