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

Chemotherapeutic intervention in advanced and metastatic non-small-cell lung cancer (NSCLC) has changed over the past 2 decades. The improvements offered by cisplatin (Platinol)-based regimens, though significant in terms of survival and quality of life, were modest at best. Carboplatin (Paraplatin), which possesses a toxicity profile favorable to that of its parent analogue cisplatin, yielded survival rates superior to that of the cisplatin-combination chemotherapy arms in a large randomized study of patients with metastatic non-small-cell lung cancer. With the introduction of taxanes in the early 1990s, paclitaxel (Taxol) demonstrated single-agent activity of 21% to 24%, with a 40% 1-year survival rate in metastatic disease. The next generation of phase I/II studies evaluated the efficacy of paclitaxel in combination with carboplatin. Results with this regimen have shown substantial promise, and 1-year survival rates as high as 54% have been reported. Full doses of both agents have been combined without any additional toxicity, and there appears to be a dose-response effect with paclitaxel. The combination of paclitaxel and carboplatin has been incorporated as the investigational arm of all the ongoing multicenter and cooperative group studies. While the results from these randomized studies are awaited, this combination has become the most widely used regimen in community practice for patients with non-small-cell lung cancer. It is also being evaluated for treatment at earlier disease stages, in the setting of minimal tumor burden, and in combined-modality regimens.
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PMID:Paclitaxel/carboplatin in the treatment of non-small-cell lung cancer. 951 17

Non-small-cell lung cancer (NSCLC) will increasingly come under better control as the current approaches to therapy are more broadly employed and as new therapies are deployed against recently elucidated molecular pathways. In the United States, real progress is finally being made in decreasing tobacco consumption and in lung cancer incidence. The traditional chemotherapeutic compounds that became available earlier this decade (paclitaxel [Taxol], docetaxel [Taxotere], gemcitabine [Gemzar], vinorelbine [Navelbine], irinotecan [Camptosar], topotecan [Hycamtin], and edatrexate) have all been tested as single agents and as doublets with cisplatin (Platinol) and carboplatin (Paraplatin). Paclitaxel with cisplatin or carboplatin and vinorelbine, docetaxel, or gemcitabine with cisplatin have all demonstrated significant activity that now appears clearly better than the prior standard therapy of etoposide (VePesid)/cisplatin. Phase III studies sorting out their benefit relative to each other should be completed in the next 1 to 2 years. To date, no triplet therapy appears better than the corresponding doublet. Non-platinum-containing doublets are just completing their first round of assessments. Aside from new drugs and applications, the use of "small" molecules to inhibit either signal transduction pathways or gene activation is likely to accelerate. Most of the newer chemotherapeutic agents can be interdigitated with radiation and surgery, although evaluations into sequence and dose issues continue. The superior outcomes seen with the newer regimens should translate to the adjuvant and preoperative or preradiotherapy settings relatively quickly. It is now clear that NSCLC is as responsive to therapy as small-cell lung cancer (SCLC) and that outcomes are superior for NSCLC. The enthusiasm for treating SCLC displayed by nononcologists and nonthoracic medical oncologists should be shared for NSCLC.
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PMID:Future directions in non-small-cell lung cancer: a continuing perspective. 951 20

The costs and relative cost-effectiveness of different treatments for common illnesses are an increasing concern. New treatments for advanced non-small-cell lung cancer are having an impact. However, these treatments vary markedly in their direct financial costs, toxicity, and quality-of-life profiles. Direct comparisons between most combination regimens are not yet completed. Vinorelbine (Navelbine) is the first new agent approved in the United States for the treatment of metastatic non-small-cell lung cancer in more than a decade. We previously reported results of a post-hoc economic analysis that compared the anticipated cost-effectiveness of three regimens used to treat non-small-cell lung cancer (vinorelbine alone versus vinorelbine plus cisplatin [Platinol] versus vindesine plus cisplatin, the assumed standard treatment in Europe). Results showed that vinorelbine plus cisplatin was the most effective regimen. Using vinorelbine alone as a baseline, vinorelbine plus cisplatin added 56 days of life at an additional cost of $2,700, resulting in a cost-effectiveness ratio of $17,700 per year of life gained. Similarly, vindesine plus cisplatin added 19 days of life at a cost of $1,150, or $22,100 per year of life gained. Compared to vindesine plus cisplatin, vinorelbine plus cisplatin added 37 days of life at a cost of $1,570, or $15,500 per year of life gained. We conclude that the incremental cost-effectiveness of the vinorelbine plus cisplatin regimen was less than most commonly accepted medical interventions. If vinorelbine is preferred because of its favorable toxicity profile, the additional effectiveness of cisplatin added substantial efficacy at an acceptable cost.
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PMID:Overview of economic analysis of Le Chevalier Vinorelbine Study. 955 78

Circulating myeloid (CFU-GM) and erythroid (BFU-E) progenitor levels were evaluated weekly throughout 3 courses of treatment with vinorelbine (VNB) ifosfamide (IFO) and filgrastim (G-CSF) with or without addition of cisplatin (DDP) in 20 stage IIIB or IV non small-cell lung cancer patients. In IFO, VNB, DDP-treated patients, BFU-E mobilization in peripheral blood following chemotherapy and G-CSF was completely lacking, in contrast with the patients treated with IFO, VNB plus G-CSF. CFU-GM release, however, was of the same order in the 2 groups of patients. Further investigations are needed to explain why presence of DDP in this chemotherapeutic protocol hinders erythroid progenitor release in peripheral blood.
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PMID:Cisplatin inhibits erythroid committed progenitor (BFU-E) mobilization in peripheral blood. 968 95

Twenty-three patients with brain metastases from non-small cell lung cancer (NSCLC) (median age 62 years, Karnofsky PS 50-100) were treated with cisplatin (100 mg/m2, day 1) and teniposide (80 mg/m2, days 1, 3 and 5) every 3 weeks. Response was evaluated by contrast-enhanced brain CT every two to three cycles of treatment. The objective response rate of brain metastases was 35% (8/23); three patients achieved complete response (CR) and five partial response (PR). The median response duration was 24 weeks for CR patients and 32 weeks for PR patients. The median survival was 21 weeks overall and 45 weeks for responding patients. Grade 3/4 leukocytopenia and thrombocytopenia were seen in 28 and 9%, respectively. Two patients died from infections while in neutropenia. Cisplatin and teniposide seems an active regimen against brain metastases in NSCLC. These data may indicate the need for reconsideration of the role of chemotherapy for brain metastases of NSCLC.
Lung Cancer 1998 May
PMID:Chemotherapy with cisplatin and teniposide for cerebral metastases in non-small cell lung cancer. 971 27

Lung cancer is the leading cause of cancer-related death in North America and Europe. Approximately 75% of lung cancer is non-small cell lung cancer, and approximately 70% of these patients present with unresectable disease. In the past, these patients were treated with either palliative radiotherapy or other best supportive care measures. The survival of patients with stage IV disease was extremely poor. Median survival was between 16 and 17 weeks, and only 10% to 15% of patients were alive at 1 year. Cisplatin-based chemotherapy was the first therapy to show that survival could be improved. Randomized trials that compared best supportive care, including palliative radiotherapy, with cisplatin-based combination therapy showed modest improvement in the survival of these patients. On average, the median survival of patients improved by 10 weeks (from 16 to 26 weeks) and the 1-year survival rate improved by 10% (from 15% to 25%). These cisplatin-based therapies also relieved symptoms and improved quality of life at acceptable costs, which were sometimes less than those associated with best supportive care. More recently, a number of new chemotherapeutic agents (gemcitabine, paclitaxel, docetaxel, vinorelbine, and irinotecan) with high, single-agent activities and novel mechanisms of action have shown superior activity and improved quality of life when used in combination with conventional agents and with each other.
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PMID:An update on North American randomized studies in non-small cell lung cancer. 972 78

Three separate phase III randomized studies were conducted to compare the efficacy of a gemcitabine plus cisplatin combination (GC) with other chemotherapy regimens in the treatment of European and North American patients with inoperable (stage IIIB or IV) non-small cell lung cancer (NSCLC). The Spanish Lung Cancer Group (SLCG) compared the GC regimen with an etoposide plus cisplatin combination (EP), the Hoosier Oncology Group (HOG) compared it with single-agent cisplatin, and the Italian Lung Cancer Project (ILCP) compared it with a mitomycin plus ifosfamide plus cisplatin combination (MIC). The three studies each had a different primary objective (response rate, survival, or quality of life, respectively). From July 1995 to February 1997, 751 patients were enrolled into the three studies. In the SLCG study, 69 were entered in the GC arm and 64 in the EP arm; in the HOG study, 155 were entered in the GC arm and 154 in the cisplatin-alone arm; and in the ILCP study, 154 were entered in the GC arm and 152 in the MIC arm. In the SLCG study, gemcitabine 1,250 mg/m2 was given by 30-minute infusion on days 1 and 8 of each 21-day cycle. In the HOG and ILCP studies, gemcitabine 1,000 mg/m2 was given on days 1, 8, and 15 of each 28-day cycle. Cisplatin 100 mg/m2 was given on day 1 in the SLCG and HOG studies and on day 2 in the ILCP study. In the EP arm, etoposide 100 mg/m2 was given on days 1, 2, and 3 of each 21-day cycle. In the MIC arm, mitomycin 6 mg/m2 and ifosfamide 3 g/m2 were given on day 1 of each 28-day cycle. In the SLCG study, 28 patients (40.6%) in the GC arm and 14 patients (21.2%) in the EP arm achieved an objective response (P = .01). In the HOG study, 48 patients (31%) in the GC arm and 14 patients (9.1%) in the cisplatin-alone arm attained on objective response (P < .001). In the ILCP study, 61 patients (40%) in the GC arm and 42 patients (28%) in the MIC arm achieved an objective response (P = .03). Progression-free time was significantly longer for the GC arm (6.8 months) than for the cisplatin-alone arm (4.2 months) (P < .001). The median survival time was remarkably identical for the GC arms in the three studies (8.7 months), whereas it was 7.2 months for the EP arm, 7.6 months for the cisplatin-alone arm, and 9.5 months for the MIC arm. The main toxicities were myelosuppression and vomiting. The assessment of quality of life in the ILCP study is ongoing. Both 21- and 28-day cycles of GC were effective in the treatment of NSCLC, and this combination can be considered as a current "standard" therapy for advanced NSCLC patients.
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PMID:The activity of gemcitabine plus cisplatin in randomized trials in untreated patients with advanced non-small cell lung cancer. 972 82

Lung cancer remains the major cause of cancer-related death in North America and Europe. Lung cancer causes 28% of all cancer deaths, more than breast, prostate, colorectal, and ovarian cancers combined. Eighty-five percent to 90% of cases of lung cancer are known to be a direct consequence of smoking. Despite this, the incidence of the disease continues to increase dramatically in women, although in the United States, the incidence and mortality rates of lung cancer in men have declined slightly in the last few years. Non-small cell lung cancer (NSCLC) represents 75% to 80% of all primary lung cancers, and approximately 70% of these patients present with unresectable disease. These patients are candidates for palliative radiotherapy and/or chemotherapy, but most of these patients will develop locally advanced or metastatic disease. Currently, the 5-year survival rate across all stages of the disease is 14% in the United States. Until recently, chemotherapy was considered to be more successful in the treatment of small cell lung cancer than NSCLC, but this is no longer true. In a recent meta-analysis of randomized trials in NSCLC, cisplatin-based chemotherapy was shown to prolong survival for patients across all stages of the disease. A role for adjuvant cisplatin-based therapy has been shown in early stage disease, and cisplatin-based therapy was shown to improve survival when combined with radiotherapy in locally advanced disease and as a single modality in metastatic disease. Other randomized trials have shown that cisplatin-based therapy improved quality of life in both stage III and IV NSCLC patients and reduced the cost of medical care compared with best supportive care. Cisplatin-based therapy should therefore be considered the standard treatment for all NSCLC patients with locally advanced or metastatic disease. However, over the last 5 years, five new agents have emerged that have increased single-agent response rates, increased survival, and, for the most part, reduced toxicity. The use of these in two-drug combinations with conventional agents will be compared with new two- and three-drug combinations.
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PMID:Triplet chemotherapy combinations with new agents: is there a rationale? 972 86

From January 1986 to May 1998, 45 lung cancer patients with chest wall invasion (P3) underwent resection (40 male, 5 female), (median age 63.2 yrs (30-79)). Histological types were squamous cell carcinoma in 20, adenocarcinoma in 14, large cell carcinoma in 7, adenosquamous cell carcinoma in 2, and unknown in 2. Operative methods of lung resection were total pneumonectomy in 2, bilobectomy in 3, lobectomy in 38, and partial lung resection in 2. Resection was regarded as complete in 35 and incomplete in 10 patients. Thirty one patients had negative lymph nodes (N0), 9 had peribronchial or hilar lymph node metastases (N1), and 5 had mediastinal lymph node metastases (N2). The extent of tumor invasion to chest wall was P3a (invasion within parietal pleura) in 11, P3b-c (invasion to intercostal muscle) in 16, P3d (invasion to rib) in 18, patients. 5-year survival rate was totally 19.7%. Cisplatin based chemotherapy and concurrent thoracic radiation following surgery (CCRT) was performed in latest nine P3d cases. Partial response was observed in 5 of 9 cases (response rate 56%) and viable tumor cell in the primary site was not seen histologically in 5 of 9 cases. Three year survival rate was 46.9% for CCRT(+) 11.1% for CCRT(-). Acturial 5-year survival rate in P3a-d was 19.76%. P3d cases had poor survival, but CCRT improved prognosis of P3d cases.
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PMID:[Surgical treatment of lung cancer with chest wall invasion]. 978 25

Concomitant use of radiation therapy and chemotherapy is increasing steadily in the treatment of locally-advanced epithelial tumors. This approach has been proved effective in head and neck, esophageal, and canal and nonsmall-cell lung cancers. One of the best radiation sensitizers known to date is 5FU. In vitro cell model have demonstrated the importance of continuous exposure to the drug during 12 to 24 hours after the radiation session. These biological data have been confirmed by a randomized study in rectal cancer comparing 5FU bolus therapy versus 5FU given continuously during irradiation. Disease-free survival and overall survival were longer in the continuous infusion group. Cisplatin is being increasingly used in moderate but repeated doses, a regimen that requires central venous access. Similarly, etoposide, whose venotoxicity is well known, is an excellent radiation sensitizer that is gaining ground, most notably in the treatment of lung cancer. Nutritional support is a key component of all radiochemotherapy regimens used to treat digestive tract cancers and usually requires parenteral nutrition via a central venous access.
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PMID:[Continuous radiosensitizing chemotherapy]. 1021 23


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