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Lung Cancer

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January 2nd 1998

Prophylactic cranial irradiation (PCI) is being reintroduced into multimodality treatment protocols of patients with small-cell lung cancer (SCLC). The history of its use brings interesting insights into clinical evaluations of treatment strategies and design of relevant and informative trials. The critical issues of effectiveness and overall health gains of prophylactic cranial irradiation have been addressed in a series of recently completed clinical trials. These trials tested prophylactic cranial irradiation in small-cell lung cancer patients achieving good response to induction therapy and confirmed the ability of standard prophylactic cranial irradiation schedules to significantly reduce the lifetime risk of brain metastases. A subset of these trials evaluated neurotoxicity in a formal and prospective manner. No sustained or significant detriment in neuropsychometric function could be linked to the use of prophylactic cranial irradiation. In addition, all the large trials have shown a consistent survival advantage in favor of the prophylactic cranial irradiation arm. None of the individual sample sizes were large enough to statistically confirm this survival benefit, but a meta-analysis is in progress and will report on this aspect of evidence shortly. Issues that remain to be answered are the optimal dose and schedule of prophylactic cranial irradiation as well as the timing of this administration. These questions form the nucleus of the next generation of collaborative trials that are being designed.[ONCOLOGY 12(Suppl 2):19-24, 1998]


CME Content


Topotecan hydrochloride (Hycamtin), as a single agent or in combination with other agents, may offer a new treatment option for people suffering from small-cell lung cancer, according to results from five clinical trials reviewed at the 15th

BETHESDA, Md-A leading medical oncologist laments the refusal of many physicians to even discuss the option of adjuvant chemotherapy with patients who have operable lung cancer. Paul Bunn, Jr., MD, director of the University of Colorado Cancer Center, noted that the first drugs used in lung cancer patients, alkylating agents, actually reduced survival time.

BETHESDA, Md-Rehabilitation techniques, honed over years of experience with patients suffering from chronic obstructive pulmonary disease (COPD), offer the potential to improve the quality of life for lung cancer patients and lower the cost of their care, Andrew L. Ries, MD, said at a workshop sponsored by the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE) and the International Cancer Alliance. These techniques should be tested further in clinical trials with lung cancer patients, he added.

PHILADELPHIA-The growing use of pulmonary cytology, and consequent increasing experience of cytopath-ologists, has raised the diagnostic accuracy of the five basic pulmonary cytology techniques, Nadia Al-Kaisi, MD, told Oncology News International in an interview after her workshop on the subject at the annual fall meeting of the American Society of Clinical Pathologists (ASCP) and College of American Pathologists (CAP).

During the past 5 years, real strides have been made in the management of advanced non-small-cell lung cancer (NSCLC). The introduction of newer chemotherapeutic agents and novel treatment regimens is paving the way for marked improvements in both clinical outcomes and quality of life.

Data from North American clinical trials have shown that vinorelbine (Navelbine) is well tolerated when used as a single agent for the treatment of non-small-cell lung cancer, advanced breast cancer, or ovarian cancer. Myelosuppression is the primary dose-limiting toxicity.

The past 5 years have witnessed an evolution in the management of unresectable non-small-cell lung cancer (NSCLC) in the United States. Combined-modality treatment with chemotherapy plus irradiation has become the standard of care for stage III (locally advanced) disease. Most patients with stage IIIB disease and cytology-positive pleural effusion are now considered candidates for chemotherapy, as are those with stage IV disease.

Newer chemotherapy drugs have shown encouraging activity in advanced non-small-cell lung cancer. Based on these improved outcomes, as well as the high rate of distant relapse in patients with locally advanced disease, several recent studies have evaluated the use of systemic therapy in patients with earlier-stage disease.

Two large-scale, randomized, phase III trials have offered new information on the response rates, survival benefits, and safety profile of vinorelbine (Navelbine) in non-small-cell lung cancer (NSCLC). In a multicenter, European trial, the response rate was significantly higher with vinorelbine/cisplatin (Platinol) than with vindesine (Eldisine)/cisplatin (P < .02) or vinorelbine alone (P < .001).

DUBLIN-A new diagnostic strategy using fluorescence bronchoscopy has proven six times more sensitive than white-light bronchoscopy alone in picking up preinvasive lung lesions, Stephen Lam, MD, of the University of British Columbia, reported at the 8th World Conference on Lung Cancer.

DUBLIN-Two metaanalyses have pointed to small but clear-cut survival gains for patients with inoperable locally advanced non-small-cell lung cancer (NSCLC) who receive chemotherapy and radiotherapy. Now, a randomized phase III Japanese study indicates that response rates are higher and survival longer when the two therapeutic modalities are given concurrently rather than sequentially.

DUBLIN-Preliminary results suggest that the use of single-agent topotecan (Hycamtin) as second-line therapy for small-cell lung cancer (SCLC) in patients who failed after an initial response to first-line therapy provides efficacy similar to that of the commonly used regimen of cyclophosphamide, doxorubicin (Adriamycin), and vincristine (CAV).

DUBLIN-Harnessing MIC chemotherapy to radiotherapy is more effective than radiotherapy alone in patients with locally advanced inoperable non-small-cell lung cancer (NSCLC), according to the findings of a multicenter randomized UK trial reported at the 8th World Conference on Lung Cancer.

DUBLIN-The question of whether patients with locally advanced non-small-cell lung cancer (NSCLC) would live longer if they underwent chemotherapy prior to surgical resection would appear to be yes, based on two randomized trials reported in 1994.

DUBLIN-The shift from histologic classification to molecular analysis of bronchial epithelial cells is opening up new prospects for detecting the molecular signature of lung cancer before the disease becomes clinically evident, James L. Mulshine, MD, of the National Cancer Institute, said at the 8th World Conference on Lung Cancer.

BETHESDA, Md-The Food and Drug Administration’s Oncologic Drugs Advisory Committee (ODAC) has recommended approval of QLT Photo-Therapeutics’ Photofrin (porfimer sodium) for use as photodynamic therapy (PDT) of T1 stage endobronchial carcinoma in patients with non-small-cell lung cancer (NSCLC) for whom surgery and radiotherapy are not indicated.