Dillman R, et al. Improved survival in stage III non-small-cell lung cancer: seven-year follow- up of Cancer and Leukemia Group B (CALGB) 8433 trial. J Natl Cancer Inst. 1996;88:1210–5.
For decades prior to the presentation of results from this trial, the standard treatment for locally or regionally advanced non-small cell lung cancer had been radiation therapy alone with 5-year survival rates of 10% or less. This trial by the CALGB changed the standard of care by demonstrating that chemotherapy should play an important role in the management of these patients.
CALGB 8433 randomized patients between 1984 and 1987 to induction chemotherapy consisting of cisplatin and vinblastine followed by radiation therapy or radiation therapy alone. The radiation therapy dose was 6000 cGy administered over 6–7 weeks.
Key Point The patients randomized to chemotherapy combined with radiation therapy experienced improved overall survival compared with patients randomized to radiation therapy alone. The median survival was 13.7 months versus 9.6 months (P = 0.012). The probability of survival at 5 years was 2.8-fold higher in the combined modality arm of the trial (Table 3.2).
The objective response rate was 56% versus 43% in favor of the combined modality therapy group (P = 0.092).
This landmark trial demonstrated that there was a role for chemotherapy in improving survival in patients with stage III non-small cell lung cancer. The CALGB 8433 trial demonstrated significantly improved overall survival with neoadjuvant chemotherapy followed by radiation therapy compared with radiation therapy alone in patients with clinical stage IIIA and IIIB non-small cell lung cancer. This trial was also instrumental in paving the way for trials that studied concurrent chemotherapy and radiation therapy and tested new chemotherapy agents in the management of patients with stage III nonsmall cell lung cancer.
Table 3.2 Rates of survival in CALGB 8433
