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2078
Neoadjuvant Chemotherapy and HER-2/neu
Overexpression in Stage IIIA/B NSCLC. Isaac Tafur, Frank E
Mott, Martha C Escobar, Robert S Beissner, Mark W Riggs, Jon
Herrington, Lucio Di Nunno, Jose A Figueroa, Scott&White
Memorial Hosp and Clinic/Texas A&M Univ Coll of Medicine,
Temple, TX; Scott&White Memorial Hosp and Clin, Temple, TX; Rush
Cancer Ctr, Chicago, IL; Joe Arrington Cancer Ctr, Lubbock, TX.
BACKGROUND Survival in NSCLC is dependent on stage. 5-yr survival
for stage IIIA and IIIB NSCLC is 15 and 5% respectively. Rosell and
Roth showed benefit of neoadjuvant chemotherapy in IIIA disease.
Rush and Macchiarini showed benefit in IIIB disease (T4 lesions).
HER2/neu is an oncogene involved in cell growth and differentiation.
In NSCLC it has been linked to chemoresistance and shortened
survival. We previously studied HER2/neu expression in 243 patients
surgically treated for stages I and II NSCLC. Overexpression
correlated with decreased median survival but did not predict
significant overall survival benefit at 8 years. Here we study the
effect of neoadjuvant Taxol/Carboplatin and the overexpression of
HER2/neu, on response rate, recurrence, and survival in stage IIIA
and IIIB NSCLC. METHODS Between 8/95 and 11/98 we studied 41
patients with locally advanced NSCLC. They received mediastinoscopy
for staging and 3 cycles of neoadjuvant chemotherapy with
Carboplatin AUC=7 and Taxol 200 mg/m2 over 3 hrs every 3 weeks.
After restaging they either had surgery or chemoradiation: 60 Gy in
30 fractions with weekly Carboplatin AUC=2.5. The surgical arm had 2
additional cycles of Carboplatin/Taxol. Deparaffinized tissue slides
were stained with DAKO Hercep Test. Slides were read per DAKO
guidelines using controls. RESULTS Stage IIIA: 13/18 responded to
initial treatment, 7 had surgery, one had no residual tumor. Stage
IIIB: 17/23 responded to initial treatment, 3 had surgery. HER2/neu
expression was determined in only 37 patients (2 had no sample left
and 2 had outside slides). Stage IIIA : 13/16 (-) and 3/16(+). Stage
IIIB: 17/21 (-) and 4/21 (+). There was no significant survival
difference by stage (P=.94) or HER2/neu overexpression (P=.97). Both
median time to progression (14.6 vs 9 months) and median survival
(38.4 vs 16.5 months) were significantly better in the surgery arm
(P=.02). CONCLUSIONS Neoadjuvant chemotherapy in locally advanced
NSCLC allows surgical treatment and increases disease free and
median survival. Overexpression of HER2/neu had no impact on the
outcome of NSCLC patients, however this study is underpowered due to
the small number of samples tested for HER2/neu.
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