| Reference (therapy) |
Study type |
Patients |
RT schedule |
Systemic therapy |
Results |
| Spigel et al.[41]
bevacizumab |
phase II
n=29 (small cel) n=5 non-small cell |
non–small-cell lung cancer trial included patients with unresectable stage III nonsquamous without pleural or pericardial effusions; ECOG 0-1; |
RT began with cycle 3, at a dose of 1.8 Gy/d to a total of 61.2 Gy |
induction treatment included: carboplatin AUC = 5, pemetrexed 500 mg/m2, and bevacizumab 15 mg/kg;
consolidative therapy with carboplatin AUC = 6, pemetrexed 500 mg/m2, and bevacizumab 15 mg/kg
patients received maintenance bevacizumab 15 mg/kg every 3 weeks for 9 cycles with restaging every 3 months |
the trial's primary PFS end point could not be assessed due to early trial closure becouse of toxicity.
the objective response rate was 88%
two patients developed tracheoesophageal fistulae, prompting early study closure. Both patients developed esophageal toxicity during chemoradiotherapy and bevacizumab treatment. |
| Socinski et al.[42]
bevacizumab |
phase I/II
n=45 |
medically inoperable or unresectable, WHO 0-1; stage IIIA or IIIB, |
conformal radiation therapy to 74 Gy |
induction chemotherapy (carboplatin AUC 6, paclitaxel 225 mg/m2, and bevacizumab 15 mg/kg followed by concurrent chemotherapy (carboplatin AUC 2 and paclitaxel 45 mg/m2 weekly with bevacizumab 10 mg/kg In the phase I portion, cohort 1 received no erlotinib, whereas cohorts 2 and 3 received erlotinib at 100 and 150 mg, respectively.
consolidation therapy with erlotinib (150 mg daily) and bevacizumab (15 mg/kg every 3 weeks) 3 to 6 weeks later for 6 cycles |
the objective response rates to induction and overall treatment were 39% and 60%.
median PFS 10.2 mo
median OS 18.4 mo |
| Kelly et al.[44]
gefitinib |
phase III
n=243 |
inoperable stage IIIA or IIIB without pleural or pericardial effusions; ECOG 0-1; |
initial field received 1.8 Gy/d for 5 weeks for a dose of 45 Gy; an additional radiation boost to gross disease with 2 Gy/d to 16 Gy was delivered without a break. The total radiation dose received was 61 Gy. |
concurrentcisplatin and etoposide with thoracic radiation. cisplatin 50 mg/m2 with etoposide 50 mg/m2.
4 to 8 weeks after completion of radiation, patients without progressive disease received 3 cycles of docetaxel 75 mg/m2
3 to 6 weeks after docetaxel, patients received gefitinib 500 mg or placebo orally, once a day for 5 years or until disease progression or intolerable toxicity. Later gefitinib was amended to the 250 mg/d |
median survival time was 23 months for gefitinib (n =118) and 35 months for placebo
the toxic death rate was 2% with gefitinib compared with 0% for placebo. |
| Martinez et al.[52]
erlotinib |
phase II
n=23 |
unresectable stage I-IIIA, not suitable to receive chemotherapy, ECOG 0- 2 |
66 Gy in 33 fractions during 6 weeks |
RT and placebo (arm a) or concomitant erlotinib 150 mg/day po maintained for 6 months (arm b) |
esophagitis 40% in arm A and 23% in arm B, (no grade 3-4).
radiodermitis 50% in arm A (no grade 3-4 observed) and 8% in arm B, being grade 3.
pneumonitis 20% in arm A (10% grade 3) and 8% in arm B (no grade 3-4 observed).
main toxicities related to erlotinib were skin rash (61.5%) and diarrhea (23%)
response rate in arm A was 55.5% and 83.3% in arm B. Disease progression is documented in 22.2% in arm A and 16.7% in arm B |
| Jensen et al.[57]
cetuximab |
phase II
n = 30 |
not candidates for concomitant chemoradiation (or refused), KPS at least 70, one of two trials with mandatory PET; stage IIIA or IIIB, no malignant pleural effusion, |
IMRT trial, 66 Gy in 33 daily fractions of 2 Gy, ENI to 50 Gy (or 40 depending on lung dose) |
cetuximab followed by 13 weekly consolidation cycles |
median OS 19.6 mo, median PFS 8.5 mo, 63% PR, no CR, |
| Jatoi et al.[56]
Cetuximab |
phase II,
n = 58 |
not candidates for concomitant chemoradiation, either age ≥ 65 years with ECOG 0-2 or younger but ECOG 2; stage IIIA or IIIB, no pleural effusion, |
RT 60 Gy in 30 daily fractions of 2 Gy, ENI to ipsilateralhilar and mediastinal nodes (44 Gy) |
cetuximab 400 mg/m(2) i.v. on day 1 followed by weekly cetuximab 250 mg/m(2) i.v. with concomitant radiation |
median OS 15.1 mo, median PFS 7.2 mo, 26% PR, no CR |
| Hallqvist et al.[58]
cetuximab |
phase II,
n = 71 |
medically inoperable or unresectable, WHO 0-1; stage IIIA or IIIB, no pleural effusion with positive cytology, |
RT 68 Gy in 34 daily fractions of 2 Gy, no ENI |
2 cycles of induction cisplatin/docetaxel, cetuximab starting one week before RT |
median OS 17 mo, PFS NR, 16% PR and 7% CR at 12 months (NR at earlier time points), patterns of failure: 31% distant only, 23% local only, 7% regional only, 11% combinations of these, |
| Hughes et al.[59]
cetuximab |
phase II,
n = 12 |
Inoperable, WHO 0-1; Stage IIIA or B, no pleural effusion |
RT 64 Gy in 32 fractions of 2 Gy, in 4 cases ENI to ipsilateralhilar and mediastinal nodes (50 Gy) |
up to 4 cycles (median 3) of platinum-based induction CT, cetuximab starting one week before RT |
median OS NR, PFS NR, 58% PR, no CR, |
| Blumenschein et al.[60]
cetuximab |
phase II,
n = 87 |
Inoperable, Zubrod 0-1; Stage IIIA or B, weight loss < 5%, FEV1 ≥ 1,2 l |
RT 63 Gy in 35 fractions of 1.8 Gy, ENI to ipsilateralhilar and mediastinal nodes (45 Gy) |
cetuximab week 1-17, weekly carboplatin/paclitaxel during RT followed by 2 cycles consolidation carboplatin/paclitaxel |
median OS 22.7 mo, median time to progression around 14-15 mo, 29% CR, 33% PR, |
| Govindan et al.[61]
cetuximab |
phase II,
n = 101 |
Inoperable, ECOG 0-1, one of two trials with mandatory PET; Stage IIIA or B, no pleural effusion, weight loss ≤ 10% |
70 Gy in 35 fractions of 2 Gy, no ENI |
cetuximab (7 weeks) plus 4 cycles carboplatin/pemetrexed vs. CT without cetuximab (n = 48), afterwards 4 cycles of pemetrexed |
median OS 25.2 mo, median failure-free survival 12.3 mo, 4% CR, 68% PR, |
