Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UNIPROT:P04141 (granulocyte-macrophage colony-stimulating factor)
 6,790 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Whereas non-small cell lung cancer (NSCLC) comprises 80% of all lung cancer cases, effective prolongation of survival in NSCLC patients using currently available combination chemotherapy has been problematic. Use of dose-intensive chemotherapy along with hematopoietic growth factor support is an attractive, albeit experimental, alternative. We have conducted a phase I study to determine the maximum tolerated dose of etoposide in the ifosfamide/carboplatin/etoposide (ICE) regimen when used with granulocyte-macrophage colony-stimulating factor (GM-CSF) support. Twenty-three patients with solid tumors refractory to standard treatment who had not received previous platinum-containing chemotherapy or for whom there was no generally accepted curative therapy were treated. We present results obtained in 11 patients with previously untreated stage IV NSCLC. The use of ICE plus GM-CSF demonstrated promising activity in this group of patients; the overall response rate was 64%, and median survival was 10.0 months. The maximum tolerated dose of this regimen is 900 mg/m2 etoposide in combination with 5 g/m2 ifosfamide, 400 mg/m2 carboplatin, and 5 micrograms/kg/d GM-CSF.
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PMID:Dose-intensive ifosfamide/carboplatin/etoposide plus granulocyte-macrophage colony-stimulating factor for non-small cell lung cancer. 820 78

Despite 20 years of chemotherapy trials in advanced NSCLC, optimal regimens leading to complete remissions have not been identified. The decision to treat a patient who has inoperable advanced NSCLC must take into account the toxicity of the chemotherapy. The toxicities most often reported are myelosuppression and emesis; however, these trials were performed before the use of colony-stimulating factors (ie, granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor) and serotonin antagonists (ie, ondansetron). Granulocyte colony-stimulating factor has been shown to shorten the duration of neutropenia and thus decrease the incidence of confirmed infections. Colony-stimulating factors also may allow significant escalation of the dose of chemotherapy. Ondansetron has been shown to ameliorate cisplatin-induced emesis better than other antiemetics. The performance status of a patient has been noted to be a predictor for survival, as well as response to therapy, and this should also be taken into consideration when deciding to treat a patient with advanced inoperable NSCLC. Ideally, patients with stage IV NSCLC should be placed on investigational therapy protocols to identify optimally active combinations of agents. One approach to the patient with inoperable NSCLC who is ineligible for a trial, or who does not wish to participate in a trial, is to offer chemotherapy soon after diagnosis, as patients in this category are likely to be less symptomatic and have optimal performance status. A platinum-containing regimen would seem to be the most reasonable regimen in such a patient. It is hoped that ongoing trials in suitable candidates will lead to the identification of more consistently active agents to deal with this devastating disease.
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PMID:Chemotherapy outcomes in advanced non-small-cell lung carcinoma. 839 89