Frontiers in Oncology (Aug 2013)

A pilot study (SWOG S0429) of weekly cetuximab and chest radiotherapy for poor-risk stage III non-small cell lung cancer

  • Yuhchyau eChen,
  • James eMoon,
  • Kishan J Pandya,
  • Derick HM Lau,
  • Karen eKelly,
  • Fred eHirsch,
  • Laurie E Gaspar,
  • Mary eRedman,
  • David eGandara

DOI
https://doi.org/10.3389/fonc.2013.00219
Journal volume & issue
Vol. 3

Abstract

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Purpose: Stage III non-small cell lung cancer (NSCLC) patients with poor performance status (PS) or co-morbidities are often not candidates for standard chemoradiotherapy (chemoRT) due to poor tolerance to treatments. A pilot study for poor-risk stage III NSCLC patients was conducted combining cetuximab, a chimeric monoclonal antibody targeting epidermal growth factor receptor (EGFR), with chest radiation (RT). Methods: Stage III NSCLC patients with Zubrod PS 2, or Zubrod PS 0-1 with poor pulmonary function and co-morbidities prohibiting chemoRT were eligible. A loading dose of cetuximab (400 mg/m2) was delivered week one, followed by weekly cetuximab (250 mg/m2)/RT to 64.5 Gy in 1.8 Gy daily fractions, and maintenance weekly cetuximab (250 mg/m2) for two years or until disease progression. H-score for EGFR protein expression was conducted in available tumors.Results: Twenty-four patients were enrolled. Twenty two were assessed for outcome and toxicity. Median survival was 14 months and median progression-free survival was 8 months. The response rate was 47% and disease control rate was 74%. Toxicity assessment revealed 22.7% overall ≥ Grade 3 non-hematologic toxicities. Grade 3 esophagitis was observed in one patient (5%). The skin reactions were mostly Grade 1 or 2 except two of 22 (9%) had Grade 3 acne and 1/22 (5%) had Grade 3 radiation skin burn. Grade 3-4 hypomagnesemia was seen in 4 (18%) patients. One patient (5%) had elevated cardiac troponin and pulmonary emboli. H-score did not reveal prognostic significance. An initially planned second cohort of the study did not commence due to slow accrual, which would have added weekly docetaxel to cetuximab/RT after completion of the first cohort of patients. Conclusions: Concurrent weekly cetuximab/chest RT followed by maintenance cetuximab for poor-risk stage III NSCLC was well tolerated. Further studies with larger sample sizes will be useful to establish the optimal therapeutic ratio of this regimen.

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