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While researchers have learned in the last decade that combining chemotherapy with radiation is better than radiation alone for treating non-small cell lung cancer patients with locally advanced disease – cancer confined to the lungs – finding the right combination of drugs – and the best timing of treatment – has been tricky.

A new study led by lung cancer specialists at Jefferson Medical College adds to growing evidence that giving patients both chemotherapy and radiation in the beginning of treatment may help patients live longer. Non-small-cell lung cancer accounts for about 80 percent of all cases of lung cancer. An estimated 40,000 Americans are diagnosed each year with locally advanced disease.

“This is a further step in looking at what is the best combination of two chemotherapy agents with radiation, which will enable us to move forward and study it more systematically,” says Walter J. Curran Jr., M.D., professor and chair of radiation oncology at Jefferson Medical College at Thomas Jefferson University in Philadelphia and clinical director of Jefferson’s Kimmel Cancer Center, who led the research.

“There are new biologic agents we want to test with chemotherapy, with radiation and with both,” he notes. “Finding the best combination of chemotherapy and radiation  provides a template by which we can test these agents.”

The results appear September 1, 2005 in the Journal of Clinical Oncology.

In the multicenter, randomized phase 2 trial, researchers compared three different approaches to treating inoperable non-small-cell lung cancer that had not spread beyond the lungs. They divided more than 250 patients into three treatment arms. One group received chemotherapy before radiation. A second group had chemotherapy before and during radiation. Patients in the third arm received chemotherapy and radiation at the same time, then added a little more chemotherapy after. Each arm had the same schedule of radiation and were given the same two standard chemotherapy agents, carboplatin and paclitaxel.

Dr. Curran and his colleagues found that the patients in the third arm did best, living several months more on average when compared against the standard treatment. 

“That’s in keeping with the observed results of other studies,” Dr. Curran says. “Giving radiation and chemotherapy from day one appears to be the best approach for these patients,” though side effects can at first appear to be worse.

“Researchers are already looking at targeted agents such as bevacizumab, cetuximab and other agents with chemotherapy and radiation in lung cancer,” he says. “This kind of study will help guide us as to which schedule to use.”

Some other institutions that participated in the trial include medical centers at the University of Pittsburgh and Vanderbilt University and Rush University Medical Center.