PURPOSE: A prospective study evaluates the combination of neoadjuvant and adjuvant chemotherapy in marginally resectable NSCLC stage IIIA. Effectiveness, tolerability of the treatment schema and survival of patients (pts) were evaluated.
METHODS: Two regimens (3 cycles) of neoadjuvant therapy were applied in 65 pts, 11 women and 54 men, mean age 59 years. Paclitaxel (200 mg/m2 D1) and carboplatin (AUC 6 D1) were apllied in 34 pts, vinorelbin (30 mg/m2 D1+8) with carboplatin (AUC 6 D1) in 31 pts. Surgical resection was performed in cases with objective response, radiotherapy (II.line chemotherapy) in cases with progression. Tumor cells were harvested during surgery and tested by MTT (methylthiasol tetrazolium blue test), which indicates in-vitro chemoresistance. Selective adjuvant chemotherapy was applied sequentionally (3 cycles of two cytostatics). In-vitro effective drugs were chosen, when MTT results were obtained.
RESULTS: Out of 191 neoadjuvant chemotherapy cycles, only 15 were postponed and 3 reduced. Toxicity Gr.4 (neutropenia mainly) did not exceed 5%. Downstaging was achieved in 34 pts (52.5%), diminishing of tumor in 15 pts (23,1%), complete resection could be realized in 47 pts (72.3%). Out of 139 adjuvant chemotherapy cycles 39 were postponed and 2 reduced. Toxicity Gr.4 (anorhexia, neutropenia) reached 6,5%. 42 pts finished all the proposed therapeutic scheme. Median survival (ms) of operated pts was 44.6 months, 3-years survival rate was 64.2% and 5-years survival rate 42.8%, ms of inoperable pts was 14.2 months. There were no significant differences in ms between both neoadjuvant regimens (44 m vs 43 m). 5-year survival rate was slightly higher in pts with chemosenzitive tumors according MTT (53.8%) than in pts with resistant tumors or tumors without known in-vitro chemorezistance (38.8%).
CONCLUSION: Combination of neoadjuvant and adjuvant chemotherapy in NSCLC stage IIIA is considered as a feasible, highly effective and well tolerated treatment of NSCLC.
CLINICAL IMPLICATIONS: Presented therapeutic approach should be applied in further studies.
DISCLOSURE: Vitezslav Kolek, None.