Lung Cancer

Patients with limited-stage small-cell carcinoma of the lung are treated with combined-modality therapy with the intent to cure. Standard therapy consists of platinum-based combination chemotherapy, thoracic irradiation, and

BETHESDA, Md-The National Cancer Institute has launched a randomized, 3,000-person study to determine the feasibility of doing a larger scale trial to test whether spiral CT screening improves lung cancer survival. Six centers began recruiting volunteers in early September and hope to enroll 500 subjects each by the end of October.

NASHVILLE, Tennessee-Irinotecan (Camptosar) combined with radiation therapy is active in non–small-cell lung cancer (NSCLC) and is most effective when the chemotherapy and radiation therapy are given concurrently, Hak Choy, MD, reported at a clinical investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology. Dr. Choy is Professor and Vice Chairman of the Department of Radiation Oncology at the Vanderbilt Cancer Center in Nashville, Tennessee.

OSAKA, Japan-Irinotecan/cisplatin combination therapy improved survival compared to etoposide/cisplatin in extensive-stage small-cell lung cancer (SCLC), Masahiro Fukuoka, MD, reported at an investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology. Two-year survival in the Japan Clinical Oncology Group (JCOG)-9511 study was 19% with irinotecan/cisplatin vs 9% with etoposide/cisplatin, according to Dr. Fukuoka, who is professor of the 4th Department of Internal Medicine at Kinki University School of Medicine in Osaka, Japan.

WASHINGTON-The use of spiral CT scanning to screen for early lung cancers poses scientific, economic, and policy issues that the oncology community, advocacy groups, insurers, and government health agencies need to address quickly, an expert panel said at a day-long conference on reducing lung cancer mortality. The conference was sponsored by the Cancer Research Foundation of America and the Roy Castle Lung Cancer Foundation, Liverpool, England.

NEW ORLEANS-The addition of paclitaxel (Taxol) to etoposide plus cisplatin (Platinol), with concurrent thoracic radiotherapy, may improve survival in patients with limited-disease small-cell lung cancer (SCLC), according to preliminary results from the RTOG 96-09 Intergroup trial. David S. Ettinger, MD, of Johns Hopkins Oncology Center, presented the study at the 36th Annual Meeting of the American Society of Clinical Oncology (ASCO).

WASHINGTON-When used to diagnose early lung cancer, low-dose spiral CT scanning has a high specificity-as well as high sensitivity-and it is cost-effective, according to as-yet-unpublished data from the New York City-based Early Lung Cancer Action Program (ELCAP). Moreover, the technique can diagnose emphysema at an earlier stage than existing tests, which has helped smokers in the study to stop.

NEW ORLEANS-First-line treatment with carboplatin (Paraplatin) and paclitaxel (Taxol) given every 4 weeks is well tolerated in patients with extensive small-cell lung cancer (SCLC), according to a multicenter phase II trial conducted in Italy and reported at the 36th Annual Meeting of the American Society of Clinical Oncology (ASCO).

PHILADELPHIA-Irinotecan (Camptosar) produces response rates in advanced non-small-cell lung cancer (NSCLC) comparable to those of some well-established combination regimens and is being tested as a radiosensitizer in combination with cis-platin and radiotherapy in locally advanced NSCLC. These and other developments using topoisomerase I inhibitors in NSCLC were reviewed by Corey Langer, MD, at a clinical investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology. Dr. Langer is Medical Director, Thoracic Oncology, at Fox Chase Cancer Center in Philadelphia, PA.

NEW HAVEN, Conn-Topoisomerase I inhibitors in combinations not based on platinum have shown significant activity in non–small-cell lung cancer (NSCLC), John R. Murren, MD, reported. These combinations include such drugs as taxanes, gemcitabine (Gemzar), and vinorelbine (Navelbine). Dr. Murren, Associate Professor of Medicine at Yale University School of Medicine, New Haven, Connecticut, reviewed research on these regimens at a clinical investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology.

Irinotecan (Camptosar) in combination with cisplatin (Platinol) increased survival, compared with the current standard treatment for patients with extensive small-cell lung cancer, according to data from a phase III study presented at the annual meeting of the American Society of Clinical Oncology (ASCO).

Currently there are a number of available agents that are moderately active in non–small-cell lung cancer (NSCLC). These include cisplatin (Platinol), gemcitabine (Gemzar), vinorelbine (Navelbine), paclitaxel (Taxol), docetaxel (Taxotere), and irinotecan (Camptosar). How best to combine them, maximizing survival while minimizing toxicity, is the subject of intense investigation.

In medically suitable patients with stage III (locally advanced) non–small-cell lung cancer, the use of cisplatin (Platinol)-based chemotherapy as induction therapy prior to definitive local therapy has been shown to improve survival (J Natl Cancer Inst 86:673-680, 1994; Ann Intern Med 125:723-729, 1996). This is true regardless of whether the local treatment modality used is surgery or thoracic irradiation. However, because cisplatin therapy is particularly toxic, there is interest in studying other agents in the induction setting. Given its activity in non–small-cell lung cancer, docetaxel (Taxotere) is one logical agent to investigate.

A meta-analysis of randomized controlled trials (Br Med J 311:899-909, 1995) has shown that the use of cisplatin (Platinol)-based combination chemotherapy in patients with good performance status leads to a modest improvement in median survival and an absolute increase in 1-year survival proportion of 10%. There are several different platinum-based regimens approved by the Food and Drug Administration for use in advanced non–small-cell lung cancer. Whether any one regimen is superior is unclear. A recent randomized controlled trial found no difference in median survival and quality of life between carboplatin (Paraplatin)/paclitaxel (Taxol)-the most commonly used regimen in the United States-and cisplatin/vinorelbine (Navelbine)-a regimen more popular in Europe and Canada (Proc Am Soc Clin Oncol 18: 461a [abstract 1777], 1999). The newer agents gemcitabine (Gemzar) and docetaxel (Taxotere) are among the most active single agents in non–small-cell lung cancer, and use of either in combination with cisplatin has shown promise.

One hundred centers from Europe, the Middle East, Asia, and South America participated in a non–small-cell lung cancer (NSCLC) study with broad inclusion criteria (first and second line) to establish the toxicity and efficacy profile of docetaxel (Taxotere) at 100 mg/m² in worldwide clinical practice.

Docetaxel (Taxotere) is an active single agent in the treatment of non–small-cell lung cancer. Weekly administration of docetaxel minimizes myelosuppression and is generally well tolerated. To further evaluate the efficacy and toxicity of this novel schedule, we performed a phase II trial in patients with advanced non–small-cell lung cancer who were either elderly (age > 65 years) or poor candidates for combination chemotherapy due to coexistent illness or poor performance status.

This study was conducted to determine whether docetaxel (Taxotere) prior to definitive local treatment improves overall survival when compared to local treatment without prior chemotherapy in patients with radically treatable stage IIIA N2 (T0–3), T3 (N0-1) or IIIB non–small-cell lung cancer. Local treatment was defined at baseline.

The purpose of this study was to define the antitumor activity of the PGT (cisplatin [Platinol]/gemcitabine [Gemzar]/paclitaxel [Taxol]) combination in chemonaive non–small-cell lung cancer patients.

The objective of this study was to determine the effects of docetaxel (Taxotere) on survival, clinical benefits, quality of life, and safety parameters for chemonaive patients with advanced non–small-cell lung cancer (NSCLC), when compared to best supportive care (BSC) (no chemotherapy or systemic anticancer therapy permitted).

The purpose of this trial was to evaluate the efficacy and safety of weekly gemcitabine (Gemzar) plus monthly docetaxel (Taxotere) (J Clin Oncol 16:3866-3873, 1998) as second-line treatment for non–small-cell lung cancer.

Docetaxel (Taxotere)/cisplatin (Platinol) and docetaxel/gemcitabine (Gemzar) are active and well-tolerated chemotherapy regimens for the treatment of patients with advanced non–small-cell lung cancer (NSCLC). A phase II randomized trial was conducted in order to compare the efficacy and toxicity of these regimens.

Designated E1594, this trial was designed to compare three platinum-based combination regimens containing third-generation drugs active against non–small-cell lung cancer to a reference regimen of cisplatin (Platinol) 75 mg/m² day 1 plus paclitaxel (Taxol) 175/mg/m²/24 h (arm A). The experimental regimens were as follows: gemcitabine (Gemzar) 1,000 mg/m² days 1, 8, 15 plus cisplatin 100 mg/m² day 1 (arm B); docetaxel (Taxotere) 75 mg/m² day 1 plus cisplatin 75 mg/m² day 1 (arm C); and paclitaxel 225 mg/m²/3 h day 1 plus carboplatin (Paraplatin) at an area under the concentration-time curve of 6 (AUC in mg/mL · min) day 1 (arm D). Arms A, C, and D were repeated every 21 days and arm B every 28 days.

We previously reported the efficacy of concurrent cisplatin (Platinol)/etoposide (PE) and radiotherapy in stage IIIB non–small-cell lung cancer in which biopsy confirmation of T4 (noneffusion) or N3 status was required (S9019). In view of the activity of docetaxel (Taxotere) as second-line therapy and potential molecular mechanisms of action favoring taxane sequencing, we designed the present study to maintain a core of concurrent PE/radiotherapy, but to substitute docetaxel consolidation for the two additional cycles of PE.

OSAKA, Japan-Induction with irinotecan (Camptosar) and cisplatin (Platinol) followed by thoracic radiation combined with weekly irinotecan in patients with unresectable non–small-cell lung cancer (NSCLC) seems to be a feasible regimen in a cooperative group setting, according to the preliminary results of a phase II study presented in an ASCO abstract.

MADISON, Wis-The first major trial to compare three of the newest chemotherapy regimens for advanced non–small-cell lung cancer (NSCLC) with the most commonly used combination found that all offered similar survival benefits.