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

Irinotecan (CPT-11) and cisplatin (P) are both active agents against non-small cell lung cancer (NSCLC), and their combination has shown in vitro an additive or synergistic effect. We conducted a phase II study to determine the toxicity and efficacy of their combination as salvage treatment in patients with advanced NSCLC progressing after a docetaxel-based front line regimen. Forty-four patients with histologically confirmed NSCLC were enrolled. The patients' median age was 60.5 years; 39 patients (87%) were male; 38 (86%) had stage IV disease; and 32 (73%) had a performance status (WHO) 0-1. CPT-11 was administered as a 60 min i.v. infusion at a dose of 100 mg/m(2) on day 1 and 110 mg/m(2) on day 8; P was administered at a dose of 80 mg/m(2) on day 8 after CPT-11 administration. Treatment was repeated every 3 weeks. A total of 159 chemotherapy cycles was administered. In an intention-to-treat analysis, nine patients (22; 95% CI: 9.28-34.62%) achieved a partial response (PR), 8 (20%) had stable disease (SD), and 24 (58%) progressive disease (PD). The median duration of response was 4 months, the median time-to-progression (TTP) 8 months, and the median survival for the entire group 8 months. Grade 3-4 neutropenia was observed in 20 (46%) patients and in four cases this was febrile, requiring patient's hospitalisation. Grade 3-4 thrombocytopenia occurred in four (9%) patients. Grade 3-4 diarrhoea was seen in 12 (27%) patients and three of them required hospitalisation. Grade 2-3 neurotoxicity was observed in two (4%) patients and grade 2-3 fatigue in 14 (32%). Other toxicity was mild and no treatment-related death was reported. The combination of CPT-11 and P is a safe, well-tolerated, and active regimen for the treatment of patients with advanced NSCLC previously treated with a docetaxel-based front-line regimen.
Lung Cancer 2001 Dec
PMID:Cisplatin and irinotecan (CPT-11) as second-line treatment in patients with advanced non-small cell lung cancer. 1174 7

Cancer-related causes of anaemia include anaemia of chronic disorders, infections, autoimmune haemolysis associated with malignant conditions, bone marrow invasion by the tumour or clonogenic marrow dysfunction, iron, folate, or vitamin B 12 deficiency and bleeding from tumour erosion. Treatment-related anaemia results from chemotherapy, radiotherapy and bone marrow fibrosis. Severe anaemia increases the burden of treatment, contributes to fatigue, reduces the quality of life and may also delay or limit further treatment. Blood transfusion is currently the most common form of treatment and patients rarely require transfusion unless the haemoglobin is less than 8 g/l. It is often difficult to predict which patients will develop anaemia and require treatment, but the proportion of patients receiving transfusions increases markedly if the pre-treatment haemoglobin concentration is below 10 g/dl. Four studies have systematically evaluated the effects of erythropoietin on anaemia in lung cancer patients and each of these trials is likely to contribute information concerning the clinical benefit of erythropoietin in treating or preventing treatment-related or disease-related anaemia. Most of the improvements in quality of life observed with erythropoietin administration occurred with haemoglobin levels between 10 and 12 g/dl, and not with levels between 7 and 10 g/dl, with a plateau effect above 12 g/dl. Consequently, a 'functional' level of haemoglobin that appears to be more important is 12 g/dl, because it may be favourably associated with a significant improvement in fatigue compared with lower haemoglobin levels. This 'functional' level would be in keeping with the body's physiological erythropoietin response.
Lung Cancer 2001 Dec
PMID:Role of erythropoietin in the treatment of lung cancer associated anaemia. 1174 10

The aim of the present phase II study was to assess the activity and safety of gemcitabine-cisplatin combination in advanced NSCLC, and to evaluate the impact of this regimen in terms of symptom benefit and quality of life (QOL). Eighty patients with pathologically confirmed advanced (stage IIIB and IV) NSCLC were enrolled into this study. Gemcitabine was administered on days 1, 8 and 15 at a dose of 1000 mg/m(2), and cisplatin was given on day 2 at a dose of 100 mg/m(2). The cycles were repeated every 4 weeks. The impact of treatment on QOL and on tumor-related symptoms was evaluated with the validated EORTC forms (QLQ-C30 and LC-13). The regimen was relatively well tolerated. Myelosuppresion was the principal toxicity. Grade 3/4 neutropenia, thrombocytopenia and anemia occurred in 58, 65 and 30% of patients respectively. In 143 cycles (35%) the administration of gemcitabine on day 15 was omitted due to myelosuppresion. Non-hematological toxicities were generally mild. Among the 76 patients available for response evaluation, there were 5 complete responses (7%) and 26 partial responses (34%); an overall response rate of 41%. The median duration of response was 8.0 months. The median survival for all 80 patients was 11.0 months and the actuarial 1-year survival probability 45%. During therapy global QOL improved in 22% of patients and particular functional domains increased in 19-37% of patients. Dyspnea was released in 36% of patients, fatigue in 45%, chest pain in 38%, shoulder pain in 27%, cough in 44%, and hemoptysis in 75%. The mean intensity scores of the last three symptoms decreased significantly with therapy. Our study confirmed relatively high efficacy of the gemcitabine-cisplatin combination in patients with advanced NSCLC. Of particular importance was that treatment with gemcitabine-cisplatin combination in a large proportion of patients was also associated with remarkable symptomatic release and with improvement of QOL. However, the high frequency of myelotoxicity-related gemcitabine omissions on day 15 of the cycle indicates that modification of the schedule should be considered in standard care.
Lung Cancer 2002 Jan
PMID:A phase II study of gemcitabine plus cisplatin in patients with advanced non-small cell lung cancer: clinical outcomes and quality of life. 1175 Jul 16

Fatigue has been identified as both a chronic and recurrent problem for individuals diagnosed with and treated for cancer, yet there is little information on how to manage the impact of fatigue. Describing what happens to individuals and their families as a result of fatigue and identifying what individuals do to manage or reduce the impact of fatigue are essential elements in determining multidimensional nursing interventions. The purpose of this pilot study was to examine the impact of fatigue on individuals with cancer of the lung and their families, and explore how they managed as a result of the fatigue. A semi-structured interview guide was used with 22 lung cancer patients and 14 family members six weeks post completion of radiation therapy. Results indicated that fatigue was not reported as a major concern by many of the participants in this study. For those who did experience fatigue, it was considered an inconvenience and a frustration that had to be dealt with for a limited time period. Some patients appeared to gradually adjust and accommodate to the fatigue and were not really aware of the changes that took place over time. Over half of the family members felt more of the impact of fatigue than did their loved ones. Family subtly assumed or took over responsibilities and activities the patient could no longer perform. The symptom of fatigue has been well documented in the cancer experience as both a chronic and recurrent problem for individuals diagnosed with and treated for cancer. The emphasis of previous work has been on deriving a conceptual definition of fatigue, achieving consensus on a definition, and developing theoretical frameworks to guide further study of this complex construct. Fatigue has been conceptualized as a multidimensional phenomenon, attributable to multiple causes and having a negative effect on quality of life (Piper, 1993; Tiesinga, Dasson, & Halfens, 1996). Describing what happens to individuals and their families as a result of fatigue and identifying what individuals do to manage or reduce the effects caused by the fatigue are essential elements in determining multidimensional nursing interventions.
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PMID:The impact and management of cancer-related fatigue on patients and families. 1184 51

Lung cancer is diagnosed at an advanced stage in a majority of patients. Recent advances made in the treatment of lung cancer have resulted in a prolongation in survival and an improvement in quality of life. The majority of lung cancer patients experience multiple symptoms, which result from both the cancer and its treatment. Fatigue and anemia cause significant morbidity and impaired quality of life among patients with lung cancer. They also contribute to a suboptimal response to treatment modalities such as radiation, decreased performance status, and poor patient compliance with treatment. The impact of anemia is frequently under-recognized. Improvements in survival made with multimodality therapy can only be meaningful when combined with interventions to improve symptoms and overall quality of life. Prompt recognition of these problems and early intervention are an integral part of cancer therapy. In this review, we discuss the impact of anemia and the treatment options that could contribute to a truly meaningful survival in lung cancer patients.
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PMID:Meaningful survival in lung cancer patients. 1189 23

The aim of this study was to assess the relationship between haemoglobin level and quality-of-life in anaemic cancer patients. Patients, diagnosed with one of four cancers, were recruited if their haemoglobin level was <12 g dl(-1) (female) or <13 g dl(-1) (male). The condition-specific Functional Assessment of Cancer Therapy-Anaemia and the generic SF-36 were used to assess quality-of-life. Thirty-six per cent of the 179 recruited patients had breast cancer, 28% ovarian cancer, 25% lung cancer, and 11% multiple myeloma. Their mean (s.d.) haemoglobin level was 10.66 (1.04) g dl(-1). Partial correlations controlling for the potentially confounding effects of age, gender, and time since diagnosis found significant positive relationships between haemoglobin and all domains of the Functional Assessment of Cancer Therapy-Anaemia, and with all but two of the SF-36 domains. On linear regression controlling for the same factors, each unit haemoglobin rise equalled an average 8.19 Functional Assessment of Cancer Therapy-Anaemia, and an average 6.88 Functional Assessment of Cancer Therapy-Fatigue, increase. Haemoglobin accounted for a similar amount of variability (8%) in SF-36 scores. In conclusion, quality-of-life has been found to be significantly positively related to haemoglobin level in anaemic cancer patients. This suggests that normalisation of haemoglobin in cancer patients is likely to increase their quality-of-life. The greater sensitivity of the condition-specific Functional Assessment of Cancer Therapy-Anaemia compared with the generic SF-36 suggests that the Functional Assessment of Cancer Therapy-Anaemia can be used alone to assess quality-of life in this patient group.
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PMID:The level of haemoglobin in anaemic cancer patients correlates positively with quality of life. 1195 80

This study aimed to compare the impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer. One hundred seventy-one outpatients with advanced lung cancer completed a questionnaire about symptom severity and whether symptoms interfered with daily life activities (normal work, walking, sleep, mood, relation with other people, enjoyment of life, and general activities). The results indicated that 1) dyspnea and fatigue interfered with at least one daily life activity in more than half the patients, and pain in about 40%, 2) dyspnea and fatigue interfered predominantly with physical activities, such as walking and work, whereas pain interfered with all activities almost equally, and 3) symptoms rated as low severity (1 to 3 on a 0-10-point numerical scale) were severe enough to interfere with at least one daily life activity. To recognize the impact of symptoms may contribute to provide better management.
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PMID:Impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer. 1200 59

Although 60% of those diagnosed with non-small-cell lung cancer are 60 years of age or older, the elderly are often undertreated. Furthermore, those older than age 70 are under-represented in clinical research trials. Tremendous bias exists against treating the elderly; therapeutic nihilism and constrained societal/financial resources conspire to maintain the status quo. In limited stage small cell carcinoma of the lung (SCLC), a pivotal meta-analysis by Pignon et al. showed no obvious benefit for chemoradiation over chemotherapy alone in patients older than 70 years of age. However, more recent trials have revealed a clear-cut benefit for fit elderly patients to receive combined modality therapy versus chemotherapy alone, even though outcome generally remains superior for younger patients. For patients with locally advanced non-small-cell lung cancer, conflicting results exist. Individual trials evaluating combined modality therapy have shown no impairment in survival for older patients, but retrospective analyses of the Radiation Therapy Oncology Group database have demonstrated that increased therapeutic intensity does not translate into improved outcome compared with standard, single daily fraction radiation alone. Weighted survival analyses that deduct time spent with progressive disease or significant toxicity have reinforced this notion. In advanced non-small-cell lung cancer, fit elderly patients who receive platinum-based regimens do as well, or nearly as well, as patients younger than age 70, although the incidence of neutropenia and fatigue is often higher. Platinum doses above 75 mg/m2 every 3 weeks to 4 weeks are relatively more toxic in the elderly than are lower doses. Three separate studies from Italy have formally assessed the elderly. One showed superiority for single-agent vinorelbine versus best supportive care regarding survival rates and quality of life. A second showed a marked survival advantage for combination vinorelbine and gemcitabine versus vinorelbine alone. However, a much larger, more credible study demonstrated no benefit for combination vinorelbine and gemcitabine versus the constituent single agents. To date, no elderly-specific trials have addressed the role of taxanes or of platinum-based combination therapy versus non-platinum monotherapy or doublets. Comprehensive evaluation of comorbidities and their influence on outcome have not been conducted, and there are virtually no data for patients older than age 80.
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PMID:Elderly patients with lung cancer: biases and evidence. 1205 91

We conducted a phase I study of irinotecan (CPT-11) and cisplatin with concurrent split-course radiotherapy in limited-disease small-cell lung cancer (LD-SCLC). This study aimed to determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of this therapy. Four chemotherapy cycles of CPT-11 (days 1, 8 and 15) and cisplatin (day 1) were repeated every 28 days. Radiotherapy of 2 Gy/day commenced on day 2 of each chemotherapy cycle with 20 Gy administered from the first to the third cycles (a total of 60 Gy). 17 patients were enrolled at three dose levels (CPT-11/cisplatin: 40/60, 50/60 and 60/60 mg/m(2)), and 16 were evaluable for toxicity and outcome. 2 of 4 patients at 60/60 mg/m(2) refused continuation of therapy because of general fatigue, and the relative dose intensity of CPT-11 at 50/60 mg/m(2) was approximately 50%. These levels were considered as the MTD. Tumour responses included four complete responses (CR), 11 partial responses (PR) and one no change (NC), and the overall response rate was 93.8% (95% confidence interval: (CI) 71.7-98.9%). This combined modality is tolerable, and CPT-11/cisplatin of 40/60 mg/m(2) in this modality is recommended for phase II study.
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PMID:Phase I study of irinotecan and cisplatin with concurrent split-course radiotherapy in limited-disease small-cell lung cancer. 1237 4

A phase I study of gemcitabine (GEM) and docetaxel (TXT) combination chemotherapy was performed for unresectable non-small-cell lung cancer. Chemotherapy consisted of a fixed dose of GEM (1,000 mg/m2) on day 1, 8 and an escalated dose of TXT (50, 60, 70 mg/m2) on day 8 every 21 days, > or = 2 courses. Nine patients were entered (each dose level: 3 patients). Leukopenia, neutropenia, GOT increase, GPT increase, anorexia, fatigue, fever, and alopecia occurred, but no dose-limiting toxicity was found at any dose level and no MTD was reached. The recommended dose for the phase II study is GEM 1,000 mg/m2 and TXT 70 mg/m2 with consideration of application to outpatients and continuing courses.
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PMID:[Phase I study of gemcitabine (GEM) and docetaxel (TXT) combination chemotherapy for unresectable non-small-cell lung cancer]. 1246 92


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