Cancer Treatment Today » Non-small Cell Lung Cancer

Temodar for Kidney Cancer

M Levin, MD — Wed, 21 Nov 2012 19:53:01 +0000

Personalized medicine approach tests individual cancers and chooses treatments based on this testing. Temodar is one of the drugs that is usually included in chemosensitivity panels. Sometimes, it is recommended to renal cell cancer patients based on such testing. Unfortunately, this new paradigm does not “fit” well with the existing approaches and methods for weighing and evaluating evidence supporting cancer treatments, and new approaches to do so have not yet been developed.

Temodar has some supporting, albeit conflicting evidence in renal cancer, if you follow the “old” paradigm. One study found it have no activity in kidney cancer, whereas anotehr found it to have minimal side effects and a total response rate of 60%. Another study found no objective responses in a group of previosuly treated patients. Temozolamide. Another study found Temodar and interferon combined to be inactive.

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Irinotecan for brain metastases of lung and breast cancer

M Levin, MD — Fri, 09 Nov 2012 15:38:40 +0000

Because irinotecan penetrates the brain-blood barrier and has an effect in primary brain cancer, there is some interest in using it for brain metastasis, especially for lung cancer and breast cancer. Most studies of irinotecan had been for brain mets of small(SCLC) and non-small cell lung cancer(NSMCLC) and not breast cancer and have had mixed results. One study enrolled several different cancer types and reported complete responses with irinotecan-based chemotherapy for brain metastases in three patients with SCLC, parotid cancer, and esophageal adenocarcinoma. The combination of cisplatin, ifosfamide and irinotecan in treatment-naive patients with NSCLC led to a response rate in the brain of 50%. A study of temozolomide (200 mg/m²) on days 1 to 5 and irinotecan (200 mg/m²) on days 1 to 5 every 4 weeks in previously untreated patients with NSCLC brain metastases reported no responses.

There are several ongoing studies for lung cancer. For breast cancer, there is also a study: Irinotecan and Temozolomide in Treating Patients With Breast Cancer Who Have Received Previous Treatment for Brain Metastases, NCT00617539.

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Axitinib and sorafenib for thyroid cancer

M Levin, MD — Fri, 26 Oct 2012 14:07:43 +0000

Medullary and papillary thyroid carcinoma (MTC and PTC) are two types of thyroid cancer that can originate from activating mutations or rearrangements in the RET gene. Axitinib has been studied for thyroid cancer. Two phase II studies were reported in the Journal of Clinical Oncology evaluating different axitinib and sorafenib therapies in patients with advanced thyroid cancer have special significance. Eligible patients in both studies included a full spectrum of thyroid cancer histologic subtypes—from differentiated to anaplastic, with both medullary and nonmedullary cancers allowed—but papillary and follicular histologies predominated. Although no complete responses were reported, a significant minority of patients had a major response to therapy by Response Evaluation Criteria in Solid Tumors (RECIST): 30% and 23%, respectively, for axitinib and sorafenib. Stable disease for no less than 3 months was also common, reported in 38% and 53%, respectively. Median progression-free survival rates were similar in both studies at approximately 18 months. The oral route of administration and noncytotoxic, targeted mechanism of action did not mean a lack of side effects. Grade 3 or 4 toxicities with both agents were not rare: 32% of patients treated with axitinib had at least one treatment-related adverse that was grade 3 or worse, and 47% of patients treated with sorafenib required dose reductions to control toxicities. Discontinuation of treatment occurred in 13% and 20% of patients treated with axitinib or sorafenib, respectively, because of toxicity.

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Stereotactic radiosurgery of lung

M Levin, MD — Fri, 24 Aug 2012 17:48:02 +0000

Stereotactic body radiation therapy (SBRT) is a technique that utilizes precisely targeted radiation to a tumor while minimizing radiation to adjacent normal tissue. This targeting allows treatment of small- or moderate-sized tumors in either a single or limited number of dose fractions. Stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) initially was used successfully forbrain cacners and malformations, orbital, and base of skull tumors, as well as benign conditions that can use the skull as a reference system. The success of SRS for intracranial indications led to the development of techniques to extend this approach to targets outside of the skull, such as lung cancer. Stereotactic radiation therapy for other body sites iwas enabled by technical advances including tumor imaging to guide radiation administration, patient immobilization, and conformal radiation delivery techniques.

The usual use for SBRT for lung cancer is to attempt a cure or occasionally to control symptomatic lung metastases. It should be realized that this is not a treatment that is free from potential side effects. American Society for Therapeutic Radiation and Oncology (ASTRO, 2007) stated that SBRT is considered appropriate for the treatment of the following conditions:

Lung or liver metastases not amenable to surgery
Medically inoperable early stage lung cancer
Primary liver cancer not amenable to surgery
Recurrent lung cancer amenable to salvage therapy
Recurrent pelvic tumors
Retroperitoneal tumors
Spinal and para-spinous tumors
Other recurrent cancers or tumors.

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SAMSA – A New Drug for Low Sodium

M Levin, MD — Fri, 10 Aug 2012 00:33:57 +0000

SAMSCA(tolvaptan) is indicated for the treatment of clinically significant hypervolemic and euvolemic hyponatremia (low blood serum sodium <125 mEq/L or less marked hyponatremia that is symptomatic and has resisted correction with fluid restriction), including patients with heart failure, cirrhosis, and Syndrome of Inappropriate Antidiuretic Hormone (SIADH). The latter condition occurs with lung cancer, especially small lung cancer, and less commonly other cancer or in associations with certain chemotherapy drugs that are used to treat cancer, such as cisplatin.

SAMSCA should be initiated and re-initiated in patients only in a hospital where serum sodium can be monitored closely. This allows observing for side effects and to titrate to an appropriate dose. The FDA aproved Prescribing information says: “The usual starting dose for SAMSCA is 15 mg administered once daily without regard to meals. Increase the dose to 30 mg once daily, after at least 24 hours, to a maximum of 60 mg once daily, as needed to achieve the desired level of serum sodium. ”

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Tarceva for Maintenance in Non-small Cell Lung Cancer

M Levin, MD — Tue, 17 Jul 2012 16:32:52 +0000

Tarceva (erlotinib) is FDA approved for non-small cell lung cancer after standard chemo has failed. Older studies showed that it does not contribute to chemotherapy in first-line. It is being studied for first line therapy of lung cancer instead of chemotherapy. This drug has been studied primarily in stage IV, when it has spread but recently it has been also studied, for maintenance, once treatment with chemotherapy had stopped. Maintenance means that after a complete response, that is no evidence of remaining cancer, or a good partial response, the patient can be maintained on a drug to improve the chance of cure or to postpone cancer’s return. Studies, such as the Saturn trial, have been encouraging for maintenance and suggest prolongation of time without progression of cancer (PFS) but not overall survival. Only overall survival translates into a high chance of cure. NICE, a European body that composes guidelines, in 2011 did not recommend routine use of Tarceva for maintenance, because the independent Appraisal Committee felt that there was too much uncertainty about the amount of extra time or overall survival gain expected from the treatment and that based on the evidence available erlotinib was not considered value for money. On the other hand, in the USA Erlotinib is recommended as an option in the NCCN Guidelines® for maintenance therapy in advanced non-small cell lung cancer (NSCLC) based on the results of the aforementioned SATURN trial.

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