Lung Cancer

Effective radiotherapy for patients with cancer should include maximal tumor cell killing with minimal injury to normal tissue. Radiation doses that can be delivered, without causing severe damage to surrounding normal

SAN FRANCISCO-GVAX, an autologous cancer vaccine, demonstrated antitumor activity in non-small-cell lung cancer (NSCLC) patients in a phase I/II multicenter clinical trial. Interim data were presented at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO abstract 1019).

NASHVILLE, Tennessee-Irinotecan (Camptosar)/cisplatin (Platinol) combination therapy was significantly more effective and less toxic than standard etoposide (VePesid)/cisplatin in phase II trials, according to Alan B. Sandler, MD. The combination is now being tested in larger clinical studies. These confirmatory studies will use a 21-day cycle of irinotecan/cisplatin rather than the 28-day cycle used in preliminary studies.

NASHVILLE,Tennessee-"The significant discovery of the 1980s was that chemoradiotherapy is better than radiation alone for treating locally advanced non-small-cell lung cancer," stated Hak Choy, MD. "In the 1990s we learned that concurrent chemoradiotherapy is better than a sequential schedule. Our task now is to discover which drug regimen is best." Dr. Choy is professor and vice-chair of the Vanderbilt University Medical Center in Nashville, Tennessee.

NEW HAVEN, Connecticut-‘‘We’ve hit the wall in management of small- cell lung cancer (SCLC). We need a paradigm shift," John R. Murren, MD, stated. He is associate professor of medicine at Yale University School of Medicine in New Haven, Connecticut.

CHICAGO-Preliminary results of a phase I trial of induction chemotherapy followed by chemoradiotherapy with irinotecan (Camptosar), paclitaxel (Taxol), and carboplatin (Paraplatin) showed that this approach is feasible and active in stage III non-small-cell lung cancer (NSCLC), reported Ann M. Mauer, MD. The dose-limiting toxicity when combining these three drugs with concurrent chest radiotherapy was neutropenia, and weekly delivery of the regimen was not feasible at the originally planned doses. Dr. Mauer is assistant professor of medicine at the University of Chicago Pritzker School of Medicine in Chicago, Illinois.

A subcommittee of the NCI’s Board of Scientific Advisors is considering whether to recommend that the NCI undertake a

HOUSTON-‘‘We appear to be approaching a ceiling for benefits of cytotoxic chemotherapy in advanced non-small-cell lung cancer (NSCLC). All recent randomized studies have had similar results, and there has been no clear efficacy benefit from nonplatinum combinations or triplets. Certainly for advanced disease and even for early disease, where metastases kill most patients, a paradigm shift is needed, and that shift will probably be to targeted therapy that works against specific biologic pathways," said Roy S. Herbst, MD, PhD. Dr. Herbst is assistant professor of medicine and chief of the Section of Thoracic Oncology at the University of Texas M.D. Anderson Cancer Center in Houston, Texas.

BMS-247550 is a methyl, semi-synthetic analog of the natural product epothilone B. Provided to the National Cancer Institute (NCI) by Bristol-Myers Squibb, BMS-247550 was chosen for clinical development because it demonstrated

TAMPA, Florida-Irinotecan (Camptosar)/gemcitabine (Gemzar) combinations are being studied in two lung cancer trials. Caio Max S. Rocha Lima, MD, assistant professor of medicine at the University of South Florida’s H. Lee Moffitt Cancer Center in Tampa, Florida, presented overviews of the protocols.

PHILADELPHIA-Concurrent chemoradiotherapy seems likely to become standard therapy for treating locally advanced lung cancer. That would make preventing radiation-induced esophagitis even more important, according to Maria Werner-Wasik, MD.

ST LOUIS-In a small phase II study, amifostine (Ethyol) provided little advantage in esophageal protection for patients with limited-stage small-cell lung cancer (SCLC) treated with chemotherapy and twice-daily radiation. Results of the trial were reported by Todd H. Wasserman, MD. Dr. Wasserman is professor of radiation oncology and clinical chief, Department of Radiation Oncology, Washington University Medical Center, St. Louis.

HOUSTON-Amifostine (Ethyol) can reduce the risk of acute pneumonitis and severe esophagitis associated with concurrent radiation and chemotherapy administered to patients with advanced non-small-cell lung cancer (NSCLC). Results of a phase III study were reported by Ritsuko Komaki, MD, professor of radiation oncology at the University of Texas M.D. Anderson Cancer Center in Houston.

PIREAUS, Greece-In advanced-stage lung cancer, radiation therapy provides effective local-regional control but requires irradiation of large tissue volumes and high total tumor doses. "Bolus tumor doses higher than 60 Gy produce better local tumor control but more toxicity," Dosia Antonadou, MD, explained.

According to phase III trial data presented at the recent meeting of the American Society of Clinical Oncology (ASCO)

Given the well-established role of angiogenesis (or new blood vessel formation) in tumor growth and metastasis, antiangiogenic therapy, a concept first proposed by Dr. Judah Folkman,[1] has become increasingly recognized as a promising

CHICAGO-Multiple independent laboratories have verified the presence of simian virus 40 (SV40) DNA and proteins in human mesotheliomas, brain tumors, and bone tumors, using a variety of methods of detection. This was the consensus reached by a panel of scientists at an international conference hosted by the University of Chicago.

BETHESDA, Md-Enrollment has begun in a trial of Neovastat (Aeterna Laboratories), also known as AE-941, to test the Canadian-produced shark cartilage extract in patients with unresectable stages IIIA and IIIB non-small-cell lung cancer (NSCLC) who are undergoing induction chemotherapy and radiation therapy.

SAN FRANCISCO-The Mayo Lung Project has been widely interpreted to be negative because it failed to demonstrate a significant reduction in lung cancer mortality among persons randomized to screening chest x-rays. But a rigorous new analysis, with mortality adjusted for cancer incidence, suggests otherwise: that mortality from non-small-cell lung cancer (NSCLC) is reduced by chest x-ray screening and that public policy recommendations against screening deserve to be reconsidered.

HAYWARD, California-A California jury has awarded $1.5 million to the family of a lung cancer patient for undertreatment of his pain in the last days of his life. The suit was filed against the patient’s physician under the state’s Elder Abuse Act, since the state’s malpractice laws do not allow recompense for pain and suffering after the patient has died. The jury found that the physician’s failure to treat the pain adequately amounted to "reckless" behavior.

SAN FRANCISCO-Weekly doses of recombinant human erythropoietin (epoetin alfa [Procrit, Eprex, Erypo]) improved quality of life as well as hemoglobin levels for 154 lung cancer patients in a 16-week, nonrandomized pilot study. Self-assessments from patients at baseline, 8, and 16 weeks showed that their energy rose by 30% above baseline, activity by 30.6%, and overall quality of life by 22%.

SAN FRANCISCO-Used with concurrent radiation therapy after induction chemotherapy, an investigational agent that decreases hemoglobin’s oxygen-binding affinity produced good response rates and favorable projected survival rates in patients with unresectable non-small-cell lung cancer (NSCLC).

SAN FRANCISCO-Amifostine (Ethyol) reduced acute pneumonitis and severe esophagitis while significantly increasing the complete response rate in patients receiving chemoradiation for inoperable stage II or III non-small-cell lung cancer (NSCLC) during a randomized phase III study. Hypotension was significantly more frequent among those receiving amifostine, although only one patient discontinued therapy because of a hypotensive episode.

Irinotecan (CPT-11, Camptosar), either alone or in combination with cisplatin (Platinol), has demonstrated activity in advanced non-small-cell lung cancer (NSCLC). In single-agent studies, response rates as high as 35%

Combination chemotherapy is the cornerstone of treatment that confers a meaningful survival benefit for patients with small-cell lung cancer. However, because there have been no major therapeutic advances for small-cell lung