Carbo/Taxol Chemoradiation
Unresectable stage III non-small cell lung cancer (NSCLC)
- Definitive Chemoradiation
Chemotherapy:
– Carboplatin and Paclitaxel (Carbo/Taxol)
– Carboplatin: Area under the curve (AUC) of 2 mg/mL/min administered weekly.
– Paclitaxel: 40 mg/m² administered weekly.
Radiation Therapy:
– Concurrent thoracic radiotherapy (TRT) with a total dose of 60 Gy in 30 fractions (2 Gy per fraction) over 6 weeks.
- Adjuvant Immunotherapy
Immunotherapy:
– Durvalumab: 10 mg/kg administered every 2 weeks.
– Duration: Continue for 1 year, starting within 1-42 days after completing chemoradiation.
Toxicity Profile
Chemoradiation with Carbo/Taxol
Hematologic Toxicities:
– Leukopenia: Grade 3 or worse in approximately 66% of patients.
– Neutropenia: Grade 3 or worse in approximately 61% of patients.
– Febrile Neutropenia: Occurs in about 10.2% of patients
Non-Hematologic Toxicities:
– Pneumonitis: Grade 3 or worse in about 4.1% of patients.
– Esophagitis: Grade 3 or worse in about 8.2% of patients
– Fatigue: Common, often worsening towards the end of treatment and persisting for weeks after
– Nausea and Vomiting: Common side effects of chemotherapy.
– Peripheral Neuropathy: Due to paclitaxel, can cause numbness and tingling in extremities
Adjuvant Immunotherapy with Durvalumab
Common Adverse Events:
– Pneumonitis: Occurs in approximately 10.3% of patients, potentially leading to treatment discontinuation
– Fatigue: Common side effect.
– Dermatologic Reactions: Rash and pruritus.
– Endocrinopathies: Hypothyroidism or hyperthyroidism, adrenal insufficiency.
Severe Adverse Events:
– Immune-mediated Adverse Events: Including pneumonitis, hepatitis, colitis, endocrinopathies, and nephritis.
– Infections: Increased risk due to immunosuppression.