Lung Cancer

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.

MIAMI BEACH-Drugs that block epidermal growth factor receptor (EGFR) tyrosine kinase activity may represent a new option for patients whose non-small-cell lung cancer (NSCLC) has progressed despite standard chemotherapy, Jose Baselga, MD, reported at the Molecular Targets and Cancer Therapeutics meeting (abstract 630A).

A fundamental assumption of lung cancer screening is that small tumors are less likely to have metastasized than large tumors. However, in a new study conducted at Duke Comprehensive Cancer Center, researchers showed that size does not necessarily indicate the severity of the cancer.

The multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.

Among the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.

Dr. Alan Sandler’s sweeping review of the role of irinotecan (CPT-11, Camptosar) in the treatment of small-cell lung cancer (SCLC) leaves few stones unturned. Some perspective, however, is necessary. To date, with the exception of the Japan Clinical Oncology Group trial, which demonstrated the superiority of irinotecan in combination with cisplatin compared to standard therapy with etoposide and cisplatin, no other new platinum agent combination has proven superior to standard therapy in the treatment of extensive SCLC.[1] The Noda study, published recently in the New England Journal of Medicine, has sparked considerable interest and anticipation in the medical oncology community.

Dr. Sandler has written a thorough and cogent review of the literature on irinotecan (CPT-11, Camptosar) in the treatment of small-cell lung cancer. The most promising data are those from a randomized trial by Noda et al, which showed that irinotecan, compared to etoposide, in combination with cisplatin resulted in an approximately 3-month survival benefit in patients with extensive disease, good performance status, and an age < 70 years. The results of this trial were published recently in The New England Journal of Medicine and, therefore, will attract wide readership and, presumably, much enthusiasm and excitement.[1]

The DNA topoisomerase inhibitor irinotecan (CPT-11, Camptosar) is being evaluated as a novel chemotherapeutic agent that may complement other agents and treatment modalities for small-cell lung cancer (SCLC). Combination chemotherapy is the most effective means of improving the survival of patients with extensive disease, but until recently, no combination demonstrated superior efficacy.

SAN FRANCISCO-Patients with inoperable non-small-cell lung cancer (NSCLC) who receive 20 Gy of radiation therapy in five fractions achieved slightly superior palliation of thoracic symptoms than those receiving a single 10-Gy dose, according to a study presented at the 43rd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 30). An unexpected finding was that patients receiving the five-fraction therapy survived significantly longer, the study authors said.

ROCKVILLE, Maryland-Members of the Oncologic Drugs Advisory Committee (ODAC) have unanimously recommended that the Food and Drug Administration approve Zometa (zoledronic acid for injection, Novartis) for the treatment of bone metastases in patients with multiple myeloma and breast cancer, prostate cancer, lung cancer, and other solid tumors.

Anew treatment for small-cell lung cancer holds promise of dramatically improving survival for patients with the disease, said Dr. Alan Sandler, director of Vanderbilt-Ingram Cancer Center’s Thoracic Oncology Program, and leader of a large US study to further evaluate the treatment’s ability to prolong survival in patients with small-cell lung cancer.

CHICAGO-Screening for lung cancer with low-dose helical CT scans is becoming increasingly popular. Computer programs to assist in the detection of lung cancers appear to increase the accuracy of CT screening, said Samuel G. Armato III, PhD, assistant professor of radiology, University of Chicago.

CHICAGO-Paclitaxel (Taxol) and gemcitabine (Gemzar) administered on a frequent basis elicited significant first-line activity against advanced non-small-cell lung cancer (NSCLC), producing an overall response rate of 31% in 27 evaluable patients.