Phase II Study of Cetuximab in Combination With Chemoradiation in Patients With Stage IIIA/B Non–Small-Cell Lung Cancer: RTOG 0324

• Published in: Journal of clinical oncology Vol. 29; no. 17; pp. 2312 - 2318
• Main Authors: BLUMENSCHEIN, George R, PAULUS, Rebecca, CURRAN, Walter J, ROBERT, Francisco, FOSSELLA, Frank, WERNER-WASIK, Maria, HERBST, Roy S, DOESCHER, Philip O, CHOY, Hak, KOMAKI, Ritsuko
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 10.06.2011
• Subjects: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - radiotherapy; Cetuximab; Combined Modality Therapy; Female; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - radiotherapy; Male; Medical sciences; Middle Aged; Neoplasm Staging; Original Reports; Patient Compliance; Pneumology; Tumors; Tumors of the respiratory system and mediastinum; Antineoplastic agent; Human; Lung disease; Drug combination; Respiratory disease; Lung cancer; B-Lymphocyte; Monoclonal antibody; Malignant tumor; non-small cell lung carcinoma; Radiotherapy; Epidermal growth factor receptor; Chemotherapy; Clinical stage; Treatment; Cancerology; Phase II trial; Bronchus disease; Combined treatment; Cetuximab; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2010.31.7875

Non-small-cell lung cancer (NSCLC) commonly expresses the epidermal growth factor receptor (EGFR), which is associated with poor clinical outcome. Cetuximab is a chimerized monoclonal antibody that targets the EGFR and, in preclinical models, it demonstrates radiosensitization properties. We report a phase II trial testing the combination of cetuximab with chemoradiotherapy (CRT) in unresectable stage III NSCLC. Eligibility criteria included unresectable stage III NSCLC, Zubrod performance status ≤ 1, weight loss ≤ 5%, forced expiratory volume in 1 second ≥ 1.2 L, and adequate organ function. Patients received an initial dose of cetuximab (400 mg/m(2)) on day 1 of week 1 and then weekly doses of cetuximab (250 mg/m(2)) until completion of therapy (weeks 2 through 17). During week 2, patients started CRT (63 Gy in 35 fractions) with weekly carboplatin at area under the [concentration-time] curve (AUC) 2 and six doses of paclitaxel at 45 mg/m(2) followed by carboplatin (AUC 6) and two cycles of paclitaxel (200 mg/m(2)) during weeks 12 through 17. Primary end points included safety and compliance of concurrent cetuximab and CRT. In all, 93 patients were enrolled and 87 were evaluable. Median follow-up was 21.6 months. Response rate was 62% (n = 54), median survival was 22.7 months, and 24-month overall survival was 49.3%. Adverse events related to treatment included 20% grade 4 hematologic toxicities, 8% grade 3 esophagitis, and 7% grade 3 to 4 pneumonitis. There were five grade 5 events. The combination of cetuximab with CRT is feasible and shows promising activity. The median and overall survival achieved with this regimen were longer than any previously reported by the Radiation Therapy Oncology Group.