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Adenovirus-Mediated Wild-Type p53 Gene Transfer in Patients Receiving Chemotherapy for Advanced Non–Small-Cell Lung Cancer: Results of a Multicenter Phase II Study

From the Departments of Medicine III, Radiology, and Pathology, Johannes Gutenberg University, Mainz; Department of Thoracic Oncology, Hospital Grosshansdorf, Grosshansdorf, Germany; Divisions of Oncology and Pneumology, Department of Medicine, Kantonsspital, Basel, Switzerland; Department of Medical Oncology, Oncology Center, Academisch Ziekenhuis, Vrije Universiteit Brussel, Brussels, Belgium; Princess Margaret Hospital, University of Toronto, Toronto; Ottawa Regional Cancer Centre, Ottawa, Ontario, Canada; Grant/Riverside Methodist Hospitals, Columbus, OH; Ochsner Clinic, New Orleans, LA; and Schering-Plough Research Institute, Kenilworth, NJ.

Address reprint requests to Martin Schuler, MD, Department of Medicine 111, Johannes Gutenberg University, D-55101 Mainz, Germany.

PURPOSE: To study the additional benefit from adenoviral p53 gene therapy in patients undergoing first-line chemotherapy for advanced non–small-cell lung cancer (NSCLC).

PATIENTS AND METHODS: Twenty-five patients with nonresectable NSCLC were enrolled in an open-label, multicenter phase II study of three cycles of regimen A, carboplatin (area under the curve, 6; day 1) plus paclitaxel (175 mg/m², day 1), or regimen B, cisplatin (100 mg/m², day 1) plus vinorelbine (25 mg/m², days 1, 8, 15, and 22) in combination with intratumoral injection of 7.5 x 10¹² particles of SCH 58500 (rAd/p53, day 1). Responses of individual tumor lesions were assessed after each cycle, and gene transfer was examined in posttreatment tumor biopsies using reverse transcriptase polymerase chain reaction.

RESULTS: There was no difference between the response rate of lesions treated with p53 gene therapy in addition to chemotherapy (52% objective responses) and lesions treated with chemotherapy alone (48% objective responses). Subgroup analysis according to the chemotherapy regimens revealed evidence for increased mean local tumor regressions in response to additional p53 gene therapy in patients receiving regimen B, but not in patients receiving regimen A. There was no survival difference between the two chemotherapy regimens, and the median survival of the cohort was 10.5 months (1-year survival, 44%). Transgene expression was confirmed in tumor samples from 68% of patients, and toxicities attributable to gene therapy were mild to moderate.

CONCLUSION: Intratumoral adenoviral p53 gene therapy appears to provide no additional benefit in patients receiving an effective first-line chemotherapy for advanced NSCLC.

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