An evaluation of concurrent chemoradiotherapy practice for locally advanced non-small cell lung cancer (NSCLC) in a single centre institution

Abstract

Introduction: The standard treatment for unresectable stage III non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (CTRT). However, only a minority of patients receive CTRT due to poor performance status (PS) or co-morbidities. Carboplatin/ paclitaxel (CP) was introduced in our centre in 2017 as an alternative to cisplatin/etoposide (CE) to increase the number of patients receiving CTRT. We compare toxicity and outcomes between two chemotherapy regimens (CE and CP) in our centre. Methods: A retrospective audit was undertaken. Demographics, baseline health, treatment toxicity, response, adjuvant durvalumab use and survival were collected for patients treated with CP and CE 2018-2019. Toxicity and outcome in patients were compared (CP v CE). Results: 106 patients were treated with concurrent CTRT 2018-2019 (CP n=20, CE n=86). Patients selected for CP mostly either had impaired renal function (n=6 (30%)), a pre-existing hearing problem (n=5 (25%)) or underlying cardiovascular co-morbidity (n=5 (25%)). Baseline demographics, eGFR and proportion receiving durvalumab were well matched (Table 1). More patients receiving CP were PS 2 (CP 15% v CE 1.2%, p=0.02). CE was associated with greater G3/G4 side effects (CP 30% v CE 60.5%, p=0.01) however CP was associated with a higher incidence of G1/2 toxicity (p< 0.05) and chemotherapy dose reduction/omission (CP 15% v CE 3%, p=0.05). There was no significant difference in the progression free (13 v 17 months, p=0.3) or 1-year overall survival (65% v 79%, p=0.24) Conclusion: The introduction of CP and durvalumab have helped facilitate increased numbers of patients receiving CTRT treatment. CE had a higher level of G3/4 toxicity and patients treated with CP had greater levels of G1/2 toxicity and reduced dose intensity. There was no overall difference in survival between the groups suggesting that both regimens should be considered in patients with stage III NSCLC.