Current perspectives on treatment strategies for locally advanced, unresectable stage III non-small cell lung cancer

Abstract

The treatment of unresectable stage III NSCLC remains challenging. However, in the last two decades, advances in terms of survival prolongation have been made, first by administering chemotherapy with definitive thoracic radiotherapy sequentially, and then by administering these two modalities concurrently. Most recently, induction and consolidation regimens have been evaluated which involve adding chemotherapy before concurrent chemoradiotherapy (as induction) or after (as consolidation). Thus far, the consolidation approach appears to be promising. For example, concurrent chemoradiotherapy with cisplatin and etoposide followed by consolidation docetaxel yielded an impressive median survival of 26 months in a Southwest Oncology Group phase II trial. A phase III trial showed interesting results in a subset of patients that received docetaxel consolidation prior to randomization to gefitinib or placebo. Although stopped early due to lack of benefit of gefitinib, preliminary results showed a median survival time of 29 months in the placebo arm. A randomized trial is currently underway that compares concurrent chemoradiotherapy (using cisplatin and etoposide) followed by either docetaxel consolidation or no further therapy.