Treatment of Brain Metastases of Small-Cell Lung Cancer: Comparing Teniposide and Teniposide With Whole-Brain Radiotherapy—A Phase III Study of the European Organization for the Research and Treatment of Cancer Lung Cancer Cooperative Group

Author:

Postmus Pieter E.1,Haaxma-Reiche Hanny1,Smit Egbert F.1,Groen Harry J. M.1,Karnicka Hanna1,Lewinski Tadeusz1,van Meerbeeck Jan1,Clerico Mario1,Gregor Anna1,Curran Desmond1,Sahmoud Tarek1,Kirkpatrick Anne1,Giaccone Giuseppe1

Affiliation:

1. From the Departments of Pulmonary Diseases and Medical Oncology, University Hospital Vrije Universiteit, Amsterdam, Departments of Neurology and Pulmonary Diseases, University Hospital, Groningen, and Department of Pulmonary Diseases, Academisch Ziekenhuis Dijkzigt, Rotterdam, the Netherlands; Department of Oncology, University Hospital, Gdansk, and Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Ospedale Regionale, Oncologia Medica, Aosta, Italy; Western General...

Abstract

PURPOSE: Approximately 60% of patients with small-cell lung cancer (SCLC) develop brain metastases. Whole-brain radiotherapy (WBRT) gives symptomatic improvement in more than 50% of these patients. Because brain metastases are a sign of systemic progression, and chemotherapy was found to be effective as well, it becomes questionable whether WBRT is the only appropriate therapy in this situation. PATIENTS AND METHODS: In a phase III study, SCLC patients with brain metastases were randomized to receive teniposide with or without WBRT. Teniposide 120 mg/m2 was given intravenously three times a week, every 3 weeks. WBRT (10 fractions of 3 Gy) had to start within 3 weeks from the start of chemotherapy. Response was measured clinically and by computed tomography of the brain. RESULTS: One hundred twenty eligible patients were randomized. A 57% response rate was seen in the combined-modality arm (95% confidence interval [CI], 43% to 69%), and a 22% response rate was seen in the teniposide-alone arm (95% CI, 12% to 34%) (P < .001). Time to progression in the brain was longer in the combined-modality group (P = .005). Clinical response and response outside the brain were not different. The median survival time was 3.5 months in the combined-modality arm and 3.2 months in the teniposide-alone arm. Overall survival in both groups was not different (P = .087). CONCLUSION: Adding WBRT to teniposide results in a much higher response rate of brain metastases and in a longer time to progression of brain metastases than teniposide alone. Survival was poor in both groups and not significantly different.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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