Lung Cancer

No clear winner has emerged in a head-to-head comparison of whole-body FDG-PET/CT and whole-body 3T MRI for non-small-cell lung (NSCLC) cancer staging. Unenhanced PET/CT proved better for detecting metastatic lymph nodes and soft-tissue involvement, while MR was more sensitive to the presence of brain and liver metastases.

An antibody to the insulin-like growth factor type 1 receptor (IGF-1R), when given with chemotherapy, is active as first-line therapy in advanced non-small-cell lung cancer, especially squamous type, finds the first trial to test an IGF inhibitor in lung cancer. Daniel D. Karp, MD, of M.D. Anderson Cancer Center, reported the trial results at ASCO 2008 (abstract 8015).

CT screening may reduce lung cancer mortality among smokers, but won’t protect them from the other adverse effects of lighting up, according to a modeling study that looked at the long-term efficacy of screening.

CHICAGO-It may be possible to identify non-small-cell lung cancer (NSCLC) patients with a high or low risk of relapse after surgery, according to findings presented at ASCO 2008 (abstract 7501).

CHICAGO-A genetic “fingerprint” detectable in the blood is able to predict with 80% accuracy which asymptomatic smokers will develop lung cancer 2 years later, according to investigators who described the test at ASCO 2008 (abstract 1509).

The anti-inflammatory medication celecoxib (Celebrex) has proven to be safe and reduces a specific proliferation measurement of precancerous lesions in the lung, according to a study from The University of Texas M. D. Anderson Cancer Center. This finding demonstrates the significance of COX-2 inhibition toward preventing lung cancer in individuals at higher risk of developing the disease. The study is the first large randomized trial of celecoxib in lung cancer prevention.

LAS VEGAS-CT multitasks in the lungs, serving as a tool for cancer screening, disease diagnosis, lesion characterization, and lung cancer treatment response. CT can be used more effectively to assess treatment response in lung cancer patients, but clinicians must look beyond current response parameters, Michael McNitt-Gray, PhD, said at the 2008 Stanford International Symposium on Multidetector-Row CT.

A large phase III study has found that the targeted therapy cetuximab (Erbitux), combined with platinum-based chemotherapy, is effective as a first-line treatment for patients with advanced non–small-cell lung cancer (NSCLC). This is the first time a targeted drug has shown a survival benefit as a first-line treatment for patients with NSCLC, including all subtypes of the disease, reported lead author Robert Pirker, md, associate professor of medicine at Medical University of Vienna in Austria at the ASCO meeting (abstract 3).

Along with various imaging modalities, serologic tumor markers such as CA 15-3 and CA 27.29 have been used for decades to monitor treatment response in patients with metastatic breast cancer (MBC). Despite the frequent use of these markers, they lack high sensitivity and specificity for breast cancer progression. The prognostic significance of these markers remains indeterminate because of the conflicting outcome of many clinical trials. The circulating tumor cell (CTC) test has recently been studied in clinical trials in patients with MBC. Some of the studies showed that high levels of CTCs are correlated with poor survival in MBC. An intergroup trial is underway to determine the implication of changing treatment based on the CTC level. This article will discuss the current data on these markers, with special emphasis on the CTC test. The potential clinical utility of these markers will also be discussed.

BASEL-Novartis’ ASA404 has entered a phase III lung cancer trial following positive outcomes of a phase II study.

Two common inherited genetic variations are associated with increased risk of lung cancer for smokers and former smokers, a research team led by scientists at The University of Texas M. D. Anderson Cancer Center reported April 2 in the online edition of Nature Genetics.

Interventional pulmonologists at The Ohio State University Medical Center are using an improved and more efficient technique to diagnose lung cancer. Attached at the tip of the bronchoscope, an ultrasound probe identifies the location of the cancerous masses in a patient's chest, allowing for an accurate biopsy, or tissue sample, under ultrasound guidance.

The article by Calhoun and colleagues, published in this issue of ONCOLOGY, is a timely review of one of the more controversial questions in thoracic oncology: whether or not patients with stage IB non–small-cell lung cancer (NSCLC) should receive adjuvant chemotherapy.

Stage IB non–small-cell lung carcinoma (NSCLC) represents a subset of early-stage, resectable NSCLC, usually treated with curative intent, but with historically modest 5-year survival rates ranging from 40% to 67% with surgical resection alone.[1,2] Disappointingly, modern adjuvant chemotherapy trials including stage IB patients have shown little evidence of chemotherapeutic benefit.

The appropriate treatment of patients with stage IIIA (N2) non–small-cell lung cancer (NSCLC) is unclear. With this case report and review, we address the history, assessment, and management of a 67-year-old patient with this diagnosis, and then discuss the challenges in managing N2 disease, as well as the roles of systemic therapy, surgery, and postoperative radiation therapy.

In this edition of Clinical Quandaries, Ramalingam et al present a 67-year-old man who seeks care for a new, asymptomatic left upper lobe lung mass, which was found incidentally on a routine chest x-ray as part of a preoperative work-up for an elective surgery. Further staging studies included a computed tomography (CT) scan of the chest and a positron-emission tomography (PET) scan followed by a magnetic resonance imaging (MRI) scan of the liver. Pathology from a fine-needle aspiration biopsy of the left lingular lesion was consistent with poorly differentiated adenocarcinoma and immunohistochemical stains consistent with a lung primary. The left lingular lesion and the prevascular lymph node were felt to be the only sites of involvement, making this stage IIIA (T1, N2, M0) lung cancer.

Nereus Pharmaceuticals, Inc. has begun enrolling patients in an open-label phase 1b study evaluating its vascular disrupting agent NPI-2358 in combination with docetaxel (Taxotere) in patients with non-small-cell lung cancer who previously failed at least one chemotherapy regimen.

n a phase III trial of the investigational chemoprotective agent dimesna (Tavocept, also known as BNP7787) in patients with advanced non-small-cell lung cancer, the drug did not significantly prevent or reduce the severity of chemotherapy-induced neuropathy, its primary endpoint, BioNumerik Pharmaceuticals, Inc and ASKA Pharmaceutical Co. (Tokyo, Japan) announced in a press release.

Accuray Incorporated has announced that approximately 90% of the more than 125 CyberKnife centers worldwide are now treating lung cancer with the CyberKnife Robotic Radiosurgery System. CyberKnife centers in 12 countries have treated more than 5,000 lung cancer patients to date with the CyberKnife System, the company said in a news release.

The always-controversial International Early Lung Cancer Action Program has been struck a serious blow with news that the trial was funded in part by a cigarette manufacturer, according to an article in the New York Times (March 26, 2008).

In a phase II, multicenter trial, sunitinib (Sutent) showed activity as a single agent in heavily pretreated non-small-cell lung cancer patients. The overall objective response rate was 11.1%, and median overall survival was 23.4 weeks (Socinski et al: J Clin Oncol 26:650-656, 2008).

A new method for converting between different definitions of lung volume may help standardize radiation dose reporting for patients receiving radiation therapy for lung cancer, finds a study using four-dimensional CT imaging. 4D-CT is a series of CT scans that measure how much a tumor moves when a patient breathes and allows radiation oncologists to personalize radiation treatment for this motion.

Drs. Kelsey, Marks, and Wilson open their excellent review article by asking “Where do we stand?” with respect to postoperative radiation therapy (PORT) for non–small-cell lung cancer (NSCLC).[1] Frankly, PORT has not exactly been standing tall for the past decade-leaning, crouching, or perhaps squatting might be a better verb.

Kelsey et al have written an excellent review on postoperative radiotherapy (PORT) for non–small-cell lung cancer (NSCLC). As pointed out in this thorough yet concise review, there are inconsistencies in the recommendation of PORT for NSCLC.

Lung cancer is the leading cause of cancer mortality in the United States. Local recurrence after surgery for operable disease has long been recognized as a hindrance to long-term survival. Postoperative radiation therapy was logically explored as a means to improve local control and survival. Multiple randomized trials were conducted, many showing improved local control, but none demonstrated a statistically significant survival benefit.

"Researchers defend NLST protocol against its critics" (ONI, January 2008, page 14) quoted three individuals in the United States who strongly support the NLST [National Lung Screening Trial] and no one on the other side of the issue.

A new MRI technique—inhaled hyperpolarized helium-3 diffusion MRI—shows lung damage in nonsmokers exposed to second-hand smoke

In a surprising discovery, reported at RSNA 2007, researchers from Germany have found that whole-body staging of patients with recently diagnosed malignant melanoma using either MRI or PET/CT could miss a substantial number of metastatic lesions

Two minimally invasive staging methods used together may be an accurate substitute for mediastinoscopy for some lung cancer patients with suspected metastatic mediastinal lymph nodes