Lung Cancer

Weekly dosing of the chemotherapy agent docetaxel (Taxotere) is active and well tolerated in elderly patients with advanced non–small-cell lung cancer (NSCLC), according to the results of a phase II study published in a recent issue of Cancer (89[2]:328-333, 2000).

ROCHESTER, Minnesota-The combination of irinotecan (Camptosar)and docetaxel (Taxotere) is a promising treatment for recurrent non–small-cell lung cancer (NSCLC), but the dosing schedule tested in phase I and II trials needs to be modified to reduce the potential for myelosuppression and diarrhea, cautioned Alex Adjei, MD, of the Mayo Clinic in Rochester, Minnesota.

NASHVILLE, Tennessee-Conceding that treatment of advanced non–small-cell lung cancer (NSCLC) has made only limited progress in the past decade, members of the Eastern Cooperative Oncology Group (ECOG) have vowed to pursue newer chemotherapeutic agents aggressively. ECOG’s focus has changed, according to David H. Johnson, MD, director of hematology and oncology with the Vanderbilt-Ingram Cancer Center, Nashville. Investigators now see the promise in new biological agents with novel mechanisms of action that might be integrated into current chemotherapeutic regimens.

AMSTERDAM, The Netherlands-Cisplatin (Platinol), the cornerstone of chemotherapy for advanced non–small-cell lung cancer (NSCLC), continues to come under increased scrutiny, noted Pieter E. Postmus, MD, FCCP. Investigators are searching for chemotherapeutic strategies that are as effective as platinum-based therapy, but are better tolerated and more cost-effective, he explained. Dr. Postmus is with the Department of Pulmonology, Vrije Universiteit, University Hospital, in Amsterdam, The Netherlands.

The aim of this pilot study was to assess the safety of the angiogenesis inhibitor thalidomide (Thalomid) given in combination with standard chemotherapy to patients with advanced non–small-cell lung cancer. Patients with unresectable stage IIIA, IIIB,

CHIBA, Japan-Combining either irinotecan (Camptosar) or vindesine with cis-platin (Platinol) produced similar objective responses and survival rates in patients with stage IIIB or IV non–small-cell lung cancer, according to final results of a randomized trial.

MONTPELLIER, France-A four-drug regimen produced better outcomes in patients with extensive small-cell lung cancer than the commonly used combination of etoposide (VePesid) and cisplatin (Platinol), a French multicenter study showed.

TOKYO, JAPAN-The administration of irinotecan (Camptosar) 60 mg/m² and cisplatin (Platinol) 80 mg/m² with concurrent thoracic radiotherapy has been identified as the recommended dose for evaluation in a phase II study in patients with locally advanced non–small-cell lung cancer (NSCLC).

OSAKA, Japan-A randomized phase III trial in small-cell lung cancer patients with extensive disease was stopped after interim analyses uncovered a clear survival benefit for a regimen combining irinotecan (Camptosar) and cisplatin (Platinol) over an etoposide (VePesid) and cisplatin combination.

CHARLESTON, South Carolina-A phase II trial involving the sequential administration of docetaxel (Taxotere), gemcitabine (Gemzar), and irinotecan (Camptosar) in patients with non–small-small cell lung cancer (NSCLC) is being planned. Announcement of the new trial comes in the wake of results of a phase I trial among patients with solid tumors that was reported at the 9th World Conference on Lung Cancer by Caio Max S. Rocha Lima, MD, assistant professor of medicine at the Medical University of South Carolina in Charleston.

NEW HAVEN, Connecticut-The combination of irinotecan (Camptosar) and a taxane is well tolerated in dose-finding studies and deserves further evaluation in non–small-cell lung cancer, according to Randy S. Rich, MD, of Yale University School of Medicine.

EAST LANSING, Michigan-A profile for elderly lung cancer patients at high risk of having major cancer-related losses in physical functioning has emerged from a Michigan State University study.

TOKYO-Weekly paclitaxel (Tax-ol) and carboplatin (Paraplatin) is an effective and well-tolerated second-line therapy in patients with non-small-cell lung cancer (NSCLC) who failed first-line therapy with the same agents, Mark A. Socinski, MD, said at the 9th World Conference on Lung Cancer. Dr. Socinski is director of the Multidisciplinary Thoracic Oncology Program, University of North Carolina, Chapel Hill.

Patients with limited-stage small-cell carcinoma of the lung are treated with combined-modality therapy with the intent to cure. Standard therapy consists of platinum-based combination chemotherapy, thoracic irradiation, and

Patients with limited-stage small-cell carcinoma of the lung are treated with combined-modality therapy with the intent to cure. Standard therapy consists of platinum-based combination chemotherapy, thoracic irradiation, and

Patients with limited-stage small-cell carcinoma of the lung are treated with combined-modality therapy with the intent to cure. Standard therapy consists of platinum-based combination chemotherapy, thoracic irradiation, and

BETHESDA, Md-The National Cancer Institute has launched a randomized, 3,000-person study to determine the feasibility of doing a larger scale trial to test whether spiral CT screening improves lung cancer survival. Six centers began recruiting volunteers in early September and hope to enroll 500 subjects each by the end of October.

NASHVILLE, Tennessee-Irinotecan (Camptosar) combined with radiation therapy is active in non–small-cell lung cancer (NSCLC) and is most effective when the chemotherapy and radiation therapy are given concurrently, Hak Choy, MD, reported at a clinical investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology. Dr. Choy is Professor and Vice Chairman of the Department of Radiation Oncology at the Vanderbilt Cancer Center in Nashville, Tennessee.

OSAKA, Japan-Irinotecan/cisplatin combination therapy improved survival compared to etoposide/cisplatin in extensive-stage small-cell lung cancer (SCLC), Masahiro Fukuoka, MD, reported at an investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology. Two-year survival in the Japan Clinical Oncology Group (JCOG)-9511 study was 19% with irinotecan/cisplatin vs 9% with etoposide/cisplatin, according to Dr. Fukuoka, who is professor of the 4th Department of Internal Medicine at Kinki University School of Medicine in Osaka, Japan.

WASHINGTON-The use of spiral CT scanning to screen for early lung cancers poses scientific, economic, and policy issues that the oncology community, advocacy groups, insurers, and government health agencies need to address quickly, an expert panel said at a day-long conference on reducing lung cancer mortality. The conference was sponsored by the Cancer Research Foundation of America and the Roy Castle Lung Cancer Foundation, Liverpool, England.

NEW ORLEANS-The addition of paclitaxel (Taxol) to etoposide plus cisplatin (Platinol), with concurrent thoracic radiotherapy, may improve survival in patients with limited-disease small-cell lung cancer (SCLC), according to preliminary results from the RTOG 96-09 Intergroup trial. David S. Ettinger, MD, of Johns Hopkins Oncology Center, presented the study at the 36th Annual Meeting of the American Society of Clinical Oncology (ASCO).

WASHINGTON-When used to diagnose early lung cancer, low-dose spiral CT scanning has a high specificity-as well as high sensitivity-and it is cost-effective, according to as-yet-unpublished data from the New York City-based Early Lung Cancer Action Program (ELCAP). Moreover, the technique can diagnose emphysema at an earlier stage than existing tests, which has helped smokers in the study to stop.

NEW ORLEANS-First-line treatment with carboplatin (Paraplatin) and paclitaxel (Taxol) given every 4 weeks is well tolerated in patients with extensive small-cell lung cancer (SCLC), according to a multicenter phase II trial conducted in Italy and reported at the 36th Annual Meeting of the American Society of Clinical Oncology (ASCO).

PHILADELPHIA-Irinotecan (Camptosar) produces response rates in advanced non-small-cell lung cancer (NSCLC) comparable to those of some well-established combination regimens and is being tested as a radiosensitizer in combination with cis-platin and radiotherapy in locally advanced NSCLC. These and other developments using topoisomerase I inhibitors in NSCLC were reviewed by Corey Langer, MD, at a clinical investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology. Dr. Langer is Medical Director, Thoracic Oncology, at Fox Chase Cancer Center in Philadelphia, PA.

NEW HAVEN, Conn-Topoisomerase I inhibitors in combinations not based on platinum have shown significant activity in non–small-cell lung cancer (NSCLC), John R. Murren, MD, reported. These combinations include such drugs as taxanes, gemcitabine (Gemzar), and vinorelbine (Navelbine). Dr. Murren, Associate Professor of Medicine at Yale University School of Medicine, New Haven, Connecticut, reviewed research on these regimens at a clinical investigators’ workshop sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology.

Irinotecan (Camptosar) in combination with cisplatin (Platinol) increased survival, compared with the current standard treatment for patients with extensive small-cell lung cancer, according to data from a phase III study presented at the annual meeting of the American Society of Clinical Oncology (ASCO).

Currently there are a number of available agents that are moderately active in non–small-cell lung cancer (NSCLC). These include cisplatin (Platinol), gemcitabine (Gemzar), vinorelbine (Navelbine), paclitaxel (Taxol), docetaxel (Taxotere), and irinotecan (Camptosar). How best to combine them, maximizing survival while minimizing toxicity, is the subject of intense investigation.

In medically suitable patients with stage III (locally advanced) non–small-cell lung cancer, the use of cisplatin (Platinol)-based chemotherapy as induction therapy prior to definitive local therapy has been shown to improve survival (J Natl Cancer Inst 86:673-680, 1994; Ann Intern Med 125:723-729, 1996). This is true regardless of whether the local treatment modality used is surgery or thoracic irradiation. However, because cisplatin therapy is particularly toxic, there is interest in studying other agents in the induction setting. Given its activity in non–small-cell lung cancer, docetaxel (Taxotere) is one logical agent to investigate.

A meta-analysis of randomized controlled trials (Br Med J 311:899-909, 1995) has shown that the use of cisplatin (Platinol)-based combination chemotherapy in patients with good performance status leads to a modest improvement in median survival and an absolute increase in 1-year survival proportion of 10%. There are several different platinum-based regimens approved by the Food and Drug Administration for use in advanced non–small-cell lung cancer. Whether any one regimen is superior is unclear. A recent randomized controlled trial found no difference in median survival and quality of life between carboplatin (Paraplatin)/paclitaxel (Taxol)-the most commonly used regimen in the United States-and cisplatin/vinorelbine (Navelbine)-a regimen more popular in Europe and Canada (Proc Am Soc Clin Oncol 18: 461a [abstract 1777], 1999). The newer agents gemcitabine (Gemzar) and docetaxel (Taxotere) are among the most active single agents in non–small-cell lung cancer, and use of either in combination with cisplatin has shown promise.

One hundred centers from Europe, the Middle East, Asia, and South America participated in a non–small-cell lung cancer (NSCLC) study with broad inclusion criteria (first and second line) to establish the toxicity and efficacy profile of docetaxel (Taxotere) at 100 mg/m² in worldwide clinical practice.