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Consolidation Chemotherapy after Concurrent Radiochemotherapy in Locally Advanced Non–small-Cell Lung Cancer May Have Been Beneficial if We Only Knew Where It Have Worked

Consolidation Chemotherapy after Concurrent Radiochemotherapy in Locally Advanced... LETTERS TO THE EDITOR failure was observed when, that is, after Branislav Jeremic, MD, PhD Consolidation  concurrent or after consolidation part, Division of Clinical and Chemotherapy  and particularly in which patients. Radiation Oncology Why exact pattern of failure is so Stellenbosch University and after Concurrent  important? First, there are several types Tygerberg Hospital of patients after the initial (concurrent) Cape Town, South Africa Radiochemotherapy  part of RT-CHT and they can easily in Locally Advanced  be separated regarding the response. REFERENCES Although it is extremely unlikely that Non–small-Cell Lung  1. Tsujino K, Kurata T, Yamamoto S, et al. Is those achieving a stable disease would consolidation chemotherapy after concurrent benefit from the consolidation CHT, Cancer May Have  chemo-radiotherapy beneficial for patients those with either a complete response with locally advanced non-small-cell lung Been Beneficial if We   cancer? A pooled analysis of the literature. J (CR) or a partial response (PR) seem Thorac Oncol 2013;8:1181–1189. as likely candidates (although not all of Only Knew Where It  2. Aupérin A, Le Péchoux C, Rolland E, et al. them) to benefit from the consolidation Meta-analysis of concomitant versus sequen- Have Worked CHT. Therefore, separation of pattern of tial radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol failure occurring in likely (CR and PR) XXX 2010;28:2181–2190. and unlikely (stable disease) candidates To the Editor: 3. O’Rourke N, Roqué I Figuls M, Farré Bernadó could be used for further studies using In a recent article by Tsujino N, Macbeth F. Concurrent chemoradiother- 1 similar design with respect to, for exam- apy in non-small cell lung cancer. Cochrane et al. pooled the data from the litera- Database Syst Rev 2010; 6:CD002140. ple, eligibility criteria. Second, and more ture investigating the effectiveness of 4. Liang HY, Zhou H, Li XL, Yin ZH, Guan P, importantly, among likely candidates consolidation chemotherapy (CHT) Zhou BS. Chemo-radiotherapy for advanced (CR and PR) to benefit from consolida- after concurrent radiochemotherapy non-small cell lung cancer: concurrent or tion CHT, a distinction should be made sequential? It’ s no longer the question: a system- (RT-CHT) in locally advanced non– between those achieving CR and those atic review. Int J Cancer 2010;127:718–728. small-cell lung cancer (NSCLC). 5. Jeremić B, Miličić B, Milisavljević S. achieving PR after concurrent RT-CHT. They found no difference (survivals, Radiotherapy alone vs. radiochemotherapy in This is so because different mechanisms toxicity) between RT-CHT followed patients with favorable prognosis of clinical (precisely, different location) of action of by consolidation CHT and exclusive stage IIIA non-small-cell lung cancer. Clin consolidation CHT would be expected. Lung Cancer 2013;14:172–180. RT-CHT, adding to previous observa- In the CR patients, consolidation CHT tions that concurrent RT-CHT is the would target only a microscopic disease standard treatment in locally advanced 2–4 5 both intrathoracically and extrathoraci- NSCLC. Another recent data showed Role of Consolidation  cally, whereas in the PR patients, it would that concurrent RT-CHT can also be Chemotherapy after  have also to address clinically overt considered as one of standards in clini- intrathoracic disease. Pattern of failure cal stage IIIA NSCLC patients. Concurrent  in these two distinct groups of patients Although reasons for ineffi- would then clearly show how and where ciency of consolidation CHT may be Chemo-Radiotherapy  consolidation CHT actually acts and to multiple, it is challenging to disclose in Locally Advanced  what extent (clinical versus subclinical). some aspects that may have adversely In addition, we would be able to investi- influenced the outcome. Although these Non–Small-Cell Lung  gate the determinants of treatment out- studies presented very detailed pat- come such as cross-resistance between Cancer tern of failure in general, this was done drugs or drugs and RT. for the whole time period of the study Although identifying pattern of (treatment plus follow-up). This way In Response: failure in patients achieving differ- we only learned about the total patterns We thank Dr. Jermic for giv- ent response after concurrent RT-CHT of failure and not about which type of ing us an opportunity to express our would place additional burden on inves- tigators and hospitals, this effort would Address for correspondence: Branislav Jeremic, Address for correspondence: Masahiko Ando, MD, be eventually rewarding. This way MD, PhD, Division of Clinical and Radiation Center for Advanced Medicine and Clinical we would be able to identify different Oncology, Stellenbosch University and Research, Nagoya University Hospital, 65 patient subsets and different options Tygerberg Hospital, Cape Town, South Africa. Tsurumai-cho, Showa-ku, Nagoya, Aichi 466– E-mail: bjeremic@sun.ac.za 8560, Japan. E-mail: mando@med.nagoya-u.ac.jp and to proceed (or not) with a consoli- Disclosure: The author declares no conflict of Disclosure: The authors declare no conflicts of dation CHT, an approach which would interest. interest. ultimately lead to a better patient-tai- Copyright © 2013 by the International Association Copyright © 2013 by the International Association lored treatment sequence, a must for a for the Study of Lung Cancer for the Study of Lung Cancer ISSN: 1556-0864/14/0901-00e7 future clinical research in lung cancer. ISSN: 1556-0864/14/0901-00e7 Journal of Thoracic Oncology  • Volume 9, Number 1, January 2014 e7 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Thoracic Oncology Wolters Kluwer Health

Consolidation Chemotherapy after Concurrent Radiochemotherapy in Locally Advanced Non–small-Cell Lung Cancer May Have Been Beneficial if We Only Knew Where It Have Worked

Journal of Thoracic Oncology , Volume 9 (1) – Jan 1, 2014

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References (5)

Copyright
Copyright © 2013 by the International Association for the Study of Lung Cancer
ISSN
1556-0864
DOI
10.1097/JTO.0000000000000036
pmid
24346106
Publisher site
See Article on Publisher Site

Abstract

LETTERS TO THE EDITOR failure was observed when, that is, after Branislav Jeremic, MD, PhD Consolidation  concurrent or after consolidation part, Division of Clinical and Chemotherapy  and particularly in which patients. Radiation Oncology Why exact pattern of failure is so Stellenbosch University and after Concurrent  important? First, there are several types Tygerberg Hospital of patients after the initial (concurrent) Cape Town, South Africa Radiochemotherapy  part of RT-CHT and they can easily in Locally Advanced  be separated regarding the response. REFERENCES Although it is extremely unlikely that Non–small-Cell Lung  1. Tsujino K, Kurata T, Yamamoto S, et al. Is those achieving a stable disease would consolidation chemotherapy after concurrent benefit from the consolidation CHT, Cancer May Have  chemo-radiotherapy beneficial for patients those with either a complete response with locally advanced non-small-cell lung Been Beneficial if We   cancer? A pooled analysis of the literature. J (CR) or a partial response (PR) seem Thorac Oncol 2013;8:1181–1189. as likely candidates (although not all of Only Knew Where It  2. Aupérin A, Le Péchoux C, Rolland E, et al. them) to benefit from the consolidation Meta-analysis of concomitant versus sequen- Have Worked CHT. Therefore, separation of pattern of tial radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol failure occurring in likely (CR and PR) XXX 2010;28:2181–2190. and unlikely (stable disease) candidates To the Editor: 3. O’Rourke N, Roqué I Figuls M, Farré Bernadó could be used for further studies using In a recent article by Tsujino N, Macbeth F. Concurrent chemoradiother- 1 similar design with respect to, for exam- apy in non-small cell lung cancer. Cochrane et al. pooled the data from the litera- Database Syst Rev 2010; 6:CD002140. ple, eligibility criteria. Second, and more ture investigating the effectiveness of 4. Liang HY, Zhou H, Li XL, Yin ZH, Guan P, importantly, among likely candidates consolidation chemotherapy (CHT) Zhou BS. Chemo-radiotherapy for advanced (CR and PR) to benefit from consolida- after concurrent radiochemotherapy non-small cell lung cancer: concurrent or tion CHT, a distinction should be made sequential? It’ s no longer the question: a system- (RT-CHT) in locally advanced non– between those achieving CR and those atic review. Int J Cancer 2010;127:718–728. small-cell lung cancer (NSCLC). 5. Jeremić B, Miličić B, Milisavljević S. achieving PR after concurrent RT-CHT. They found no difference (survivals, Radiotherapy alone vs. radiochemotherapy in This is so because different mechanisms toxicity) between RT-CHT followed patients with favorable prognosis of clinical (precisely, different location) of action of by consolidation CHT and exclusive stage IIIA non-small-cell lung cancer. Clin consolidation CHT would be expected. Lung Cancer 2013;14:172–180. RT-CHT, adding to previous observa- In the CR patients, consolidation CHT tions that concurrent RT-CHT is the would target only a microscopic disease standard treatment in locally advanced 2–4 5 both intrathoracically and extrathoraci- NSCLC. Another recent data showed Role of Consolidation  cally, whereas in the PR patients, it would that concurrent RT-CHT can also be Chemotherapy after  have also to address clinically overt considered as one of standards in clini- intrathoracic disease. Pattern of failure cal stage IIIA NSCLC patients. Concurrent  in these two distinct groups of patients Although reasons for ineffi- would then clearly show how and where ciency of consolidation CHT may be Chemo-Radiotherapy  consolidation CHT actually acts and to multiple, it is challenging to disclose in Locally Advanced  what extent (clinical versus subclinical). some aspects that may have adversely In addition, we would be able to investi- influenced the outcome. Although these Non–Small-Cell Lung  gate the determinants of treatment out- studies presented very detailed pat- come such as cross-resistance between Cancer tern of failure in general, this was done drugs or drugs and RT. for the whole time period of the study Although identifying pattern of (treatment plus follow-up). This way In Response: failure in patients achieving differ- we only learned about the total patterns We thank Dr. Jermic for giv- ent response after concurrent RT-CHT of failure and not about which type of ing us an opportunity to express our would place additional burden on inves- tigators and hospitals, this effort would Address for correspondence: Branislav Jeremic, Address for correspondence: Masahiko Ando, MD, be eventually rewarding. This way MD, PhD, Division of Clinical and Radiation Center for Advanced Medicine and Clinical we would be able to identify different Oncology, Stellenbosch University and Research, Nagoya University Hospital, 65 patient subsets and different options Tygerberg Hospital, Cape Town, South Africa. Tsurumai-cho, Showa-ku, Nagoya, Aichi 466– E-mail: bjeremic@sun.ac.za 8560, Japan. E-mail: mando@med.nagoya-u.ac.jp and to proceed (or not) with a consoli- Disclosure: The author declares no conflict of Disclosure: The authors declare no conflicts of dation CHT, an approach which would interest. interest. ultimately lead to a better patient-tai- Copyright © 2013 by the International Association Copyright © 2013 by the International Association lored treatment sequence, a must for a for the Study of Lung Cancer for the Study of Lung Cancer ISSN: 1556-0864/14/0901-00e7 future clinical research in lung cancer. ISSN: 1556-0864/14/0901-00e7 Journal of Thoracic Oncology  • Volume 9, Number 1, January 2014 e7

Journal

Journal of Thoracic OncologyWolters Kluwer Health

Published: Jan 1, 2014

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