Lung Cancer

The majority of individuals diagnosed with lung cancer in theUnited States are 70 years of age and older. Defining appropriatetherapy for older patients with non–small-cell lung cancer (NSCLC) isbecoming a major focus of clinical research. In this article, we reviewthe available data on clinical predictors of risk and benefit for elderlyNSCLC patients receiving treatment via a variety of modalities, includingsurgery, radiotherapy, combined radiotherapy and chemotherapy,and chemotherapy alone. The data demonstrate that subgroups ofelderly patients benefit from appropriately selected treatment. Participationof older patients in clinical trials designed to assess efficacy,toxicity, and quality-of-life outcomes for recently developed treatmentmodalities in this population is critical.

NEW YORK-Computed tomography (CT) screening for lung cancer has revealed subtypes of nodules whose natural histories are being assessed in long-term follow-up, according to Claudia I. Henschke, PhD, MD, director, Division of Chest Imaging, and professor of radiology, Weill Medical College, Cornell University.

ORLANDO - About half of the new cases of lung cancer diagnosed each year occur in patients who have already quit smoking. Treatment with oral doses of 9-cis-retinoic acid (9cRA), a form of vitamin A, might help protect ex-smokers from previous damage done to their lungs, said Jonathan M. Kurie, MD, Thoracic and Head and Neck Medical Oncology, M.D. Anderson Cancer Center.

BETHESDA, Maryland-Researchers have begun accruing 50,000 patients for the National Lung Screening Trial (NLST), the much-awaited comparison of the efficacy of spiral CT scans and chest x-rays in reducing lung cancer mortality. Investigators in the 8-year, National Cancer Institute-supported study expect to complete enrollment within 2 years. Enrollment will be aided by a $5 million educational campaign funded and organized by the American Cancer Society (ACS), and aimed at encouraging current and former cigarette smokers to participate in the trial.

SILVER SPRING, Maryland-The Oncologic Drugs Advisory Committee (ODAC) has essentially recommended that the US FDA grant accelerated approval to Iressa (gefitinib, AstraZeneca) for the oral treatment of locally advanced or metastatic non-small-cell lung cancer (NSCLC) in patients who have previously received platinum-based chemotherapy regimens.

WASHINGTON-An assessment by the US Environmental Protection Agency’s National Center for Environmental Assessment concludes that long-term inhalation of diesel engine exhaust "is likely to pose a lung cancer hazard to humans, as well as damage the lung in other ways, depending on exposure."

ORLANDO-Weekly docetaxel (Taxotere) combined with gemcitabine (Gemzar) is a useful doublet in circumstances in which a platinum-containing doublet is not desirable in the treatment of advanced non-small-cell lung cancer (NSCLC), according to the ACORN 9901 multicenter trial. Ravindrath Patel, MD, of the Comprehensive Blood and Cancer Institute, Bakersfield, California, presented the data at a poster session of the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 1276).

n ROCKVILLE, Maryland-The FDA’s Oncologic Drugs Advisory Committee (ODAC) voted 11 to 3 that phase II results of AstraZeneca Pharmaceuticals’ EGFR tyrosine kinase inhibitor Iressa (ZD1839, gefitinib) as third-line therapy for advanced non-small-cell lung cancer (NSCLC) were "reasonably likely to predict clinical benefit." The FDA considers this a recommendation for accelerated approval. Look for a complete report of the ODAC decision and a review of the phase II trials of Iressa in NSCLC in next month’s issue of ONI.

HORSHAM, Pennsylvania-Cell Pathways, Inc. has announced that the National Cancer Institute is sponsoring two phase II studies of the company’s investigational drug Aptosyn (exisulind) in combination therapies for lung cancer. The Cancer and Leukemia Group B (CALGB) is studying Aptosyn in combination with eto-poside (VePesid) and carboplatin (Paraplatin) in patients with extensive-stage small-cell lung cancer. The Eastern Cooperative Oncology Group (ECOG) is investigating Aptosyn in combination with gemcitabine (Gem-zar) and carboplatin in patients with advanced non-small-cell lung cancer.

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 (CPT-11, Camptosar).

For more than 2 decades, combination chemotherapy has been the standard treatment for patients with small-cell lung cancer. Despite high initial response rates in both extensive- and limited-stage disease, long-term survival

Lung cancer is the leading cause of cancer-related death in the United States. There was rapid progress in the treatment of lung cancer during past decades, but local control and survival rates are still poor.

Although treatment of advanced non-small-cell lung cancer has been improved with the availability of such new agents as the taxanes, topoisomerase inhibitors, vinorelbine (Navelbine), and gemcitabine (Gemzar), platinum-

Lung cancer is the leading cause of cancer-related death in males and females in the United States. Most patients have advanced disease at diagnosis. Chemotherapy is the treatment of choice for patients with good performance

The DNA topoisomerase inhibitor irinotecan (CPT-11, Camptosar) is being evaluated as a novel chemotherapeutic agent for small-cell lung cancer that may complement other agents and treatment modalities. Combination

ORLANDO-Inhaled doxorubicin has clinical activity and can be delivered without major toxicity to adults with advanced solid tumors affecting the lungs, according to a multicenter phase I study reported at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 1204).

The comprehensive review by Dr. Karen Kelly meticulously outlines the rationale for the study of irinotecan in non-small-cell lung cancer (NSCLC), summarizes results of trials of this agent as monotherapy and as a component of doublet and triplet regimens in previously untreated NSCLC patients, and then reviews its role in previously treated NSCLC patients.

Dr. Kelly has provided a complete, well-written review of the current status and evolving role of irinotecan (CPT-11, Camptosar) as a cytotoxic agent for patients with non-small-cell lung cancer (NSCLC). Her review clearly demonstrates the value of irinotecan in this patient population and further supports the continued development of this agent in concert with other chemotherapeutic agents, biologically targeted agents, surgery, and/or radiotherapy.

Lung cancer remains the primary cause of cancer-related death in both men and women in the United States. Chemotherapy has been shown to provide a survival benefit in patients with advanced non-small-cell lung cancer (NSCLC), and current regimens have produced median survivals of approximately 8 months and 1-year survival rates of 30% to 35% in patients with stage IIIB and IV disease. Nevertheless, there remains room for improvement. Irinotecan (CPT-11, Camptosar) has demonstrated efficacy in the treatment of small-cell lung cancer (SCLC). It also appears to have promising activity in advanced NSCLC, producing overall response rates of up to 32%. Combinations of irinotecan and cisplatin or carboplatin (Paraplatin) have resulted in overall response rates of 25% to 56% in phase II and III studies in patients with advanced disease, with median survivals ranging from 9 to 13 months and 1-year survival rates of 33% to 58%. Current irinotecan-based doublet and triplet regimens appear to produce promising response rates with manageable toxicities. In addition, irinotecan has demonstrated potential as a radiosensitizing agent and is currently being evaluated in several trials of combined-modality therapy in patients with locally advanced NSCLC. Early trials of irinotecan in combination with cisplatin or carboplatin along with radiation therapy have reported overall response rates of 60% to 67%. The approach appears to have potential and warrants further study. [ONCOLOGY 16:1153-1168, 2002]

BETHESDA, Maryland-A lung cancer screening trial supported by the National Cancer Institute (NCI) that will compare spiral CT and standard chest x-ray is back on track after being delayed for several months. Andrew von Eschenbach, MD,

LOS ANGELES-An investigational radiolabeled monoclonal antibody (MoAb) that targets the necrotic core of solid tumors (Cotara, Peregrine Pharmaceuticals Inc., Tustin, California) produced good response rates when injected intratumorally into lung cancers. Alan L. Epstein, MD, PhD, of the University of Southern California Keck School of Medicine, reported the results at the 49th Annual Meeting of the Society of Nuclear Medicine (abstract 1265).

LINKOPING, Sweden-Swedish researchers found that gemcitabine (Gemzar) plus carboplatin (Paraplatin) improved response rates and survival in patients with advanced non-small-cell lung cancer during a phase III trial, according to a

LONDON, UK-Preliminary results of the Big Lung Trial in a supportive care setting found chemotherapy improved survival of patients with non-small-cell lung cancer (NSCLC) without diminishing their quality of life, according to a report presented by R.J. Stephens, MD, representing the CRC and UCL Cancer Trials Centre, London (ASCO abstract 1161).

PHILADELPHIA-"Do not exclude the fit elderly from combined modality therapy for locally advanced non-small-cell lung cancer (NSCLC)," Corey. J. Langer, MD, of Fox Chase Cancer Center, reported in his poster presentation (ASCO

ORLANDO, Florida-Although a combination of paclitaxel, carboplatin (Paraplatin), and thoracic radiation therapy is commonly used to treat patients with locally advanced non-small-cell lung cancer (NSCLC), the optimal sequencing of these