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Adding chemotherapy
to radiation is no more effective than radiation alone in extending
survival in certain lung cancer patients who have already had their
tumors surgically removed, a new study concludes.
The
findings add to an ongoing controversy surrounding the value of
chemotherapy for non-small cell lung cancer (NSCLC) patients (see a
related
story).
The
study tested a combination of two chemotherapy drugs plus radiation
on patients with NSCLC who had undergone successful tumor-removal
surgery to treat the later stages of the disease, and compared that
to radiation alone following surgery. Not only was there no
difference in survival between the two groups, but also a higher
number of those on the combined regimen suffered serious side
effects, with 31 percent unable to finish the entire regimen of
chemotherapy.
“The morbidity associated with combination
therapy must be considered in the design of future trials,” wrote
authors David H. Johnson, M.D., of Vanderbilt University in
Nashville, Steven M. Keller, M.D., of Beth-Israel Medical Center in
New York, and colleagues.
In spite of these findings, Frank
Anthony Greco, M.D., of the Centennial Medical Center’s Sarah Cannon
Cancer Center in Nashville, said in an interview that he sees a
“very good future” for chemotherapy for NSCLC. He noted that newer
chemotherapy drugs developed since the Keller study began are less
toxic and have fewer side effects. Whether these newer drugs will be
better tolerated by patients and will extend survival remains to be
seen, he said.
NSCLC is the most common form of lung cancer,
accounting for 75 to 80 percent of all cases. The best chance for a
cure is resection, or surgical removal, of the affected area of the
lung.
Even if the cancer appears to be completely resected,
the procedure may still leave behind microscopic amounts of cancer
cells that can potentially spread to other parts of the body. For
this reason, chemotherapy, which most commonly consists of the drug
cisplatin by itself or with other drugs, is widely used as a
post-operative supplement to destroy any residual cancer.
But the widespread use of post-operative chemotherapy for
NSCLC has not been without controversy. In an editorial accompanying
the new study, Desmond N. Carney, M.D., of the Mater Hospital in
Dublin, Ireland wrote, “Only a few of the many published trials of
adjuvant [supplemental] chemotherapy after curative resection have
reported any meaningful survival benefit from the addition of
chemotherapy.”
The Keller study sought to further elucidate
the role of chemotherapy in a clinical
trial of 488 NSCLC patients at nine cancer centers throughout
the United States.
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