The 4th Investigators’ Workshop sponsored by The University of Texas M. D. Anderson Cancer Center was held on July 25-29, 2001, in Colorado Springs, Colorado. The purpose of these annual workshops has been to review the latest data on new agents, with a particular focus on the broadly used agent irinotecan(Drug information on irinotecan) (CPT-11, Camptosar).
Investigators from around the world were invited to present current research. The forums were highly interactive and frank, thus allowing stimulation of new ideas and directions. The meetings were more like a workshop rather than didactic sessions. Six separate scientific sessions were held, and the respective sessions covered colorectal carcinoma, upper gastrointestinal/genitourinary carcinoma, lung carcinoma, and new combinations and other tumor types.
In addition to stimulating research, another purpose of these workshops is to develop enduring material for wider distribution to those who did not attend. Thus, four volumes have been published. This fourth and final volume is devoted to lung carcinomas. The three previous volumes focused on colorectal cancers, upper gastrointestinal/genitourinary carcinomas, and new combinations and other tumor types.
Treatment Options in Small-Cell and Non-Small-Cell Lung Cancer
In this volume, Hong-Gyun Wu and Hak Choy review current treatment options for patients with non-small-cell lung cancer and small-cell lung cancer, and note that the combination of chemotherapy and radiation therapy has improved outcomes in patients with non-small-cell lung cancer. Phase I/II studies have demonstrated the single-agent activity of irinotecan against advanced non-small-cell lung cancer, similar to that reported for other new active agents such as vinorelbine (Navelbine), gemcitabine(Drug information on gemcitabine) (Gemzar), paclitaxel(Drug information on paclitaxel), and docetaxel(Drug information on docetaxel) (Taxotere). The synergistic effect of irinotecan and cisplatin(Drug information on cisplatin) was also observed in both in vitro and clinical studies, and phase I/II studies of thoracic radiation therapy and concurrent irinotecan and cisplatin demonstrated encouraging response and survival rates with acceptable toxicities.
Studies in small-cell lung cancer have demonstrated that concurrent chemotherapy and radiation therapy is more efficacious than sequential chemotherapy and radiation therapy, early thoracic radiotherapy is better than late radiotherapy, and twice-daily radiation is more beneficial than once-daily treatment. While the cisplatin/etoposide combination is currently the standard chemotherapy regimen for patients with limited-disease small-cell lung cancer, trials are needed to explore the potential role of irinotecan in these patients.
Agents Targeting Specific Biologic Pathways
Although treatment of advanced non-small-cell lung cancer has improved with the availability of new agents such as the taxanes, topoisomerase inhibitors, vinorelbine, and gemcitabine, platinum-based combination therapy has appeared to have reached a threshold of therapeutic effectiveness. Roy Herbst discusses the development of agents targeting specific biologic pathways in tumor development. These agents include endothelial growth factor receptor (EGFR) inhibitors (eg, monoclonal antibody trastuzumab(Drug information on trastuzumab) [Herceptin]) and EGFR tyrosine kinase inhibitors (eg, ZD1839 [Iressa] and OSI-774 [Tarceva]), angiogenesis inhibitors (eg, matrix metalloproteinase inhibitors, vascular endothelial growth factor (VEGF) inhibitors (eg, monoclonal antibody to VEGF), and signal transduction inhibitors (eg, ISIS-3521, an antisense oligonucleotide to protein kinase C-a).
A number of these agents have entered advanced-phase clinical investigation, and Dr. Herbst notes that targeted therapy will have applications in combination with cytotoxic chemotherapy or radiation therapy at all stages of treatment.