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Query: UMLS:C0242379 (lung cancer)
 71,905 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Interleukin-2 (IL-2) and beta-interferon (beta-IFN) are biologic agents with antitumor activity observed in preclinical models. Some studies of patients with advanced non-small cell lung cancer treated with IL-2 report relatively long survival, despite low response rates. Seventy-six evaluable patients with stage IV non-small cell lung cancer were treated in a randomized Phase II study with either IL-2 alone or IL-2 plus beta-IFN. Patients received either IL-2 at 6 x 10(6) Cetus units/m2 3 days weekly or the combination of IL-2 at 5 x 10(6) Cetus units/m2 plus beta-IFN at 6 x 10(6) units/m2, both given 3 days weekly. Both biologic agents were administered by intravenous bolus injection on an outpatient basis. Objective responses were observed in 3/76 (4%)) patients. Grade 4 toxicity occurred in 3/39 patients treated with IL-2 alone, and in 4/37 patients treated with IL-2 plus beta-IFN. An additional lethal respiratory toxicity occurred in a patient who received IL-2 plus beta-IFN. The median survival of all patients treated on this study was 33 weeks. Despite producing only a 4% objective response rate. IL-2 appears to have a favorable impact on survival comparable to chemotherapy. The role for this immune therapy in the management of non-small cell lung cancer requires further study.
Lung Cancer 1999 Sep
PMID:A randomized Phase II study of interleukin-2 with and without beta-interferon for patients with advanced non-small cell lung cancer: an Eastern Cooperative Oncology Group study (PZ586). 1051 31

The purpose of this study was to evaluate the outcome of treatment for patients with newly diagnosed nonsmall-cell lung cancer (NSCLC) with an isolated, single, synchronous brain metastasis. A retrospective review was performed evaluating any patient diagnosed between 1982 and 1996 at the Cleveland Clinic Foundation with NSCLC metastatic only to the brain. Patients with multiple brain metastases or with systemic metastases to any other organ were excluded. Survival was measured from the date of the first treatment for malignancy. All hospital records were thoroughly reviewed in a retrospective manner. Thirty-three patients were identified who met the study criteria. Twelve patients had primary disease limited to the lung and hilar nodes, and 21 had more advanced primary disease with involvement of the mediastinum. Treatment of the chest was considered aggressive in 13 patients and palliative in 15. The primary tumor was observed in 5 patients. The management of the brain metastasis was as follows: 21 patients underwent surgical resection and postoperative whole brain radiotherapy (WBRT), 5 underwent stereotactic radiosurgery (SRS) and WBRT, 3 had resection alone, 2 had SRS alone, and 2 underwent WBRT alone. The median overall and disease-free survival for all patients was 6.9 months and 3.3 months, respectively. Overall survival was markedly improved with the addition of WBRT (P = 0.002) and with the aggressive management of the primary tumor (P = 0.005). A total of 9 patients experienced CNS failure, including both patients receiving WBRT alone. CNS failures were divided as follows: 3 local, 5 distant, and 1 local and distant. Two of the 4 patients with a local failure were salvaged, and ultimate local control of the original brain metastasis was achieved in 93.6% of cases. Survival remains poor for patients with Stage IV NSCLC even when metastatic disease is limited to a single site within the brain; however, aggressive therapy of both the lung primary and the brain metastasis may provide a survival advantage. Excellent local control of single brain metastases was achieved with a combination of WBRT with either surgical resection or SRS.
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PMID:Treatment outcome for patients with primary nonsmall-cell lung cancer and synchronous brain metastasis. 1058 Sep 1

Oral chemotherapeutic regimens with limited toxicity are desirable in that quality of life can be maintained and clinic/hospital visits minimised during therapy. We have investigated the use of extended courses of oral cyclophosphamide and oral etoposide for the treatment of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). A 14-day course of oral combination chemotherapy every 28 days resulted in a 12% response rate and a median survival of 6 months (1-year survival, 26%) in stage IV NSCLC. This regimen could not be intensified with carboplatin because of synergistic granulocytopenia. A 14-day course every 28 days resulted in a 40% response rate and a median survival of 7 months in poor-prognosis extensive-disease SCLC. Pharmacodynamic modelling revealed that the granulocyte nadir could be predicted from a single plasma etoposide level drawn on the second day of therapy, potentially allowing dose adjustment during the treatment cycle. Oral chemotherapy remains a promising route for the treatment of lung cancer.
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PMID:Cyclophosphamide and etoposide for non-small cell and small cell lung cancer. 1071 36

BACKGROUND:The management of stage IV non-small-cell lung cancer (NSCLC) has been a controversial subject over the past several decades. Data from randomized trials and from phase II trials on new cancer agents are changing physician attitudes and treatment practices. METHODS: The literature on the management of metastatic lung cancer was reviewed and interpreted. RESULTS: There is good evidence from randomized controlled trials and meta-analyses that chemotherapy provides a modest survival benefit in stage IV NSCLC. There is indirect evidence of improvement in quality of life, as systemic chemotherapy palliates cancer-related symptoms in the majority of patients. New drug combinations are likely to improve recent treatment results with less morbidity than older chemotherapy regimens. Despite the relatively high cost of these treatments, chemotherapy is cost effective in the Canadian health care environment relative to other accepted medical interventions. CONCLUSIONS: Chemotherapy will play an increasing role in the management of patients with advanced NSCLC.
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PMID:Management Issues for Stage IV Non-Small Cell Lung Cancer. 1076 36

The paper is aimed at approaching radiation therapy methods to physicians of other specialties and pointing to the potential of radiation therapy in the management of lung cancer patients. With the reference to its incidence and mortality rates, lung cancer ranks among the most frequent human malignant tumors. Therapy procedures for lung cancer depend upon tumor histology type, stage of disease and patient general condition. The said parameters therefore determine the application of surgery, radiation therapy and/or chemotherapy. In general, treatment results are usually rather poor, primarily due to lung cancer being the most frequently detected only as locally advanced or metastatic disease. Alike surgery, radiotherapy is a local form of treatment aimed at achieving local tumor control. This curative or palliative form of treatment is either applied alone or in combination with other treatment modalities. Irradiation is usually delivered by high energy photon beams from a telecobalt device or linear accelerator. The success of radiation therapy complies with the irradiation dose managed to be applied to tumor or tumor bed, which depends on patients general condition and site, size and spread of tumor. Radiotherapy with curative intent is applied in stage I, II and III non-small cell lung cancer patients with surgery being primarily applied in those with stage I and II. The efficacy of surgical treatment is to be improved by a combined-modality treatment. In stage III patients, who are more frequent than others, radical radiotherapy alone or in combination with chemotherapy is applied. Results of clinical trials report patients of relatively good general condition benefiting from combined-modality therapy. Palliative radiotherapy is to be applied in patients with stage IV non-small cell lung cancer. On the other hand, in patients with small cell lung cancer chemotherapy is the primary modality treatment. When the disease is limited to the lungs, the aim of radiotherapy is to optimize local control of the primary tumor.
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PMID:[Radiotherapy of lung cancer]. 1083 86

Small-cell lung cancer (SCLC) is, in general, sensitive to anti-cancer chemotherapy and radiotherapy. Standard therapies for extensive SCLC are combination chemotherapies with cyclophosphamide, adriamycin and vincristine (CAV), with cisplatin and etoposide (PE), as well as an alternating CAV/PE program. On the other hand, the standard therapy for limited SCLC is chemoradiotherapy, especially PE and concurrent accelerated hyperfractionated radiotherapy. Based on the therapy, the current state of treatment of small cell lung disease is a median survival time of 10 months and a 3-year survival in 10% of patients with extensive disease, and a median survival time of 30 months and a 3-year survival in 30% of patients with limited disease. Promising trials under investigation including those for dose-intensive chemotherapy, multimodality treatment and combination chemotherapy adopting new drugs are introduced. The standard therapy for inoperable stage III non-small cell lung cancer is a multimodality therapy employing chemotherapy and radiotherapy. However, neither the timing of the radiotherapy nor the optimal combination of anti-cancer agents has yet been established. Nowadays, the combination of cisplatin-based chemotherapy and radiotherapy is expected to bring a median survival time of 15 months and a 3-year survival in 25% of patients. For stage IV non-small cell lung cancer, chemotherapy prolongs survival time by a modest but statistically significant amount of time. For the treatment of inoperable lung cancer, the survival benefit from the use of newly developed drugs with or without platinum is under investigation.
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PMID:[Treatment of lung cancer--state of the art in 2000]. 1094 23

Several drugs active against non-small-cell lung cancer currently available. The efficacy of the cicplatin-gemcitabine combination was recently demonstrated in three randomized trials published over the last twelve months in the Journal of Clinical Oncology. This association compares favorably with cisplatin alone, cisplatin-etoposide and mitomycin-ifosfamide-cisplatin combinations. The cisplatin-gemcitabine combination can now be considered as a new "classical" activ regimen in stage IV NSCLC patients and could be used in patients with more favorable prognosis (i.e. in the periopertive seeting). Nevertheless, the benefit of such treatment in stage IV NSCLC seems to be limited to patients with a good performance status (PS 0 and 1).
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PMID:[Chemotherapy of stage IV non-small-cell lung cancer: contribution of gemcitabine]. 1113 61

A phase II study in patients with stage IIIB/IV non-small cell lung cancer (NSCLC) was carried out to evaluate the clinical activity and toxicity of the chemotherapeutic combination of gemcitabine+vinorelbine (GEM/VNR). Forty-five patients (40 male, 5 female) with a median age of 67 years (range 37-73) and a median ECOG performance status of 1 (range 0-2) were enrolled into the trial. Twenty patients had stage IIIB (two positive supraclavicular nodes and 20 cytologically positive pleural effusion), and 25 had stage IV NSCLC. GEM 1000 mg/m(2) diluted in 250 cc(3) of normal saline was administered iv on days 1, 8, and 15, while VNR was given 30 mg/m(2) on days 1 and 8 every 4 weeks. The median number of courses/patient was 4 (range 3-7). According to an intent-to-treat analysis 2 (4%) patients had a complete response and 16 (36%; 95% CL 22-52%) had a partial response for an overall response rate of 40% (95% CL 26-56%). Twelve (27%) patients had stable disease and 15 (33%) were considered as treatment failures. Median overall survival of the whole series was 8+ months with 33% of patients alive at 1 year. Toxicity was generally mild. WHO grade 3-4 neutropenia was recorded in 22% of cases, grade 1-3 liver toxicity in 6% of patients and neutropenia-unrelated fever in 9%. This multicentre phase II study suggests that the GEM/VNR combination regimen is an active and well tolerated regimen in patients with stage IIIB/IV NSCLC. Larger studies comparing cisplatin-based regimens to new schedules without cisplatin are warranted.
Lung Cancer 2001 Oct
PMID:Gemcitabine plus vinorelbine in stage IIIB or IV non-small cell lung cancer (NSCLC): a multicentre phase II clinical trial. 1155 21

Treatment of stage IV NSCLC has been a controversial issue during the last decade. However, there is now clear evidence that cisplatin-containing chemotherapy regimens lead to prolonged survival with an increase of the 1-year survival rates at about 10%. New drugs like gemcitabine, the taxanes (paclitaxel, docetaxel), and vinorelbine have shown very promising single-agent activity and have been included into modern combination chemotherapy regimens achieving response rates of 40 to 50% and 1-year survival rates of between 30 and 40%. In comparison to single-agent cisplatin or cisplatin/etoposide as 'standard treatment approaches', most of these modern combinations could demonstrate advantages in terms of response, survival and improved QOL. Patients with favourable prognostic factors are at the moment frequently treated with platinum-based combination chemotherapy often including one of these newer active drugs. Patients with adverse prognostic factors such as elderly or stage IV patients with a reduced performance status are preferably treated with single agents such as gemcitabine, paclitaxel or vinorelbine.
Lung Cancer 2001 Sep
PMID:Indications for chemotherapy in stage IV non-small cell lung cancer. 1157 15

Cisplatin-based chemotherapy improves survival in appropriately selected patients with stage IV non-small cell lung cancer (NSCLC). However, cisplatin-based regimens have well-known dose-related toxicities, particularly renal insufficiency and neurotoxicity. On the basis of prior preclinical and phase I studies, we initiated a phase II study of SPI-77 (STEALTH) Liposomal Cisplatin) in patients with stage IIIB and IV NSCLC who failed previous treatment with platinum. Disease in all subjects had progressed during therapy, failed to respond, or progressed within 3 months after discontinuing the platinum-based chemotherapy. Between January and June 1999, 13 patients were enrolled at our institution. Patient characteristics included: seven women, six men; median age, 61 years; median Karnofsky performance status, 80%; median number of prior chemotherapy regimens, two (range, 1-3). All patients had adequate hepatic and renal function. SPI-77 was administered at a dose of 260 mg/m(2) IV every 3 weeks. A median of two cycles (range 1-6) were given; the total number of cycles was 35. Among the 12 patients evaluable for response, two had (17%) stable disease and ten (83%) had progressive disease. The median survival was 24.3 weeks, and the median follow-up was 43.9 weeks. Toxicity could be evaluated in all subjects. Moderate anemia (46% of cycles, <or=grade 2; 3% of cycles, >or=grade 3) with minimal granulocytopenia and thrombocytopenia (26% of cycles grade 1; 0% of cycles, >or=grade 2) were the most notable manifestations of myelosuppression. Grade 3 nonhematological toxicities included dyspnea (8%), fatigue (8%), and pain (8%). There were no grade 4 toxicities. These data suggest that this liposomal cisplatin formulation does not have appreciable activity in this population of patients with NSCLC who had received prior platinum-based chemotherapy. The lack of encouraging results from SPI-77 use in other phase I and II studies resulted in early closure of this trial by the manufacturer.
Lung Cancer 2001 Dec
PMID:A phase II study of STEALTH cisplatin (SPI-77) in patients with advanced non-small cell lung cancer. 1171 40


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