Lung Cancer

Many readers may find the article by Ost on photodynamic therapy (PDT) for lung cancer to be their introduction to this novel modality. If, for no other reason than this, the article is valuable. For those who address cancer as a systemic problem, first and foremost, the article may offer little to whet the appetite. On the other hand, the review may tempt the intellectual palates of those of us who focus our efforts on solving the sour problems of local cancers, their control, and the cost of aggressive therapies.

Photodynamic therapy (PDT) involves the use of photosensitizing agents that are selectively retained within tumor cells. The agents remain inactive until exposed to light of the proper wavelength. When activated by light, these

NEW YORK-An improved 2-year survival rate was achieved in stage III non-small-cell lung cancer (NSCLC) patients with a combination of paclitaxel (Taxol) and carboplatin (Paraplatin) given concurrently with radiation therapy, according to a report at the Chemotherapy Foundation Symposium XVII.

Docetaxel (Taxotere) was recently approved by the Food and and Drug Administration (FDA) for the treatment of locally advanced or metastatic non–small-cell lung cancer (NSCLC) after failure of prior platinum-based chemotherapy.

NEW YORK-Esophagitis was less frequent and less severe in patients with locally advanced non-small-cell lung cancer (NSCLC) treated with standard chemotherapy and thoracic radiation when amifostine (Ethyol) was added to the regimen, according to a report at the Chemotherapy Foundation Symposium XVII.

NEW YORK-A new prototype machine is producing images that combine CT and scintillation-camera-based PET scans into a single image. In a presentation at the Chemotherapy Foundation Symposium XVII, Hak Choy, MD, professor of radiation oncology, Vanderbilt University, showed images of lung cancer produced by the new device-the GE Millennium VG-code-named “Hawkeye”.

WASHINGTON—Three cancer specialists offered a more optimistic view for the future of lung cancer patients during a congressional briefing. Despite the disease’s “dismal” 5-year survival statistics, advances in genetics, a new screening technique, and treatment improvements promise earlier diagnosis and prolonged life for some patients, they said.

Seeking effective drugs for advanced non–small-cell lung cancer (NSCLC), researchers are trying ever more creative combinations, and at the 35th annual meeting of the American Society of Clinical Oncology (ASCO), some investigators suggested that platinums may be “on the way out” as pivotal components of regimens for the disease.

BETHESDA, Md-As ONI went to press, the FDA acted on the recommen-dation of its Oncology Drugs Advisory Committtee (ODAC) to approve Taxotere for injection (docetaxel) for the treat-ment of locally advanced or metastatic non-small-cell lung cancer (NSCLC) after failure of cisplatin-based chemotherapy. The panel voted 12 to 1 for approval and unanimously agreed that data presented by the company showed acceptable safety for Taxotere in NSCLC patients when given at a dose of 75 mg/m² over 1 hour every 3 weeks.

NEW YORK-Two important developments are bringing about a reappraisal of major institutional policy recommendations against lung cancer screening: (1) The amassing of compelling evidence that resection of early lung cancer has a major impact on survival and (2) the emergence of new techniques allowing earlier disease detection.

Studies in the first phase of the Early Lung Cancer Action Project (ELCAP), a joint research study with Weill Cornell Medical Center at New York Presbyterian Hospital and New York University Hospital, show that not only can spiral (“helical”) chest computed tomographic (CT) scans detect four times as many lung cancer tumors as conventional chest x-rays, but also the scans find these tumors when they are significantly smaller. Results of these studies (published in the July 10th issue of the Lancet) show that lung cancer patients have a significantly improved chance for long-term survival if the CT scan (which travels completely around the patient’s torso), is used to detect early-stage tumors.

NEW YORK-Less money is being spent on research for lung cancer than for other common cancers because “people believe that most lung cancer patients are to blame for their disease,” said Betty Layne, director of national planning and policy for the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE). The group held a teleconference to draw attention to this issue, to inform the public about the disease, and to say that lung cancer patients, like all cancer patients, deserve the best in prevention, early detection, treatment, and support.

BUFFALO, NY-Although adjuvant therapies have made important inroads into improving overall survival for many cancer patients, lung cancer patients have not been so fortunate, Robert J. Ginsberg, MD, said at the Roswell Park Surgical Oncology Symposium.

WASHINGTON-Continuous, hyperfractionated, accelerated radiotherapy, or CHART, has won over official British medicine for the treatment of non-small-cell lung cancer (NSCLC).

Smoking-once a socially accepted behavior-is the leading preventable cause of death and disability in the United States. During the first decades of the 20th century, lung cancer was rare; however, as cigarette smoking became increasingly popular, first among men and later among women, the incidence of lung cancer became epidemic (Figure 1).

NEW YORK-Fewer blacks than whites receive potentially curative surgery for early stage lung cancer, and this disparity is substantially responsible for lower survival rates for black patients, according to researchers at Memorial Sloan-Kettering Cancer Center and the National Cancer Institute.

I enjoyed the review of malignant mesothelioma by Drs. Sean Grondin and David J. Sugarbaker that appeared in the July 1999 issue of oncology. On page 920, the authors mention that mesothelioma will recur locally at sites of pleuroscopy or thoracoscopy. From a radiation therapy standpoint, it is worth bringing to the readers’ attention that a small, prospective trial published by Boutin et al in Chest (108[3]:754-758, 1995) showed that radiotherapy to these sites prevents entry tract metastases. A radiation dose of 21 Gy in three fractions given 10 to 15 days after thoracoscopy decreased the incidence of entry tract metastases from 40% to 0%. This regimen should be considered for patients who will not receive a more definitive surgical procedure and adjuvant radiotherapy.

Inoperable non–small-cell lung cancer has become the domain of combined-modality treatment based on several recent, large, phase III studies. Results of Radiation Therapy Oncology Group (RTOG) phase II studies have

Gene therapy has the potential to provide cancer treatments based on novel mechanisms of action with potentially low toxicities. This therapy may provide more effective control of locoregional recurrence in diseases like non–small-cell lung cancer (NSCLC) as well as systemic control of micrometastases. Despite current limitations, retroviral and adenoviral vectors can, in certain circumstances, provide an effective means of delivering therapeutic genes to tumor cells. Although multiple genes are involved in carcinogenesis, mutations of the p53 gene are the most frequent abnormality identified in human tumors. Preclinical studies both in vitro and in vivo have shown that restoring p53 function can induce apoptosis in cancer cells. High levels of p53 expression and DNA-damaging agents like cisplatin (Platinol) and ionizing radiation work synergistically to induce apoptosis in cancer cells. Phase I clinical trials now show that p53 gene replacement therapy using both retroviral and adenoviral vectors is feasible and safe. In addition, p53 gene replacement therapy induces tumor regression in patients with advanced NSCLC and in those with recurrent head and neck cancer. This article describes various gene therapy strategies under investigation, reviews preclinical data that provide a rationale for the gene replacement approach, and discusses the clinical trial data available to date. [ ONCOLOGY 13(Suppl 5):148-154, 1999]

Despite recent advances in the treatment of lung cancer, long-term survival remains rare. As more information pertaining to the biology of lung cancer is understood, it is hoped that improvements in outcome can be realized

Prospects for the multimodality treatment of non–small-cell lung cancer have improved substantially with the demonstration of fairly dramatic results, in terms of 5-year survival, in several phase III trials that employed

After nearly 4 decades of use in treating small-cell lung cancer (SCLC), thoracic radiation has become integral to the management of limited-stage disease. Many prospective randomized trials have demonstrated that adding

Lung cancer is the leading cause of cancer death in the United States. Surgery is the treatment of choice for early stage patients. Despite radical surgery, patients with early stage lung cancer remain at risk for recurrence. The

Chemoprevention is defined as the use of specific natural or pharmacologic agents to reverse, suppress, or prevent the carcinogenic process to the development of invasive cancer. The basic idea behind lung cancer

NEW ORLEANS-The high negative predictive value of positron emission tomography (PET) imaging can spare some patients with early non-small-cell lung cancer (NSCLC) the need for mediastinoscopy prior to thoracotomy,

Patients with advanced non–small-cell lung cancer benefit mainly from chemotherapy using cisplatin (Platinol)-based combinations. Platinum compounds, however, due to their toxicity profile, have limited use in combination

The development of effective and well-tolerated combinations of chemotherapy and radiotherapy is of great importance to improve disease-free survival in patients treated for non–small-cell lung cancer. Studies

Many physicians have questioned whether the additional survival benefit gained from the use of combination chemotherapy in non–small-cell lung cancer has been offset by chemotherapy-induced toxicity, particularly with

Combined-modality approaches integrating carboplatin (Paraplatin) and low doses of weekly paclitaxel (Taxol) with thoracic radiation therapy for prolonging survival in patients with locally advanced non–small-cell lung cancer

New treatment strategies for small-cell lung cancer patients are required, as there have been few developments in the past 20 years. Paclitaxel (Taxol) has been shown to be effective in non–small-cell lung cancer when given in