In a nutshell
This trial assessed whether chemotherapy based on ERCC1 and RRM1 levels is more beneficial than the conventional carboplatin and gemcitabine (GemCarbo) chemotherapy, in patients with advanced non-small-cell-lung cancer (NSCLC).
Some background
ERCC1 and RRM1 are proteins found in human cells and are a part of the cell's cycle of life. These proteins have roles in DNA repairing and tumor suppression and when they are mutated (defected), cancer may develop. These mutated proteins are associated with NSCLC. Recently, different trials have found that patients with high levels of ERCC1 and RRM1 may show resistance to chemotherapy based on carboplatin and gemcitabine (GemCarbo). Resistance to chemotherapy can result in low survival rates. This clinical trial investigated whether selecting chemotherapy agents according to the mutated proteins levels has any survival benefits in patients with advanced NSCLC compared with GemCarbo chemotherapy.
Methods & findings
275 with advanced NSCLC were chosen for the trial. The participants were randomly assigned to receive either GemCarbo regardless of their ERCC1 and RRM1 levels (control group) or they received chemotherapy according to their ERCC1 and RRM1 levels (intervention group). In the intervention group, if ERCC1 and RRM1 levels were low, patients received GemCarbo, if ERCC1 was high and RRM1 was low, they received gemcitabine/docetaxel, if RRM1 was high and ERCC1 was low, they received docetaxel/carboplatin and if both protein levels were high patients received docetaxel/vinorelbine. Patients received an average of 4 cycles of chemotherapy and the main parameter evaluated was the progression-free survival or PFS (the time patients survived without the cancer progressing).
The trial found no significant difference in survival between the control group and the intervention group, with a PFS of approximately 6.1 months in the intervention group and 6.9 months in the control group. Overall survival was 11.0 months in the intervention groups versus 11.3 months in the control group.
The bottom line
In summary, while there were no significant differences regarding survival rates between groups, patients with low levels of ERCC1 and RRM1, showed some benefit from gemcitabine and carboplatin chemotherapy.
What’s next?
Consult with your doctor about choosing the most appropriate chemotherapy regimen for your condition.
Published By :
Journal of clinical oncology
Date :
Jul 01, 2013
