The multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.
Among the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.
Dr. Alan Sandler’s sweeping review of the role of irinotecan (CPT-11, Camptosar) in the treatment of small-cell lung cancer (SCLC) leaves few stones unturned. Some perspective, however, is necessary. To date, with the exception of the Japan Clinical Oncology Group trial, which demonstrated the superiority of irinotecan in combination with cisplatin compared to standard therapy with etoposide and cisplatin, no other new platinum agent combination has proven superior to standard therapy in the treatment of extensive SCLC.[1] The Noda study, published recently in the New England Journal of Medicine, has sparked considerable interest and anticipation in the medical oncology community.
Dr. Sandler has written a thorough and cogent review of the literature on irinotecan (CPT-11, Camptosar) in the treatment of small-cell lung cancer. The most promising data are those from a randomized trial by Noda et al, which showed that irinotecan, compared to etoposide, in combination with cisplatin resulted in an approximately 3-month survival benefit in patients with extensive disease, good performance status, and an age < 70 years. The results of this trial were published recently in The New England Journal of Medicine and, therefore, will attract wide readership and, presumably, much enthusiasm and excitement.[1]
The DNA topoisomerase inhibitor irinotecan (CPT-11, Camptosar) is being evaluated as a novel chemotherapeutic agent that may complement other agents and treatment modalities for small-cell lung cancer (SCLC). Combination chemotherapy is the most effective means of improving the survival of patients with extensive disease, but until recently, no combination demonstrated superior efficacy.
SAN FRANCISCO-Patients with inoperable non-small-cell lung cancer (NSCLC) who receive 20 Gy of radiation therapy in five fractions achieved slightly superior palliation of thoracic symptoms than those receiving a single 10-Gy dose, according to a study presented at the 43rd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 30). An unexpected finding was that patients receiving the five-fraction therapy survived significantly longer, the study authors said.
ROCKVILLE, Maryland-Members of the Oncologic Drugs Advisory Committee (ODAC) have unanimously recommended that the Food and Drug Administration approve Zometa (zoledronic acid for injection, Novartis) for the treatment of bone metastases in patients with multiple myeloma and breast cancer, prostate cancer, lung cancer, and other solid tumors.
Anew treatment for small-cell lung cancer holds promise of dramatically improving survival for patients with the disease, said Dr. Alan Sandler, director of Vanderbilt-Ingram Cancer Center’s Thoracic Oncology Program, and leader of a large US study to further evaluate the treatment’s ability to prolong survival in patients with small-cell lung cancer.
CHICAGO-Screening for lung cancer with low-dose helical CT scans is becoming increasingly popular. Computer programs to assist in the detection of lung cancers appear to increase the accuracy of CT screening, said Samuel G. Armato III, PhD, assistant professor of radiology, University of Chicago.
CHICAGO-Paclitaxel (Taxol) and gemcitabine (Gemzar) administered on a frequent basis elicited significant first-line activity against advanced non-small-cell lung cancer (NSCLC), producing an overall response rate of 31% in 27 evaluable patients.
NEW YORK-An evolving international protocol for early lung cancer screening is moving beyond initial scrutiny and pilot application, bringing prospects for widespread and cost-effective screening one step closer to clinical practice.
NEW YORK-Lung cancer screening investigators are sharpening their focus on the small, only partly solid nodules they observe on initial and follow-up spiral CT. Recent data show that these nodules are more often malignant than completely
SAN FRANCISCO-Chinese-Americans take in significantly less nicotine per cigarette than whites and Latinos, allowing Chinese-American smokers to smoke fewer cigarettes than their ethnic counterparts to achieve the same nicotine-related
NEW YORK-A study of an aggressive front-line regimen for limited-stage small-cell lung cancer (SCLC) is proceeding in a community-based setting. The regimen consists of topotecan (Hycamtin), carboplatin (Paraplatin), and paclitaxel (Taxol) along
EAST MELBOURNE, Australia-Two studies from the Peter MacCallum Cancer Institute, East Melbourne, Australia, have shown the utility of 18F-FDG-PET for newly diagnosed and suspected recurrent non-small-cell lung cancer (NSCLC). These
LISBON, Portugal-In patients with advanced or metastatic non-small-cell lung cancer (NSCLC), first-line docetaxel (Taxotere) plus cisplatin (Platinol) has been shown to offer a survival advantage relative to a standard regimen of vinorelbine
WASHINGTON-Smoking "light" or "ultralight" cigarettes, which are promoted as less hazardous to health than regular brands, does not reduce a person’s risk of developing lung cancer or other tobacco-related diseases, according to a new
NEW YORK-Two large phase III trials using tirapazamine (investigational, also known as tirazone) in triplet regimens for non-small-cell lung cancer (NSCLC) are rapidly accruing patients, according to a report presented at the Chemotherapy
LISBON, Portugal-New phase III trials testing novel combinations of platinums and taxanes in patients with small-cell lung cancer (SCLC) are yielding encouraging results, according to two studies presented at the 11th European Cancer Conference (ECCO).
SAN FRANCISCO-Patients with inoperable, locally advanced lung cancer can tolerate up to 80 Gy of conformally delivered radiation therapy, given in 1.6 cGy fractions twice daily, following carboplatin (Paraplatin)/paclitaxel (Taxol) or carboplatin/vinorelbine (Navelbine), according to a phase I study presented at the 43rd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 35).
The search for effective postoperative adjuvant therapy for patients with resected non-small-cell lung cancer (NSCLC) has been spurred by a high rate of failure after definitive surgery. Except for patients with resected T1, N0, M0 lesions, failure rates exceed 30%. Widespread application of adjuvant therapy has been reined in by a disappointing lack of effectiveness in this setting.
Dr. Movsas has written a thorough, accurate description of the state of the art on postoperative, adjuvant therapy for resected "high risk" non-small-cell lung carcinoma (NSCLC). Management of this common situation indeed remains an "art," since the results of "scientific" randomized trials have been singularly disappointing.
The role of adjuvant therapy following complete resection of node-positive (stage II/IIIA) non-small-cell lung cancer remains controversial. Five-year survival rates in pathologic stage II disease range from 30% to 50% and in resected stage IIIA disease from 10% to 30%. The majority of recurrences following surgery are distant metastases.
Advances in the treatment of lung cancer have been precious and few over the past 40 years, as reflected in the minimal rise in overall survival from this disease since 1960. Significant progress has occurred in staging accuracy, surgical morbidity, radiation delivery, and new chemotherapeutics. And yet, patients with stage II disease have a 5-year survival rate of 50% or less, while patients with stage III disease fare poorly overall.
NEW YORK-In a recent Cancer Care, Inc. survey, 44% of lung cancer patients said they feel they are treated differently than people with other cancers. Even more medical professionals surveyed (77%) said they believe people with lung care are often stigmatized.
