COMPARISON OF TOXICITIES BETWEEN CISPLATIN-ETOPOSIDE VERSUS PACLITAXEL-CARBOPLATIN REGIMEN ALONG WITH THORACIC RADIOTHERAPY IN UNRESECTABLE LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER

Janak Raman Parajuli, Md Masudur Rahman*, Mohammad Jahan Shams, Mostafa Sanaul Haque and Shourov Biswas

ABSTRACT

Background: Combined modality of treatment i.e., platinum-based doublet chemotherapy with concurrent radiotherapy is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). However, the optimal chemotherapy regimen to use with radiotherapy is still not established. Aim of this study was to compare the acute toxicities between cisplatin-etoposide (EP) and paclitaxel-carboplatin (PC) along with thoracic radiotherapy in unresectable locally advanced NSCLC. Materials and Methods: A Quasi-experimental study was conducted from October 2020 to September 2021 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and National Institute of Cancer Research and Hospital (NICR&H), Dhaka. Patients with unresectable, locally advanced NSCLC who met the inclusion criteria were enrolled and distributed equally into two arms. Patients received thoracic radiotherapy with 60Gy in 2Gy daily fractions, 5 fractions a week, for 6 weeks with either Injection Cisplatin 50 mg/m2 administered on days 1, 8, 29, and 36, and Injection Etoposide 50 mg/m2/day on days 1–5 and 29–33 (Arm A), or Injection Carboplatin (AUC-2) and Injection Paclitaxel (45 mg/m2) administered on day 1, weekly, over a 6-week period (Arm B). All the patients were evaluated before, during, and after the completion of the treatment. Follow ups were done at 6 weeks, 12 weeks and 24 weeks following the completion of treatment using history, clinical examination and investigations. Results: most commonly observed toxicities were nausea, esophagitis and radiation pneumonitis. Although grade 1 esophagitis was more in arm B (56.76% vs 35.14%), grade 2 and 3 esophagitis were more in arm A (40.54% vs 16.21%; and 13.51% vs 5.41% respectively; p 0.043). Grade 1 pneumonitis was same (16 or 43.24%) in both arms. However, Grade 2 and 3 radiation pneumonitis were significantly more in Arm B (40.54% vs 16.22% and 5.41% vs 2.7 % respectively; p 0.004). Observed differences in nausea, vomiting, dermatitis, neurotoxicity, and hematological toxicities were not found to be statistically significant. Conclusion: This study suggests that the toxicities of cisplatin-etoposide regimen is comparable to paclitaxel-carboplatin regimen when given with concurrent radiotherapy in unresectable locally advanced non-small cell lung cancer.

Keywords: Lung cancer, Concurrent chemoradiation, Non-small cell lung cancer, Locally advanced, Cisplatin and etoposide, Carboplatin and Paclitaxel.