Lung Cancer

CHICAGO--Implantation of iodine-125 seeds along the edges of a limited surgical resection can enhance local control of stage I non-small-cell lung carcinoma (NSCLC) in patients who cannot have more extensive surgery, Jack McGrath, MD, said at the Radiological Society of North America meeting.

Two different clinical trials using biological agents directed against an autocrine growth factor and a surface marker of neuroendocrine differentiation have been used for patients with relapsed small-cell lung cancer. In a

The treatment of potentially curable non-small-cell lung cancer (NSCLC) is currently evolving. Drs. Greco and Hainsworth provide information about the potential use of chemotherapy, radiation, and surgery in patients with stage IB-IV NSCLC. The authors have taken on the challenging task of summarizing recent clinical research, referencing current clinical studies, and providing some predictions on the outcomes of ongoing clinical investigation.

In recent years, the treatment of many patients with non-small-cell lung cancer (NSCLC) has evolved into a multidisciplinary effort combining the talents of medical oncologists, radiation oncologists, and thoracic surgeons. Prospective, randomized trials have demonstrated improved survival rates in patients with locally advanced disease who are treated with cisplatin (Platinol)-based induction chemotherapy prior to radiation therapy[1,2] or surgery.[3,4] However, interpretation of these and other studies and application of the findings to the management of an individual patient require a thorough understanding of prognostic factors and staging.

The management of patients with non-small-cell lung cancer (NSCLC) is still evolving. Newer third-generation chemotherapy (paclitaxel [Taxol]-based; vinorelbine [Navelbine]/cisplatin [Platinol]) is more effective than

ROCKVILLE, Md-The FDA has given final approval to the Xillix LIFE-Lung Fluorescence Endoscopy System for use in detecting early lung cancer. Xillix Technologies Corp., of Richmond, British Columbia, plans to market the system worldwide in early 1997.

Patients with advanced non-small-cell lung cancer (NSCLC) who are treated with chemotherapy and radiation therapy live longer, on average, than patients treated with radiation therapy alone, according to results of a long-term follow-up study by Robert O. Dillman, md, and colleagues at the Hoag Cancer Center, Newport Beach, California. In the study report appearing in the September 4th issue of the Journal of the National Cancer Institute, the authors recommend that cisplatin (Platinol)-based chemotherapy followed by radiation therapy be considered the current standard treatment for advanced (stage III) disease.

Gemcitabine (Gemzar), recently approved by the FDA as a treatment IND for patients with advanced or metastatic pancreatic cancer, has shown promise in the treatment of non-small-cell lung cancer (NSCLC), both as a single agent and in combination with other chemotherapy drugs, Alan Sandler, md, reported at a symposium held at the Chemotherapy Foundation meeting last year.

BETHESDA, Md--Although there is some "good news" on the tobacco front--lung cancer deaths have declined in one US demographic group--the bad news continues to pour in from all over the globe, an NCI official told a symposium sponsored by NCI and the American Society of Clinical Oncology (ASCO).

RICHMOND, BC--The FDA's Ear, Nose, and Throat Device Advisory Panel has voted unanimously in favor of recommending a premarket approval (PMA) application for Xillix LIFE-Lung, a fluorescence imaging system that helps identify early lung cancer (see figure ).

ASCO--Cycling docetaxel (Taxo-tere) treatments with cisplatin (Platinol) and vinorelbine (Navelbine) achieves better response rates in non-small-cell lung cancer (NSCLC) patients than can be expected from any of the components used alone or in traditional combination, according to the multicenter pilot study presented by Jean Viallet, MD, at a pos-ter session of the American Society of Clinical Oncology (ASCO) meeting in Philadelphia

ASCO--Non-small-cell lung cancer (NSCLC) patients receiving paclitaxel (Taxol) plus cisplatin (Platinol) had longer survival and achieved high-er rates of response than patients receiving a current standard chemotherapy regimen of cisplatin plus etoposide (VePesid) in a multicenter phase III trial, Phillip Bonomi, MD, reported at a scientific session of the American Society of Clinical Oncology (ASCO) annual meeting in Philadelphia.

Dr. Krasna provides a thoughtful review of thoracoscopy as an emerging technique for the staging of patients with lung and esophageal cancers. In lung cancer, thoracoscopy can be used as a complement to cervical mediastinoscopy in the evaluation of mediastinal and hilar lymph nodes. This is especially true in patients who have left-sided neoplasms with enlarged lymph nodes in the aortico-pulmonary window--a region typically inaccessible to cervical mediastinoscopy.

The incidence of breast cancer has risen steadily over the past several decades. Breast cancer is second only to lung cancer as a cause of cancer deaths among women; 46,000 women died of breast cancer in the United States alone in 1995. Despite efforts to improve the survival of women with metastatic breast cancer with currently available chemotherapeutic agents, results remain disappointing. The primary use of such agents continues to be for palliation, not cure.

Staging is extremely important in determining the proper treatment of patients with thoracic malignancies. Staging groups can be used to predict outcome after cancer treatment and allocate patients to appropriate treatment

FORT LAUDERDALE, Fla--One of the most debated topics of the preliminary practice guidelines prepared by the National Comprehensive Cancer Network (NCCN) has been the level of surveillance after treatment, and this was also the case with the preliminary guideline for small-cell lung cancer (SCLC), presented by George D. Demetri, MD, at the NCCN's first annual conference.

Many patients with non-small-cell lung cancer (NSCLC) respond to treatment with docetaxel (Taxotere), according to results presented at the 1994 European Society for Medical Oncology (ESMO) meeting in Lisbon, Portugal.

For patients with either limited or extensive small-cell lung cancer (SCLC), dose intensification of VICE chemotherapy affords a significant survival advantage without increasing the danger of sepsis or drug-related death, W.P. Steward, MD, said at the Eighth Annual European Cancer Conference (ECCO-8).

The delivery of chemotherapy simultaneously with radiotherapy may be the optimal way to improve survival in patients with non-small-cell lung cancer (NSCLC). The median survival time of the 79 patients in a nonrandomized pilot trial (RTOG 91-06) was 19 months.

Topotecan HCl, an investigational anticancer drug, has demonstrated significant antitumor activity in previously treated small-cell lung cancer (SCLC) patients, according to European Organization for Research and Treatment of Cancer (EORTC) researchers, who presented phase II trial data at the Eighth European Conference on Clinical Oncology, Cancer Research and Cancer Nursing (ECCO-8) in Paris.

PARIS--Relapse after induction chemotherapy is a virtual inevitability in patients with small-cell lung cancer (SCLC), and response rates to second-line chemotherapy have been generally disappointing. However, new study results presented at the Eighth Annual European Cancer Conference (ECCO-8) suggest that topotecan, an investigational topoisomerase I inhibitor, may improve second-line results.

BETHESDA, Md--The Oncologic Drugs Advisory Committee (ODAC), in a vote of 9 to 4, recommended that Verluma imaging be approved for the initial staging of patients with biopsy-confirmed small-cell lung cancer (SCLC). Verluma is a murine monoclonal antibody (MoAb) Fab fragment, targeted to the NR-LU-10 antigen and linked to technetium-99m.

Topotecan HCl, an investigational anticancer drug, has demonstrated significant antitumor activity in previously treated small-cell lung cancer (SCLC) patients, according to European Organization for Research and Treatment of Cancer (EORTC) researchers, who presented phase II trial data at the Eighth European Conference on Clinical Oncology, Cancer Research and Cancer Nursing (ECCO-8) in Paris.

New research suggests that the reason aspirin may protect against certain cancers is its ability to inhibit prostaglandins, chemicals naturally produced by the body that are suspected of playing a role in colorectal and lung cancer.

Positron emission tomography (PET) can save hospitals tens of thousands of dollars in the evaluation of patients with

LUXEMBOURG-Home administration of erythropoietin (epoetin alfa, Epogen, Procrit) safely prevented or delayed the development of chemotherapy-associated anemia and reduced transfusion requirements by as much as 35% in a multicenter study of patients with small-cell lung cancer (SCLC), Nicholas Thatcher, MD, said at the 7th International Symposium of the Multinational Association of Supportive Care in Cancer (MASCC).

The POpulation HEalth Model (POHEM) lung cancer microsimulation model has provided a useful framework for calculating the cost of managing individual cases of lung cancer in Canada by stage, cell type, and treatment modality, as well as the total economic burden of managing all cases of lung cancer diagnosed in Canada. These data allow an estimation of the overall cost effectiveness of lung cancer therapy. The model also provides a framework for evaluating the cost effectiveness of new therapeutic strategies, such as combined modality therapy for stage III disease or new chemotherapy drugs for stage IV disease. By expressing the cost of lung cancer treatment as cost of life-years gained, such analyses allows useful comparisons of the cost effectiveness of these treatments with those of other costly but accepted medical therapies. [ONCOLOGY 9(Suppl):147-153, 1995]

SEATTLE-"Staging of lung cancer by physicians is frequently incomplete and often inaccurate," Scott B. Chelemer, MD, said in an interview at the 1995 International Conference of the American Thoracic Society and American Lung Association. He believes that a computerized lung cancer database that included all clinical, radiographic, and histologic data for every patient could improve staging and possibly outcomes.

SEATTLE-The idea that limited resections in lung cancer necessarily yield a poorer outcome does not hold up, says John P. Griffin MD, chief, Division of Pulmonary and Critical Care Medicine, University of Tennessee, Memphis, Health Science Center.

WINNIPEG, Canada-Clinical trials have shown that the level of symptom distress at the time of lung cancer diagnosis can predict survival, and now a study performed in an ambulatory setting has confirmed this finding. Patients with higher symptom distress scores are likely to die more quickly than those with lower scores, report University of Manitoba researchers Lesley F. Degner, RN, PhD, and Jeffrey A. Sloan, PhD.