Lung Cancer

NEW YORK-Two important developments are bringing about a reappraisal of major institutional policy recommendations against lung cancer screening: (1) The amassing of compelling evidence that resection of early lung cancer has a major impact on survival and (2) the emergence of new techniques allowing earlier disease detection.

Studies in the first phase of the Early Lung Cancer Action Project (ELCAP), a joint research study with Weill Cornell Medical Center at New York Presbyterian Hospital and New York University Hospital, show that not only can spiral (“helical”) chest computed tomographic (CT) scans detect four times as many lung cancer tumors as conventional chest x-rays, but also the scans find these tumors when they are significantly smaller. Results of these studies (published in the July 10th issue of the Lancet) show that lung cancer patients have a significantly improved chance for long-term survival if the CT scan (which travels completely around the patient’s torso), is used to detect early-stage tumors.

NEW YORK-Less money is being spent on research for lung cancer than for other common cancers because “people believe that most lung cancer patients are to blame for their disease,” said Betty Layne, director of national planning and policy for the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE). The group held a teleconference to draw attention to this issue, to inform the public about the disease, and to say that lung cancer patients, like all cancer patients, deserve the best in prevention, early detection, treatment, and support.

BUFFALO, NY-Although adjuvant therapies have made important inroads into improving overall survival for many cancer patients, lung cancer patients have not been so fortunate, Robert J. Ginsberg, MD, said at the Roswell Park Surgical Oncology Symposium.

WASHINGTON-Continuous, hyperfractionated, accelerated radiotherapy, or CHART, has won over official British medicine for the treatment of non-small-cell lung cancer (NSCLC).

Smoking-once a socially accepted behavior-is the leading preventable cause of death and disability in the United States. During the first decades of the 20th century, lung cancer was rare; however, as cigarette smoking became increasingly popular, first among men and later among women, the incidence of lung cancer became epidemic (Figure 1).

NEW YORK-Fewer blacks than whites receive potentially curative surgery for early stage lung cancer, and this disparity is substantially responsible for lower survival rates for black patients, according to researchers at Memorial Sloan-Kettering Cancer Center and the National Cancer Institute.

I enjoyed the review of malignant mesothelioma by Drs. Sean Grondin and David J. Sugarbaker that appeared in the July 1999 issue of oncology. On page 920, the authors mention that mesothelioma will recur locally at sites of pleuroscopy or thoracoscopy. From a radiation therapy standpoint, it is worth bringing to the readers’ attention that a small, prospective trial published by Boutin et al in Chest (108[3]:754-758, 1995) showed that radiotherapy to these sites prevents entry tract metastases. A radiation dose of 21 Gy in three fractions given 10 to 15 days after thoracoscopy decreased the incidence of entry tract metastases from 40% to 0%. This regimen should be considered for patients who will not receive a more definitive surgical procedure and adjuvant radiotherapy.

Inoperable non–small-cell lung cancer has become the domain of combined-modality treatment based on several recent, large, phase III studies. Results of Radiation Therapy Oncology Group (RTOG) phase II studies have

Gene therapy has the potential to provide cancer treatments based on novel mechanisms of action with potentially low toxicities. This therapy may provide more effective control of locoregional recurrence in diseases like non–small-cell lung cancer (NSCLC) as well as systemic control of micrometastases. Despite current limitations, retroviral and adenoviral vectors can, in certain circumstances, provide an effective means of delivering therapeutic genes to tumor cells. Although multiple genes are involved in carcinogenesis, mutations of the p53 gene are the most frequent abnormality identified in human tumors. Preclinical studies both in vitro and in vivo have shown that restoring p53 function can induce apoptosis in cancer cells. High levels of p53 expression and DNA-damaging agents like cisplatin (Platinol) and ionizing radiation work synergistically to induce apoptosis in cancer cells. Phase I clinical trials now show that p53 gene replacement therapy using both retroviral and adenoviral vectors is feasible and safe. In addition, p53 gene replacement therapy induces tumor regression in patients with advanced NSCLC and in those with recurrent head and neck cancer. This article describes various gene therapy strategies under investigation, reviews preclinical data that provide a rationale for the gene replacement approach, and discusses the clinical trial data available to date. [ ONCOLOGY 13(Suppl 5):148-154, 1999]

Despite recent advances in the treatment of lung cancer, long-term survival remains rare. As more information pertaining to the biology of lung cancer is understood, it is hoped that improvements in outcome can be realized

Prospects for the multimodality treatment of non–small-cell lung cancer have improved substantially with the demonstration of fairly dramatic results, in terms of 5-year survival, in several phase III trials that employed

After nearly 4 decades of use in treating small-cell lung cancer (SCLC), thoracic radiation has become integral to the management of limited-stage disease. Many prospective randomized trials have demonstrated that adding

Lung cancer is the leading cause of cancer death in the United States. Surgery is the treatment of choice for early stage patients. Despite radical surgery, patients with early stage lung cancer remain at risk for recurrence. The

Chemoprevention is defined as the use of specific natural or pharmacologic agents to reverse, suppress, or prevent the carcinogenic process to the development of invasive cancer. The basic idea behind lung cancer

NEW ORLEANS-The high negative predictive value of positron emission tomography (PET) imaging can spare some patients with early non-small-cell lung cancer (NSCLC) the need for mediastinoscopy prior to thoracotomy,

Patients with advanced non–small-cell lung cancer benefit mainly from chemotherapy using cisplatin (Platinol)-based combinations. Platinum compounds, however, due to their toxicity profile, have limited use in combination

The development of effective and well-tolerated combinations of chemotherapy and radiotherapy is of great importance to improve disease-free survival in patients treated for non–small-cell lung cancer. Studies

Many physicians have questioned whether the additional survival benefit gained from the use of combination chemotherapy in non–small-cell lung cancer has been offset by chemotherapy-induced toxicity, particularly with

Combined-modality approaches integrating carboplatin (Paraplatin) and low doses of weekly paclitaxel (Taxol) with thoracic radiation therapy for prolonging survival in patients with locally advanced non–small-cell lung cancer

New treatment strategies for small-cell lung cancer patients are required, as there have been few developments in the past 20 years. Paclitaxel (Taxol) has been shown to be effective in non–small-cell lung cancer when given in

Despite the availability of combination chemotherapy, response rates are poor in patients with non–small-cell lung cancer. Recently, phase II trials have been undertaken with single-agent paclitaxel (Taxol). Good results have

Despite a response rate of only 9%, single-agent carboplatin (Paraplatin) produced the best 1-year survival rate with the lowest toxicity in a five-arm Eastern Cooperative Oncology Group study of cisplatin (Platinol)

The combination regimen of paclitaxel (Taxol) and cisplatin (Platinol) for non–small-cell lung cancer has shown improved response rates in some phase II trials, and because of its safety profile, it could offer patients with this

Despite growing evidence that patients with advanced non–small-cell lung cancer have improved survival and better symptom control with modern systemic therapy, there is still resistance to the use of chemotherapy because

The effectiveness of paclitaxel (Taxol) in a range of tumors has been established in a large number of trials. In non–small-cell lung cancer, paclitaxel combined with cisplatin (Platinol) has been shown to be highly effective.

The activity and toxicity profiles of carboplatin (Paraplatin) and paclitaxel (Taxol) used as single agents in non–small-cell lung cancer made them logical agents for study in combination therapy. Once preliminary trials

In the 1980s, the introduction of cisplatin (Platinol)-based chemotherapy prolonged survival and improved quality of life in patients with stage III and IV non–small-cell lung cancer. More recently, the use of five new

In an attempt to further improve the quality of life and prognosis of patients with non–small-cell lung cancer, several clinical strategies exist to evaluate newer chemotherapy agents for this disease. Several of these

According to the results of a landmark phase III, multicenter, Southwest Oncology Group clinical trial (SWOG 9509), the use of paclitaxel (Taxol) plus carboplatin (Paraplatin) can be considered a standard regimen for non–small-cell lung cancer