Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 21PROCLAIM trial: Pemetrexed/cisplatin or etoposide/cisplatin with radiation therapy followed by consolidation chemotherapy for locally advanced nonsquamous NSCLC
1:52 minutes.
TRANSCRIPTION:
DR MOK: The PROCLAIM trial is actually looking to the neoadjuvant pemetrexed/platinum followed by concurrent versus the standard of care, which is the concurrent chemo/RT with the etoposide and platinum. Now in a way, it’s that there is no difference in the overall survival. I think that is what is defined as a negative study. However, it does demonstrate that there is less toxicity using the pemetrexed combination, and also it’s feasible to use the doublet in this combination. So in that case, we learned something from the PROCLAIM study. To me, the patient already received 4 cycles in a neoadjuvant setting. The role of chemotherapy in concurrence with RT is actually to augment the radiation effect. I’m not quite sure whether a doublet is going to be better than a single agent, if I’m just looking for the augmentation effect. And as I said, this patient already got the doublet therapy. They do have this, so for the systemic efficacy from the neoadjuvant treatment. So to minimize the local toxicity, I just stay with the single agent. DR LOVE: It is interesting, though, that that PROCLAIM study, a lot of people do consider it negative, because there wasn’t an efficacy advantage. But, I mean, even in the metastatic setting, the reason people are using pemetrexed is lack of toxicity. What kind of toxicity is less in the chemoradiation setting? And from your point of view, is it clinically significant? DR MOK: Right. So the nausea and vomiting bit is less. However, there’s no significant difference in term of pneumonitis. And to us, when you give concurrent chemo/RT, the pneumonitis or esophagitis are actually more of a concern than the other systemic toxicities. |