Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although small-cell lung cancer (SCLC) represents only 20% of all lung cancer cases in the United States, it is the most lethal subtype. Combination chemotherapy unequivocally offers the best chance for improved survival in SCLC. Either PE (platinum plus etoposide) or CAV (cyclophosphamide, Adriamycin, and vincristine) is a reasonable first-line therapy. Alternating PE with CAV does not appear to be significantly superior to PE or CAV alone. Increasing dose intensity, although sometimes associated with higher response rates, does not appear to significantly improve survival and should not be used outside of a clinical study. Several new agents with novel mechanisms of action show promise in treating SCLC. These include: gemcitabine (Gemzar), paclitaxel (Taxol), docetaxel (Taxotere), topotecan (Hycamtin), and irinotecan (Camptosar). Given the poor survival and response rates in relapsed patients and the chemoresponsiveness of SCLC, patients with newly diagnosed extensive disease should be encouraged to enroll in phase I or II trials. Thoracic radiotherapy confers a small survival advantage in limited-stage SCLC patients. Although prophylactic cranial irradiation does not significantly improve survival, it does reduce central nervous system (CNS) recurrences with minimal long-term sequelae. Surgery should be considered only for: (1) resection of a solitary pulmonary nodule, which must be followed by adjuvant chemotherapy; and (2) resection of an unresponsive chest tumor, which may harbor a non-small-cell lung cancer component.
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PMID:Small-cell lung cancer: treatment progress and prospects. 959 76

Irinotecan has recently been found to be one of the most active agents in the treatment of small-cell lung cancer (SCLC). Japanese investigators have led the way in the early investigation of irinotecan, and multiple studies are now ongoing in the United States. In a phase II trial conducted by the West Japan Thoracic Oncology Group, irinotecan was associated with a median survival of 13 months in patients with extensive-stage disease. Subsequently, the Japanese Clinical Oncology Group completed a phase III trial comparing irinotecan plus cisplatin to cisplatin and etoposide. In this study, median, 1-year, and 2-year survival rates were superior with irinotecan and cisplatin. Two confirmatory phase III trials are in progress in the United States. Based on these early data, it is likely that irinotecan and a platinum agent will prove to be at least as effective as any other treatment for patients with extensive-stage SCLC. Investigators have embarked on combining irinotecan with carboplatin in anticipation that this will be a preferable treatment. Phase I/II trials are complete and the doses and schedules have been recommended. As a result, we are currently exploring irinotecan and carboplatin in phase II trials in both extensive- and limited-stage settings. In addition, several of the newer biologic targeted agents are being tested in SCLC in combination with newer chemotherapy regimens. The results from these trials are eagerly awaited.
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PMID:Evolving role of irinotecan in small-cell lung cancer. 1625 36