Lung Cancer

Prophylactic cranial irradiation (PCI) is being reintroduced into multimodality treatment protocols of patients with small-cell lung cancer (SCLC). The history of its use brings interesting insights into clinical evaluations of treatment strategies and design of relevant and informative trials. The critical issues of effectiveness and overall health gains of prophylactic cranial irradiation have been addressed in a series of recently completed clinical trials. These trials tested prophylactic cranial irradiation in small-cell lung cancer patients achieving good response to induction therapy and confirmed the ability of standard prophylactic cranial irradiation schedules to significantly reduce the lifetime risk of brain metastases. A subset of these trials evaluated neurotoxicity in a formal and prospective manner. No sustained or significant detriment in neuropsychometric function could be linked to the use of prophylactic cranial irradiation. In addition, all the large trials have shown a consistent survival advantage in favor of the prophylactic cranial irradiation arm. None of the individual sample sizes were large enough to statistically confirm this survival benefit, but a meta-analysis is in progress and will report on this aspect of evidence shortly. Issues that remain to be answered are the optimal dose and schedule of prophylactic cranial irradiation as well as the timing of this administration. These questions form the nucleus of the next generation of collaborative trials that are being designed.[ONCOLOGY 12(Suppl 2):19-24, 1998]

The 1997 revision of the lung cancer staging system has added very little to disease staging, and many changes have been totally unnecessary. Before the next revision of the staging system, anticipated in the year 2007, a

Despite advances in the treatment of small-cell lung cancer during the 1970s, with the use of combination chemotherapy, and in the 1980s, with the combination of etoposide and cisplatin plus concurrent radiation

Although the need to combine thoracic radiotherapy with systemic chemotherapy in the curative treatment of limited small-cell lung cancer is now widely acknowledged, there is substantial disagreement on how best to do this. This paper reviews radiotherapeutic factors but also highlights the important interactions that occur with some classes of chemotherapeutics. Studies examining variables like dose and volume are clearly in order. Concurrent therapy given early has been adopted throughout most of the world, except Europe. The reasons for this are explored. Multiple studies are now showing excellent results with fewer total cycles of chemotherapy. Integrationof newer drugs is another challenge for clinical investigators at the close of this century. [ONCOLOGY 12(Suppl 2):15-18, 1998]

We report here the preliminary results of a large phase II multicenter study done in the community setting, using paclitaxel (Taxol) (given by 1-hour infusion) plus carboplatin (Paraplatin) to treat patients with advanced non-small-cell lung cancer (NSCLC). In this study, 155 chemotherapy-naive patients with stage IIIB, stage IV, or recurrent metastatic non-small-cell lung cancer received the two drugs in 21-day cycles. Paclitaxel 225 mg/m² was given by 1-hour intravenous infusion followed immediately by carboplatin at a targeted area under the concentration-time curve of 6.0 (calculated according to the Calvert formula). Colony-stimulating factors were not used routinely. Objective responses occurred in 53 of 155 patients (34%) (53 of 144 [36%] evaluable patients) including three complete responses and 50 partial responses. Fifty-two other patients had stable disease at initial reevaluation. The median survival among all 155 patients was 8 months; the 1-year survival rate was 42%, and the 2-year survival rate was 20%. Leukopenia and cumulative peripheral neuropathy occurred consistently but rarely were severe or affected the course of therapy. One patient died due to sepsis. Other grade 3 and grade 4 toxicities were uncommon. This paclitaxel-carboplatin combination chemotherapy appears to be a relatively convenient, safe, and active regimen in advanced non-small-cell lung cancer.[ONCOLOGY 12(Suppl 2):71-73, 1998]

Topotecan hydrochloride (Hycamtin), as a single agent or in combination with other agents, may offer a new treatment option for people suffering from small-cell lung cancer, according to results from five clinical trials reviewed at the 15th

BETHESDA, Md-A leading medical oncologist laments the refusal of many physicians to even discuss the option of adjuvant chemotherapy with patients who have operable lung cancer. Paul Bunn, Jr., MD, director of the University of Colorado Cancer Center, noted that the first drugs used in lung cancer patients, alkylating agents, actually reduced survival time.

BETHESDA, Md-Rehabilitation techniques, honed over years of experience with patients suffering from chronic obstructive pulmonary disease (COPD), offer the potential to improve the quality of life for lung cancer patients and lower the cost of their care, Andrew L. Ries, MD, said at a workshop sponsored by the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE) and the International Cancer Alliance. These techniques should be tested further in clinical trials with lung cancer patients, he added.

A study of lung cancer patients led by Duke University investigators and funded by the V Foundation showed chromosome loss in nearly half of those classified as “heavy smokers.”

PHILADELPHIA-The growing use of pulmonary cytology, and consequent increasing experience of cytopath-ologists, has raised the diagnostic accuracy of the five basic pulmonary cytology techniques, Nadia Al-Kaisi, MD, told Oncology News International in an interview after her workshop on the subject at the annual fall meeting of the American Society of Clinical Pathologists (ASCP) and College of American Pathologists (CAP).

Topotecan (Hycamtin) is a promising new topoisomerase I-targeting anticancer agent that first entered clinical trials in 1989 under National Cancer Institute sponsorship in collaboration with SmithKline Beecham. In 1996, it

Anthracycline antibiotic use is limited by cardiac toxicity. The risk factors are cumulative dose, radiation to the chest and mediastinum, age, and preexisting myocardial impairment. Dexrazoxane (Zinecard) can prevent

During the past 5 years, real strides have been made in the management of advanced non-small-cell lung cancer (NSCLC). The introduction of newer chemotherapeutic agents and novel treatment regimens is paving the way for marked improvements in both clinical outcomes and quality of life.

Paclitaxel (Taxol) and vinorelbine (Navelbine) are both microtubule toxins but with opposite mechanisms of action. Paclitaxel promotes the assembly of microtubules, whereas vinorelbine prevents microtuble assembly.

Data from North American clinical trials have shown that vinorelbine (Navelbine) is well tolerated when used as a single agent for the treatment of non-small-cell lung cancer, advanced breast cancer, or ovarian cancer. Myelosuppression is the primary dose-limiting toxicity.

Cisplatin (Platinol) has played a major role in the treatment of non-small-cell lung cancer (NSCLC). As a single agent, cisplatin has produced a response rate of approximately 21% in a large number of trials.

Chemotherapy has been shown to prolong survival in patients with stage IV non-small-cell lung cancer (NSCLC). However, traditional cisplatin (Platinol)-containing regimens are associated with significant toxicity.

The past 5 years have witnessed an evolution in the management of unresectable non-small-cell lung cancer (NSCLC) in the United States. Combined-modality treatment with chemotherapy plus irradiation has become the standard of care for stage III (locally advanced) disease. Most patients with stage IIIB disease and cytology-positive pleural effusion are now considered candidates for chemotherapy, as are those with stage IV disease.

Newer chemotherapy drugs have shown encouraging activity in advanced non-small-cell lung cancer. Based on these improved outcomes, as well as the high rate of distant relapse in patients with locally advanced disease, several recent studies have evaluated the use of systemic therapy in patients with earlier-stage disease.

Randomized trials in patients with advanced non-small-cell lung cancer (NSCLC) have demonstrated that the combination of vinorelbine (Navelbine) and cisplatin

Two large-scale, randomized, phase III trials have offered new information on the response rates, survival benefits, and safety profile of vinorelbine (Navelbine) in non-small-cell lung cancer (NSCLC). In a multicenter, European trial, the response rate was significantly higher with vinorelbine/cisplatin (Platinol) than with vindesine (Eldisine)/cisplatin (P < .02) or vinorelbine alone (P < .001).

DUBLIN-A new diagnostic strategy using fluorescence bronchoscopy has proven six times more sensitive than white-light bronchoscopy alone in picking up preinvasive lung lesions, Stephen Lam, MD, of the University of British Columbia, reported at the 8th World Conference on Lung Cancer.

DUBLIN-Two metaanalyses have pointed to small but clear-cut survival gains for patients with inoperable locally advanced non-small-cell lung cancer (NSCLC) who receive chemotherapy and radiotherapy. Now, a randomized phase III Japanese study indicates that response rates are higher and survival longer when the two therapeutic modalities are given concurrently rather than sequentially.

DUBLIN-Preliminary results suggest that the use of single-agent topotecan (Hycamtin) as second-line therapy for small-cell lung cancer (SCLC) in patients who failed after an initial response to first-line therapy provides efficacy similar to that of the commonly used regimen of cyclophosphamide, doxorubicin (Adriamycin), and vincristine (CAV).

DUBLIN-Harnessing MIC chemotherapy to radiotherapy is more effective than radiotherapy alone in patients with locally advanced inoperable non-small-cell lung cancer (NSCLC), according to the findings of a multicenter randomized UK trial reported at the 8th World Conference on Lung Cancer.

DUBLIN-The question of whether patients with locally advanced non-small-cell lung cancer (NSCLC) would live longer if they underwent chemotherapy prior to surgical resection would appear to be yes, based on two randomized trials reported in 1994.

DUBLIN-The shift from histologic classification to molecular analysis of bronchial epithelial cells is opening up new prospects for detecting the molecular signature of lung cancer before the disease becomes clinically evident, James L. Mulshine, MD, of the National Cancer Institute, said at the 8th World Conference on Lung Cancer.

BETHESDA, Md-The Food and Drug Administration’s Oncologic Drugs Advisory Committee (ODAC) has recommended approval of QLT Photo-Therapeutics’ Photofrin (porfimer sodium) for use as photodynamic therapy (PDT) of T1 stage endobronchial carcinoma in patients with non-small-cell lung cancer (NSCLC) for whom surgery and radiotherapy are not indicated.

Breast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a

Given that no therapeutic methods of postoperative adjuvant chemotherapy for non-small-cell lung cancer have been established, we selected UFT (tegafur and uracil) for investigation because UFT is less injurious to the host