Evaluating S-1 plus cisplatin with radiotherapy for inoperable stage III non-small cell lung cancer

This study looked at the use of chemotherapy with S-1 (Teysuno) plus cisplatin (Platinol) versus docetaxel (Taxotere) plus cisplatin and radiotherapy (RT) for stage III non-small-cell lung cancer (NSCLC) that cannot be surgically removed. The authors found that S-1 plus cisplatin (SP) should be considered as a treatment option due to good outcomes and lower toxicity in these patients.

NSCLC accounts for 85% of all lung cancer diagnoses. Cisplatin-based chemotherapy is a standard treatment of NSCLC that cannot be surgically removed. Docetaxel is a CT agent used to treat NSCLC. The use of full-dose RT is highly toxic. The reduction in chemotherapy dose has been used previously to reduce these toxic effects. 

S-1 is a new chemotherapy agent that is designed to increase anti-cancer effects and reduce toxicity. It has been shown to be promising in previous trials in treating NSCLC. The best chemotherapy-based regimen with RT for NSCLC that has cannot be surgically removed has not yet been decided. 

There were 106 patients with NSCLC that could not be surgically removed involved in this study. 53 patients were assigned to chemotherapy with S-1 and cisplatin (SP). 53 patients were assigned to docetaxel and cisplatin (DP) chemotherapy. Both groups received RT along with chemotherapy. Most patients completed a course of 60Gy of RT. The average follow-up was 2 years. 

In the SP group, 71.7% of patients responded to treatment compared to 67.9% in the DP group. The 2-year OS in the SP arm was 79% compared to 69% in the DP group. The average survival of patients in the SP arm was 55.2 months compared to 50.8% in the DP group. The average survival without progression of disease was 11.8 months in the SP group and 19.9 months in the DP group. 

Serious treatment-related side effects occurred more frequently in the DP arm compared to the SP arm.

The authors concluded that SP with RT should be considered as a treatment option for non-operable NSCLC due to decreased toxicity and good survival outcomes in comparison with DP. 

This study had a small number of participants. Also, comparisons with targeted therapies are needed.