CANCER DE PULMON DE CELULA NO PEQUEÑA: TRATAMIENTO DEL ESTADIO III. Nuria Viñolas POSTMUNDIAL DE PULMON 8 de octubre 2015 Madrid

Transcription

1 CANCER DE PULMON DE CELULA NO PEQUEÑA: TRATAMIENTO DEL ESTADIO III Nuria Viñolas POSTMUNDIAL DE PULMON 8 de octubre 2015 Madrid

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6 1.Papel de la cirugia 2. Radioterapia: dosis y técnica 3. Tipos de quimioterapia: eficacia y toxicidad 4. Pacientes ancianos 5. Terapias moleculares

7 apel de la cirugia

8 ORAL05.05: Trimodality Therapy in the Treatment of Stage IIIA Non-Small Cell Lung Cancer (NSCLC): A National Cancer Database Analysis Behera M et al Study objective To compare the outcomes and predictors associated with trimodality therapy vs. chemoradiotherapy alone in patients with NSCLC from the National Cancer Database CRT + lobectomy PD Key patient inclusion criteria Stage IIIA-N2 (n=29,584) CRT + pneumonectomy CRT alone PD PD Primary endpoint OS Behera et al. J Thorac Oncol 2015; 10 (suppl 2): ORAL05.05

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12 2. Radioterapia: dosis y técnica

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14 ORAL20.03: Radiation Dose Escalation in Patients with Locally Advanced Non- Small Cell Lung Cancer; 60 Month Follow-Up of a Randomized Phase II Trial Walraven I* et al Study objective To evaluate the efficacy of dose escalation with hypofractionation in patients with locally advanced NSCLC treated with concurrent cisplatin ± cetuximab Key patient inclusion criteria Inoperable stage II and IIIA/B NSCLC WHO PS 0 1 (n=102) Primary endpoint OS R RT (24 x 2.75 Gy) + cisplatin* (n=51) RT (24 x 2.75 Gy) + cisplatin* + cetuximab (n=51) PD PD *6 mg/m 2 qd; 400 mg/m 2 loading dose then 250 mg/m 2 qw *Presented by Belderbos J Walraven et al. J Thorac Oncol 2015; 10 (suppl 2): ORAL20.03

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24 3. Tipos de quimioterapia: eficacia y toxicidad

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27 ORAL20.01: A Systematic Review of Carboplatin-Paclitaxel versus Cisplatin- Etoposide Concurrent with Thoracic Radiation for Stage III NSCLC Patients Steuer C et al Key results Anaemia (8% vs. 16%; p=0.06), thrombocytopenia (6% vs. 14%; p=0.001) and neutropenia (23% vs. 54%; p<0.0001) were all lower in the CP vs. CE arm Conclusions Carboplatin-paclitaxel Cisplatin-etoposide p-value ORR, % PFS, months year survival, % OS, months There were no differences in efficacy between the CP and CE arms Prospective data are required to establish the optimum regimen Steuer et al. J Thorac Oncol 2015; 10 (suppl 2): ORAL20.01

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32 4. Pacientes ancianos y frágiles

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37 5. Terapias moleculares

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39 ORAL20.03: Radiation Dose Escalation in Patients with Locally Advanced Non- Small Cell Lung Cancer; 60 Month Follow-Up of a Randomized Phase II Trial Walraven I* et al Study objective To evaluate the efficacy of dose escalation with hypofractionation in patients with locally advanced NSCLC treated with concurrent cisplatin ± cetuximab Key patient inclusion criteria Inoperable stage II and IIIA/B NSCLC WHO PS 0 1 (n=102) Primary endpoint OS R RT (24 x 2.75 Gy) + cisplatin* (n=51) RT (24 x 2.75 Gy) + cisplatin* + cetuximab (n=51) PD PD *6 mg/m 2 qd; 400 mg/m 2 loading dose then 250 mg/m 2 qw *Presented by Belderbos J Walraven et al. J Thorac Oncol 2015; 10 (suppl 2): ORAL20.03

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44 CONCLUSIONES 1. La cirugía debe considerarse en algunos pacientes con estadio IIIA en el contexto de un tratamiento multimodal 2 Se siguen investigando nuevas estrategias para mejorar la eficacia de la RT 3. No diferencias de actividad entre diferentes regímenes de quimioterapia pero si diferencias en la toxicidad 4. Los pacientes ancianos también se benefician de tratamiento con quimio y radioterapia concomitante 5. No beneficio de la adición de terapias moleculares al tratamiento con quimioterapia y radioterapia radical

45 Referencias (I) Behera M, Steuer C, Fernandez F, Liu Y, Chao F, Gillespie T, Higgins K, Saba N, Pillai R, Force S, Pakkala S, Shin D, Owonikoko T, Belani Ch, Curran W, Khuri F, Ramalingam S. Trimodality therapy in the treatment of stage IIIA non-small cell Lung cancer (NSCLC): a national cancer database analysis. Abstract #2962 Walraven M, Heuvel M, van Diessen H, Shaake E, Uyterlinde W, Aerts J, Koppe F, Codrington H, Kunst P, Dieleman E, van de Vaart P, Verheij M. Long-term follow-up of patients with locally advanced NSCLC receiving concurrent hypofractionated chemoradiotherapy with or without cetuximab. Abstract #1190 Hu CH, Choy H, Komaki R, Timmerman R, Schild S, Bogart J, Dobelbower M, Bosch W, Galvin J, Kavadi V, Narayan S, Iyengar P, Robinson C, Wynn R, Raben A, Augspurger M, MacRae R, Paulus R, Bradley J. Outcomes of intensity modulated and 3D-conformal radiotherapy for stage III non-small cell lung cancer in NRG oncology/rtog Abstract #938 Sun X, Deng Q, Yu X, Ji Y, Zheng Y, Jiang H, Xu Y, Ma S. A phase II study of endostatin in combination with paclitaxel, carboplatin, and radiotherapy in patients wiht unresectable locally advanced non-small cell lung cancer (NCT ). Abstract #2830

46 Referencias (II) Steuer C, Behera M, Higgins K, Saba N, Shin D, Pakkala S, Pillai R, Owonikoko T, Curran W, Belani Ch, Khuri F, Ramalingam S. A systematic review of carboplatin-paclitaxel versus cisplatin-etoposide concurrent with thoracic radiation for stage III NSCLC patients. Abstract # 600 Shimizu J, Seto T, Sasaki T, Yamanaka T, Kodaira T, Kunitake N, Nishio M, Kozuka T, Takahashi T, Harada H, Yoshimura N, Tsutnami S, Kitajima H, Kataoka M, Nakagawa k, Nishimura Y, Nakanishi Y. A randomized phase II study of S-1 and cisplatin vs vinorelbine and cisplatin with concurrent thoracic radiotherapy for locally advanced NSCLC: WJOG5008L. Abstract #544 Dawe D, Christiansen D, Zarychanski R, Abou-Setta A, Ellis P, Swaminath A, Rothney J, Rabbani R, Mahmud S. MINI07,02-Chemotherapy versus radiotherapy alone in elderly patients with stage III non-small cell lung cancer: a systematic review. Abstract #3163 Lee J, Moon S, Lim K, Nam B, Kook G, Lee Y, Kim H, Yun T, Cho K, Yoon S, Han J. Incorporating erlotinib into chemoradiation therapy for unresectable stage IIIA/B NSCLC. Abstract # 1761