Lung Cancer

A significant proportion of patients with non-small cell lung cancer (NSCLC) present with locally advanced, unresectable disease. For the most part, fit patients with this diagnosis are treated with combined-modality therapy. Relatively few are rendered resectable. Over the past two decades, combination chemotherapy and radiation, preferably concurrent chemoradiation, has emerged as the standard of care. However, survival gains have been offset, to some extent, by local, normal-tissue, in-field toxicity, particularly esophagitis and pneumonitis.

Erlotinib (Tarceva) is a human epidermal growth factor receptor type 1/epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor initially approved by the US Food and Drug Administration for the treatment of patients with locally advanced or metastatic non–small-cell lung cancer after failure of at least one prior chemotherapy regimen. In this report, we present the pivotal study that led to the approval of erlotinib in combination with gemcitabine (Gemzar) in patients with locally advanced/metastatic chemonaive pancreatic cancer patients. The combination demonstrated a statistically significant increase in overall survival accompanied by an increase in toxicity. Physicians and patients now have a new option for the treatment of locally advanced/metastatic adenocarcinoma of the pancreas.

Pemetrexed (Alimta) showed additional utility in the treatment of non–small-cell lung cancer (NSCLC)

10 notable developments and events in cancer research and care

Erlotinib (Tarceva) is a human epidermal growth factor receptor type 1/epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor initially approved by the US Food and Drug Administration for the treatment of patients with locally advanced or metastatic non–small-cell lung cancer after failure of at least one prior chemotherapy regimen. In this report, we present the pivotal study that led to the approval of erlotinib in combination with gemcitabine (Gemzar) in patients with locally advanced/metastatic chemonaive pancreatic cancer patients. The combination demonstrated a statistically significant increase in overall survival accompanied by an increase in toxicity. Physicians and patients now have a new option for the treatment of locally advanced/metastatic adenocarcinoma of the pancreas.

Angiogenesis is a critical requirement for malignant growth, invasion, and metastases. Agents interfering with angiogenesis have shown efficacy in the treatment of a number of solid tumors, such as metastatic colorectal cancer, non–small-cell lung cancer, and renal cell cancer, and are being studied in many more. Each of the three agents currently approved by the US Food and Drug Administration-bevacizumab (Avastin), sunitinib (Sutent), and sorafenib (Nexavar)-offer challenges to nurses, in terms of assessment and management of toxicity, and to their patients as well: learning and integrating self-care strategies, such as self-assessment and self-administration (for sorafenib and sunitinib). This article reviews the recommended dosing, drug interactions, potential side effects, and management strategies for these three agents. Other agents that have antiangiogenesis properties, such as the epidermal growth factor inhibitors, the mTOR inhibitors, bortezomib, and thalidomide will not be addressed.

A growing number of novel antiangiogenic agents are entering clinical trials to study their clinical safety and efficacy. A few, such as bevacizumab (Avastin), sorafenib (Nexavar), and sunitinib (Sutent), have received US Food and Drug Administration approval and are already in widespread clinical use. As knowledge about the intricacies of intracellular signaling within multiple tumor types expands, agents with the capacity to impact these pathways are being incorporated into additional clinical trials alone and in combination with other targeted and/or traditional antineoplastic agents. Early clinical trials have focused on highly vascular tumor types, as well as those known to significantly overexpress the VEGF (vascular endothelial growth factor) receptor family. This article aims to review the status of antiangiogenic therapy in selected tumor types and discuss areas for further research.

After failing on an annual lung cancer 'report card,' Congress makes the disease a public health priority

FDA removes partial hold on Telcyta clinical development

Spending More for Lung Cancer Treatment Did Not Substantially Increase Patients' Lives

The FDA has approved GlaxoSmithKline's oral Hycamtin (topotecan) capsules for the treatment of relapsed small-cell lung cancer (SCLC)

FDA Approves Oral Topotecan for Relapsed Small-Cell Lung Cancer

Spiral computed tomography (CT), a highly sensitive technology that finds early lung cancers, has sparked both renewed interest and controversy in lung cancer screening.

The issue of cancer in the elderly is of growing concern given the aging population. It is a particular issue in lung cancer, where the median age of patients is over 60.

Although significant advances have been made in the systemic therapy of non–small-cell lung cancer (NSCLC) in patients with a good performance status (PS), the subgroup of patients with a poor PS has not been studied as well.

Researchers have found that the breast cancer susceptibility gene BRCA1 plays a significant role in non-small-cell lung cancer.

New evidenced-based guidelines from the American College of Chest Physicians (ACCP) recommend against the use of low-dose computed tomography (LDCT) for the general screening of lung cancer.

ImClone Systems Incorporated and Bristol-Myers Squibb Company announced that a phase III study of cetuximab (Erbitux) in combination with platinum-based chemotherapy (vinorelbine plus cisplatin) met its primary endpoint of increasing overall survival compared with chemotherapy alone in patients with advanced non–small-cell lung cancer (NSCLC).

A phase II study of Antisoma's investigational agent ASA404 in combination with carboplatin and paclitaxel showed positive survival results in non-small-cell lung cancer patients.

Lung cancer is one of the most common and deadly malignancies in the United States, with an estimated 213,380 new cases in 2007 and an estimated 160,390 deaths in 2007. Approximately 85% of these patients will be diagnosed with non-small cell lung cancer (NSCLC), and only 10%-20% will have potentially curable disease.

Epidermal growth factor receptor inhibitors (EGFRIs) have demonstrated clinical activity in patients with non–small-cell lung cancer, pancreatic cancer, and colorectal cancer. EGFRIs are generally well tolerated, but reversible dermatologic toxicities are commonly associated with their use. Limited clinical evidence has characterized these adverse reactions as a class effect. For panitumumab (Vectibix), mild-to-moderate dermatologic toxicities are the most common associated adverse reactions. This report details the Japanese experience in the management of dermatologic toxicities associated with panitumumab use. Treatment selection for skin toxicity in Japan is also detailed, with a flowchart depicting strategies to treat various stages of dermatologic toxicities. Panitumumab was well tolerated in Japanese patients with advanced solid tumors, with a safety profile similar to that seen in non-Japanese patients.

Long-term disease stabilization in some patients who had progressed after one or two prior therapies suggests possible activity for the investigational agent enzastaurin (Eli Lilly) in non-small-cell lung cancer (NSCLC)

Small-cell lung cancer (SCLC) appears to be declining in frequency. This reduced incidence of SCLC seems to have curtailed interest and investigation as well.

Pretreatment with induction chemotherapy appears to give certain inoperable non-small-cell lung cancer (NSCLC) patients who undergo radiation and concurrent chemotherapy (chemoradiation) a small but statistically significant increase in overall, 5-year, and distant-metastasis-free survival, compared with concurrent chemoradiation alone, the standard of care.

Variations in two genes related to inflammation may be a major risk factor for developing lung cancer, according to a team of scientists from the National Cancer Institute and the University of Texas

A MAGE-A3 antigen-specific cancer immunotherapeutic (ASCI) showed very encouraging activity in the postoperative adjuvant treatment of non-small-cell lung cancer (NSCLC) in a multicenter, double-blind phase II European study

The appearance of a rash in cancer patients treated with erlotinib (Tarceva) is strongly associated with longer survival, according to researchers from the drug's developer, OSI Pharmaceuticals

Swiss drug regulators have become the first to approve Novartis' Tasigna (nilotinib) for the treatment of patients with Ph+ chronic myeloid leukemia who are resistant or intolerant to imatinib (Gleevec)

Breast cancer is the most commonly diagnosed cancer in women and is the second leading cause of cancer-related mortality, after lung cancer. The overall incidence of breast cancer was increasing until recently, but mortality has declined since 1990, presumably due to earlier detection and better treatments.

A global phase III study is the second to show that adding bevacizumab (Avastin) to chemotherapy extends progression-free survival (PFS) in patients with advanced non-small-cell lung cancer (NSCLC)