Lung Cancer

LOS ANGELES--The addition of tirapazamine to cisplatin (Platinol) significantly prolongs survival in patients with advanced non-small-cell lung cancer (NSCLC), without causing additional myelosuppression, Joachim von Pawel, MD, of Central

CHICAGO--A role is emerging for multimodality therapy in the treatment of both resectable and unresectable stage III non-small-cell lung cancer (NSCLC). When given as an adjunct to radiotherapy or surgery, chemotherapy can downstage local disease and control systemic disease spread by eliminating micro-metastases or delaying the development of metastases, Ann Mauer, MD, a senior fellow in oncology at the University of Chicago, said at the International Conference of the American Thoracic Society and American Lung Association.

CHICAGO--Monitoring instruments that evaluate the symptoms and psychosocial problems of patients with non-small-cell lung cancer (NSCLC) may not provide clear answers regarding the quality of patients’ lives because they are difficult to analyze and they measure aspects of quality that are not affected by chemotherapy, said Richard Gralla, MD, chief of immunology and oncology and director of the Ochsner Cancer Center, New Orleans.

INDIANAPOLIS--Patients with advanced non-small cell lung cancer (NSCLC) have higher response rates, longer time to progression, and better overall survival with gemcitabine (Gemzar) plus cisplatin (Platinol) than with cis-platin alone, according to data from a multicenter, randomized, phase III study presented at the annual ASCO meeting.

NAPLES, Italy--Platinum-based chemotherapy is often avoided in elderly lung cancer patients due to concerns about tolerability. Since about one-third of patients with non-small cell lung cancer (NSCLC) are over age 70 at diagnosis, this presents a significant problem.

HAMBURG, Germany--Increasing cisplatin dose intensity was less effective than combining standard cisplatin (Platinol) with paclitaxel (Taxol) in a multicenter multinational study of advanced non-small cell lung cancer (NSCLC) reported at ASCO.

LOUISVILLE, Kentucky--Photodynamic therapy (PDT) offers a simple and effective alternative to conventional techniques for palliative debridement of endobronchial obstructions in lung cancer patients, data from two clinical trials suggest.

NASHVILLE--Medical and radiation oncologists have distinctly different views on how best to treat non-small-cell lung cancer (NSCLC), results of a nationwide survey suggest.

LOS ANGELES--Twice-daily chest irradiation concurrent with cycle 1 chemotherapy substantially improves survival and reduces the rate of local failure in limited stage small-cell lung cancer (SCLC), compared with a less intensive once-daily schedule, a large intergroup trial has shown.

HOUSTON--Adenoviral-p53 gene therapy with Introgen Therapeutics’ INGN 201 was well tolerated and showed evidence of clinical activity both alone and with cisplatin (Platinol) in patients with advanced non-small-cell lung cancer (NSCLC) who had failed conventional therapy. Stephen Swisher, MD, of the M. D. Anderson Cancer Center, presented the completed phase I/II trial results at an ASCO poster session.

The FDA’s Oncologic Drugs Advisory Committee (ODAC) recommended that gemcitabine HCl (Gemzar) be approved both as a single agent and in combination with cisplatin (Platinol) for the treatment of locally advanced or metastatic non-small-cell

NASHVILLE--Adding gemcitabine (Gemzar) to the widely used combination of paclitaxel (Taxol) and carboplatin (Paraplatin) may increase the response rate in advanced non-small-cell lung cancer (NSCLC), compared with the two-drug combination, a phase I/II study has shown.

CHICAGO--Molecular biologic markers may be able to identify patients with early-stage non-small-cell lung cancer (NSCLC) who are at the highest risk for metastasis and therefore may benefit from aggressive therapy.

Recent advances in research focused on identifying genetic and other markers that can predict cancer risk were reported at the annual meeting of the American Association for Cancer Research (AACR). Included in the presentations were reports of

WASHINGTON--Minority teenagers are smoking more, and this threatens to undermine the progress against lung cancer among minority populations that was made during the early 1990s.

BUFFALO, NY--In January 1998, the Food and Drug Administration approved photodynamic therapy (PDT) using the sensitizer porfimer sodium (Photofrin) for the treatment of early-stage lung cancer. PDT was originally approved in 1995 for the palliative treatment of obstructive esophageal cancer.

Cark and Ihde have written an excellent review of small-cell lung cancer (SCLC). My commentary will provide some additional information, as well as explore several issues that require clarification.

Although small-cell lung cancer (SCLC) represents only 20% of all lung cancer cases in the United States, it is the most lethal subtype. Combination chemotherapy unequivocally offers the best chance for improved survival in

This comprehensive, well-written review of small-cell lung cancer by Drs. Clark and Ihde covers nearly all of the important clinical issues. However, a few areas warrant additional comment and discussion.

BETHESDA, Md--Bristol-Myers Squibb went 2-for-2 before the FDA’s Oncologic Drugs Advisory Committee (ODAC). The panel recommended that the FDA approve injectable Taxol (pacli-taxel), in combination with cisplatin (Platinol), for both the first-line treatment of ovarian cancer and for the treatment of non-small-cell lung cancer (NSCLC) in patients who are not candidates for potentially curative surgery and/or radiation therapy.

WASHINGTON--Radon contributes to a significant number of lung cancer deaths each year, perhaps as many as 12% of those in the United States, a new National Research Council (NRC) report confirms. The threat is greatest for smokers, and reducing radon levels in all homes below the current recommended guideline could prevent about one-third of the lung cancer deaths associated with radon exposure.

WASHINGTON--Medicare officials have expanded coverage for positron emission tomography (PET) scans to include their use in assessing lung cancer. Effective Jan. 1, the new coverage allows the use of PET in Medicare patients to determine the type of lung cancer (characterization of single lung nodules) or to do initial staging. Previously, Medicare limited PET coverage to perfusion rate studies in the heart.

WASHINGTON--One key element to increasing survivorship among lung cancer patients lies in finding ways to detect the disease early, and recent results in the quest for a preclinical biomarker for the malignancy offer great promise, a National Cancer Institute scientist told a Capital Hill briefing.

Women must make lung cancer as hot and as female a public issue as they have made breast cancer, urged a cancer expert speaking at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer in Washington, DC. Five years from now, twice as many women will die of lung cancer than of breast cancer, warned Paul Bunn, Jr., md, Grohne/Stapp Chair in Cancer Research and director of the University of Colorado Cancer Center.

In 1985, a survey found that only about one-third of physicians and oncology nurses would have consented to chemotherapy for non-small-cell lung cancer. In response to statements made at a recent American Society of Oncology (ASCO) Board of Directors meeting questioning whether these data are still valid, Dr. Smith and colleagues conducted a new survey of oncologists attending a 1997 National Comprehensive Cancer Network (NCCN) annual meeting. The results of that survey are summarized and analyzed.

Because many types of cancers metastasize to the lungs, early detection may affect both tumor staging and treatment planning. On the other hand, it is also important to refrain from subjecting patients to procedures that

The costs and relative cost-effectiveness of different treatments for common illnesses are an increasing concern. New treatments for advanced non-small-cell lung cancer are having an impact. However, these treatments vary markedly in their direct financial costs, toxicity, and quality-of-life profiles. Direct comparisons between most combination regimens are not yet completed. Vinorelbine (Navelbine) is the first new agent approved in the United States for the treatment of metastatic non-small-cell lung cancer in more than a decade. We previously reported results of a post-hoc economic analysis that compared the anticipated cost-effectiveness of three regimens used to treat non-small-cell lung cancer (vinorelbine alone versus vinorelbine plus cisplatin [Platinol] versus vindesine plus cisplatin, the assumed standard treatment in Europe). Results showed that vinorelbine plus cisplatin was the most effective regimen. Using vinorelbine alone as a baseline, vinorelbine plus cisplatin added 56 days of life at an additional cost of $2,700, resulting in a cost-effectiveness ratio of $17,700 per year of life gained. Similarly, vindesine plus cisplatin added 19 days of life at a cost of $1,150, or $22,100 per year of life gained. Compared to vindesine plus cisplatin, vinorelbine plus cisplatin added 37 days of life at a cost of $1,570, or $15,500 per year of life gained. We conclude that the incremental cost-effectiveness of the vinorelbine plus cisplatin regimen was less than most commonly accepted medical interventions. If vinorelbine is preferred because of its favorable toxicity profile, the additional effectiveness of cisplatin added substantial efficacy at an acceptable cost.[ONCOLOGY(Suppl 4):14-17, 1998]

Le Chevalier and colleagues have reported results of a randomized controlled clinical trial comparing vinorelbine alone, versus vinorelbine combined with cisplatin, versus standard treatment consisting of vindesine and cisplatin in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Data on survival in the three study arms and estimates of the resources used to treat these patients were extracted from the publication and inserted into Statistics Canada’s POpulation HEalth Model (POHEM).

BUFFALO, NY-Photofrin (porfi-mer sodium), a photosensitizer used in photodynamic therapy (PDT), has received FDA approval for use in early-stage microinvasive lung cancer. The agent, manufactured by QLT Photo-Therapeutics, was approved in 1995 for palliative use in esophageal cancer.

MELVILLE, NY-Docetaxel (Taxo-tere) is becoming increasingly important for the second-line treatment of advanced non-small-cell lung cancer (NSCLC), said Jeffrey Crawford, MD, director of Clinical Research, Duke Comprehensive Cancer Center, Duke University.