What is the number of doses of concurrent carboplatin (Carboplatin) and paclitaxel (Paclitaxel) administered with radiation therapy for non-small cell lung cancer (NSCLC)?

From the Guidelines

For non-small cell lung cancer, the standard concurrent chemoradiation regimen typically involves weekly carboplatin and paclitaxel for 6-7 weeks, administered alongside radiation therapy to a total dose of 60 Gy, with the chemotherapy given on the same day each week throughout the radiation treatment course, resulting in 6-7 total doses of each medication 1.

Chemotherapy Regimen

The most common schedule consists of weekly carboplatin at an AUC of 2 and paclitaxel at 45 mg/m², as seen in the RTOG 0617 trial, which is a randomized phase III trial that tested the addition of cetuximab to concurrent chemoradiation and the use of 74 Gy compared with 60 Gy thoracic radiation in 2 Gy daily fractions 1.

• The weekly dosing schedule allows for better tolerance than higher doses given less frequently, while still providing radiosensitization to enhance the effectiveness of radiation therapy.
• Patients should be monitored closely for common side effects including myelosuppression, esophagitis, pneumonitis, neuropathy, and fatigue during this treatment course.

Radiation Therapy

The radiation therapy is typically delivered to a total dose of 60 Gy in 30 fractions, as established by the RTOG 7301 study, which showed that 60 Gy led to longer 3-year OS rates than 50 Gy, 40 Gy, or 40 Gy delivered as a split course with a 2-week break after 20 Gy 1.

• The delivery of 60 Gy in 30 fractions was subsequently similarly found to improve outcomes of hyperfractionated radiotherapy in a phase III North Central Cancer Treatment Group and Mayo Clinic trial.
• A long-term report of the RTOG 0617 trial showed that 5-year OS and PFS were better with the standard dose arm of 60 Gy, and this further established 60 Gy as the standard-of-care radiation dose to be delivered with concurrent chemotherapy 1.

From the Research

Dosing Regimen for Concurrent Carboplatin and Paclitaxel with Radiation

• The dosing regimen for concurrent carboplatin and paclitaxel with radiation for non-small cell lung cancer is not explicitly stated in terms of the number of doses in the provided studies 2, 3, 4, 5, 6.
• However, the studies provide information on the dosing schedules and toxicity profiles of the regimens.
• For example, one study used paclitaxel 50 mg/m2/wk and carboplatin area under the concentration-time curve of 2/wk for 7 weeks with radiation, followed by two additional cycles of paclitaxel 200 mg/m2 and carboplatin (area under the concentration-time curve of 6) 3 weeks apart 3.
• Another study used weekly paclitaxel (45 mg/m2)/carboplatin (AUC = 2) with concurrent TRT 63.0 Gy, followed by two cycles of paclitaxel (200 mg/m2)/carboplatin (AUC = 6) 5.

Toxicity Profiles

• The studies report varying toxicity profiles for the different regimens, with esophagitis being a common side effect 3, 5, 6.
• Hematological toxicities, such as neutropenia, were also reported 2, 5.
• The toxicity profiles were generally considered acceptable, with some regimens being associated with greater toxicity than others 5.

Efficacy

• The studies report varying response rates and survival outcomes for the different regimens 2, 3, 4, 5, 6.
• One study reported an overall response rate of 82% with a regimen of paclitaxel and carboplatin with concurrent radiation 3.
• Another study reported a median overall survival of 16.3 months with a regimen of concurrent weekly paclitaxel, carboplatin, and TRT followed by consolidation 5.