Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)

 

Different Chemo Choices for Concurrent Chemo/Radiation
Author
Howard (Jack) West, MD

My last post included studies that demonstrated no additional benefit from giving chemo after concurrent chemo/radiation for locally advanced NSCLC, but it's important to add a qualifier to that conclusion. The studies that have shown an overall favorable result from two cycles, or about 6-7 weeks, of chemo with radiation have thus far primarily been with cisplatin and not carboplatin. As I've mentioned previously, there is some evidence that cisplatin and carboplatin, while related drugs and overall similar in performance, may have some differences, and I wouldn't want to generalize the results in stage III NSCLC from cisplatin to carboplatin and visa versa.

The reason is that cisplatin is unusual among chemo agents in that it can be given at full dose with radiation concurrently. Carboplatin is generally given with paclitaxel when administered concurrently with radiation, and both drugs are given at much lower doses than would be used if patients were not receiving radiation at the same time. The reason is that carboplatin and paclitaxel are very potent radiation sensitizers, and giving these drugs at full dose would likely lead to very significant toxicity problems in the area of the radiation field. So carboplatin and paclitaxel are routinely given at a low weekly dose, which enhances the radiation quite effectively.

The problem, however, is that we're fighting cancer on two fronts: local and distant. I've mentioned this in passing before, but we often need to consider the risk of recurrence within the region of the cancer and also the risk of distant disease. When cisplatin/etoposide or some other cisplatin-based regimens are given with radiation, it's possible to give doses that both enhance the radiation effect locally and also provide systemic, "whole body" treatment against micrometastases outside of the radiation field. Since the great majority of patients with stage III NSCLC have recurrence distant from the main cancer, giving effective systemic therapy is an important consideration. And it's not likely that we're offering that with low dose weekly carbo/paclitaxel with radiation.

We're now recognizing the issue of a third compartment of the brain more and more, since 20-35% of patients with stage III NSCLC develop disease recurrence in the brain first or brain only. We don't have an established role yet for prophylactic cranial irradiation in this setting, but it's something we've been studying because the central nervous system (brain, basically) is a potential sanctuary site for untreated micrometastatic disease. Most of our chemo doesn't seem to get into the brain very effectively due to the blood-brain barrier.

Threats of Recurrence in LC (Click to enlarge)

All of this is basically to say that my conclusion about two cycles of chemo concurrent with radiation being as good as more treatment for stage III NSCLC can only be interpreted as applying to cisplatin. We do have some information about carboplatin-based chemo, generally in the context of induction chemo (chemo before concurrent chemoradiation), and I'll cover that next.

Next Previous link

Previous PostNext Post

Related Content

Image
Bladder Cancer Video Library 2024
Video
Dr. Petros Grivas discusses intravesical treatment for patients with nonmuscle invasive, or early-stage, bladder cancer, the importance of participating in clinical trials for bladder cancer, combination therapy options for patients with metastatic or incurable bladder cancer, and the importance of family history of cancer and discussing that history with your doctor.
Image
Case Based Panel
Video
The panel discusses treatment options for a patient diagnosed with EGFR Exon 19 Deletion NSCLC and examines data from the Laura Trial, a patient with a smoking history and diagnosis of small cell lung cancer, and how the Adriatic Study factors into decisions, and a patient with NSCLC adenocarcinoma, and a EGFR Exon 21 L858R Alteration, and how data from the Flaura 2 Trial can impact treatment decisions.
Image
Terapias Dirigidas de Cancer de Pulmón 2024
Video
La Dra. Estelamari Rodríguez presenta información básica sobre el NSCLC EGFR+ y analiza la importancia de las pruebas de biomarcadores en el cáncer de pulmón y ofrece una descripción general de las opciones de tratamiento para la enfermedad EGFR+.  Para ver la playlist completa, de click aquí.        

Forum Discussions

Hello Linda, my name is Alexandra Beneke, I'm the Outreach Manager for GRACE. Your willingness to share your experiences and knowledge with the cancer community is truly inspiring. Your dedication to...

Hi Bluebird,  Welcome to GRACE.  I'm sorry you're going through this scare and hope it's just inflammation or from an infection you didn't know you had. 

 

A CT would be...

Radiation + Brain Operation has just been discarded due to high risk. They will double Tagrisso dosis and then wait to see if it works, then try traditional Chemo. I would...

Hi and welcome to GRACE.  I'm sorry to know you are entering a new stage.  I'm not about to comment just now but wanted to let you know I see your...

Edit to say, we can't give advice but we can comment with views and facts.  :)

 

My first thought is to ask if she has been seen at a large...

Hi Barbro, Welcome to GRACE. I'm sorry you're worrying about this. We aren't able to give feedback on scan reports. Interpreting scan reports in this setting is not only unethical but...

Recent Comments

JOIN THE CONVERSATION
Tagrix FDA Approval
By mariachristian on
Hi Judy! It is so good to…
By JanineT GRACE … on
Tagrix vs Tagrisso
By Dipakchavan on
Hello Linda, my name is…
By AlexandraGBeneke on