Lung Cancer

Lung cancer remains the primary cause of cancer-related death in both men and women in the United States. Chemotherapy has been shown to provide a survival benefit in patients with advanced non-small-cell lung cancer (NSCLC), and current regimens have produced median survivals of approximately 8 months and 1-year survival rates of 30% to 35% in patients with stage IIIB and IV disease. Nevertheless, there remains room for improvement. Irinotecan (CPT-11, Camptosar) has demonstrated efficacy in the treatment of small-cell lung cancer (SCLC). It also appears to have promising activity in advanced NSCLC, producing overall response rates of up to 32%. Combinations of irinotecan and cisplatin or carboplatin (Paraplatin) have resulted in overall response rates of 25% to 56% in phase II and III studies in patients with advanced disease, with median survivals ranging from 9 to 13 months and 1-year survival rates of 33% to 58%. Current irinotecan-based doublet and triplet regimens appear to produce promising response rates with manageable toxicities. In addition, irinotecan has demonstrated potential as a radiosensitizing agent and is currently being evaluated in several trials of combined-modality therapy in patients with locally advanced NSCLC. Early trials of irinotecan in combination with cisplatin or carboplatin along with radiation therapy have reported overall response rates of 60% to 67%. The approach appears to have potential and warrants further study. [ONCOLOGY 16:1153-1168, 2002]

BETHESDA, Maryland-A lung cancer screening trial supported by the National Cancer Institute (NCI) that will compare spiral CT and standard chest x-ray is back on track after being delayed for several months. Andrew von Eschenbach, MD,

LOS ANGELES-An investigational radiolabeled monoclonal antibody (MoAb) that targets the necrotic core of solid tumors (Cotara, Peregrine Pharmaceuticals Inc., Tustin, California) produced good response rates when injected intratumorally into lung cancers. Alan L. Epstein, MD, PhD, of the University of Southern California Keck School of Medicine, reported the results at the 49th Annual Meeting of the Society of Nuclear Medicine (abstract 1265).

LINKOPING, Sweden-Swedish researchers found that gemcitabine (Gemzar) plus carboplatin (Paraplatin) improved response rates and survival in patients with advanced non-small-cell lung cancer during a phase III trial, according to a

LONDON, UK-Preliminary results of the Big Lung Trial in a supportive care setting found chemotherapy improved survival of patients with non-small-cell lung cancer (NSCLC) without diminishing their quality of life, according to a report presented by R.J. Stephens, MD, representing the CRC and UCL Cancer Trials Centre, London (ASCO abstract 1161).

PHILADELPHIA-"Do not exclude the fit elderly from combined modality therapy for locally advanced non-small-cell lung cancer (NSCLC)," Corey. J. Langer, MD, of Fox Chase Cancer Center, reported in his poster presentation (ASCO

ORLANDO, Florida-Although a combination of paclitaxel, carboplatin (Paraplatin), and thoracic radiation therapy is commonly used to treat patients with locally advanced non-small-cell lung cancer (NSCLC), the optimal sequencing of these

According to the results of a multinational phase III trial reported at the 38th annual meeting of the American Society of Clinical Oncology (ASCO), the combination of docetaxel (Taxotere) and a platinum compound leads to a significantly better quality of life than the combination of vinorelbine (Navelbine) and cisplatin in chemonaive patients with advanced non-small-cell lung cancer (NSCLC). The combination of vinorelbine and cisplatin is a standard first-line regimen for these patients.

ORLANDO-The largest prospective evaluation of quality of life (QOL) in chemotherapy-naïve patients with advanced non-small-cell lung cancer (NSCLC) found that first-line treatment with docetaxel (Taxotere) plus a platinum agent achieved

ORLANDO, Florida-An aggressive strategy of induction and concurrent chemoradiotherapy was feasible and well tolerated in a North Carolina study of advanced non-small-cell lung cancer (NSCLC) patients, reported Mark A. Socinski,

MIAMI BEACH-Chemotherapy doublets outperform single-agent chemotherapy in advanced non-small-cell lung cancer (NSCLC), producing higher response rates and a modest gain in overall survival, according to results of a study from the

VANCOUVER, Canada-QLT Inc. has begun patient enrollment for two phase III clinical trials using tariquidar as an adjunctive treatment in combination with first-line chemotherapy for non-small-cell lung cancer patients, the company said in a

ORLANDO-Patients with locally advanced, un1resectable, non-small-cell lung cancer (NSCLC) who received the radiation enhancer RSR13 (efaproxiral) along with thoracic radiation therapy (RT) had a median survival of more than 20

Enrollment in the National Lung Screening Trial (NLST), which was projected to have begun this spring, has been delayed. The National Cancer Institute (NCI) apparently wants to ensure that it makes every effort to listen to the complaints of critics.

Combination Chemotherapy Should Be Standard of Care for Lung Cancer

Malignant pleural mesothelioma is a relatively rare malignancy with an annual incidence in the United States of approximately 3,000 cases. Based on asbestos exposure demographics, incidence should peak in the United States in the next 10 to 20 years. Peto et al have suggested that the incidence in Western Europe may continue to climb for substantially longer, possibly reaching as high as 1/100 among middle-aged men.[1,2] In developing countries (often bereft of asbestos regulation), the incidence is not known

Drs. Zellos and Sugarbaker have provided a concise yet complete review of the current management of resectable diffuse malignant mesothelioma and have identified areas worthy of further investigation. Although, on occasion, surgical treatment can produce long-term cure, in general, diffuse malignant mesothelioma is a devastating disease. One only has to look at the survival curves provided by the Brigham group to understand that, of 183 patients, only 7 survived for 5 years.[1] However, neither the number eligible for evaluation at 5 years nor the disease-free survival figures were reported.

Drs. Zellos and Sugarbaker nicely summarize the current treatment strategies for malignant pleural mesothelioma. The management of this disease remains controversial, and several aspects of the review merit discussion.

Diffuse malignant pleural mesothelioma is a rare and aggressive malignancy of the pleura that is usually caused by exposure to asbestos. Between 2,000 and 3,000 new cases are expected to be diagnosed annually in the

NEW YORK-As an explosion of lung cancer deaths is set to overwhelm developing countries, the American Cancer Society (ACS) plans to work worldwide to combat the tobacco pandemic.

Lung cancer is a global problem fueled by the continuous use of tobacco in most countries, despite efforts at expanding smoking cessation programs. Several advances in the diagnosis and treatment of lung cancer were achieved in the past decade. This progress notwithstanding, most lung cancer patients succumb to their illness, and few enjoy long-term survival.

NEW YORK-The invention of the manufactured cigarette in Cuba in 1875 sparked "the manmade epidemic of lung cancer" and other smoking-related diseases that emerged in the 20th century, said Prof. Peter Boyle, director of the Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.

SAN FRANCISCO-In a study from Johns Hopkins University Medical School, one third of sporadic lung adenocarcinomas were found to have the inactivated LKB1/STK11 gene. A germ-line mutation in this gene has been shown to result in Peutz-Jegher’s syndrome. Patients with this autosomally dominant disease have an increased risk of developing malignancies. Montserrat Sanchez-Cespedes, PhD, now a senior scientist at the Spanish National Cancer Center, Madrid, presented the study at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 720).

ASCO-A new study from the Cancer and Leukemia Group B (CALGB 9730) shows that chemotherapy doublets should be the standard treatment for advanced non-small-cell lung cancer (NSCLC), Rogerio C. Lilenbaum, MD, reported at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 2).

Two phase III trials were conducted using docetaxel (Taxotere), administered every 3 weeks, as second-line treatment of non-small-cell lung cancer (NSCLC) in patients previously treated with platinum-based chemotherapy. In the TAX 317 trial, 204 patients were randomized to receive either docetaxel (49 received 100 mg/m² and 55 received 75 mg/m²) or best supportive care (100 patients). Median survival was 7.5 months with docetaxel at 75 mg/m² (D75) vs 4.6 months for best supportive care (P = .010); and 1-year survival was 37% for D75 vs 11% for best supportive care (P = .010).

Docetaxel (Taxotere) has shown activity both as a single-agent and in combination with multiple other cytotoxic agents in the front-line therapy of advanced, metastatic non-small-cell lung cancer (NSCLC). A randomized, phase III trial demonstrated a survival advantage for docetaxel over best supportive care in the front-line setting, with docetaxel achieving a 2-year survival of 12% vs 0% for best supportive care. Combinations of docetaxel with the platinum agents have been the most extensively studied in the front-line setting and have produced notably high response rates and encouraging median survivals.

Dyspnea is defined as a sensation of difficult or uncomfortable breathing. The symptom is highly prevalent among cancer patients with and without direct lung involvement. The gold standard of assessment is based on

In less than a decade, docetaxel (Taxotere) has progressed from initial studies in anthracycline-refractory metastatic breast cancer to several large, phase III randomized trials evaluating its efficacy as adjuvant, neoadjuvant, and first-line therapy for metastatic breast cancer, non-small-cell lung cancer (NSCLC), and ovarian cancer. In other tumor types, including prostate, head and neck, gastric, and bladder cancer, ongoing phase III trials are comparing docetaxel-containing regimens to previously established regimens. For the seven tumor types reviewed in this supplement, phase III study information for docetaxel or docetaxel-based combinations are presented. Impressive results have been consistently demonstrated in the trials reported to date.

Combined-modality approaches for the treatment of non-small-cell lung cancer (NSCLC), head and neck cancer, and esophageal cancer offer survival benefits by improving locoregional control and treating micrometastatic disease. The taxanes are active, tolerable drugs in these solid tumors and have radiation-sensitizing activity.

Only 19% of current smokers say they would quit smoking if a computed tomography (CT) scan to detect lung cancer was negative, but 91% say they would want smoking cessation counseling. These findings are part of a Fox Chase Cancer Center study that measured attitudes and beliefs about the uses of spiral CT for early detection of lung cancer among a high-risk population. The study was presented at a recent meeting of the American Society of Preventative Oncology held in Bethesda, Md.