Cancer Treatment Today » Non-small Cell Lung Cancer http://cancertreatmenttoday.org Knowledge is Power Thu, 26 Mar 2026 23:39:25 +0000 en-US hourly 1 Electromagnetic Navigation Bronchoscopy – pro http://cancertreatmenttoday.org/electromagnetic-navigation-bronchoscopy-pro/ http://cancertreatmenttoday.org/electromagnetic-navigation-bronchoscopy-pro/#comments Sun, 16 Dec 2012 20:06:39 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=10226 ENB (Electromagnetic Navigation Bronchoscopy) or EMN bronchoscopy is a type of bronchoscopy that uses electromagnetic guidance to project catheters into and through bronchial passages. Using a virtual, three-dimensional (3D) bronchial map from a recent CT scan and disposable catheters, it makes it possible to navigate to a desired location within the lung  and to look at it or biopsy it, stage lymphatic nodes or to insert markers to guide future radioatherapy. FDA cleared it in 2004 through the 510(k) process. One prospective study concluded that  there is a  “yield/procedure [rate at] 74% and 100% for peripheral lesions and lymph nodes, respectively.” A diagnosis was obtained in 80.4% of bronchoscopic procedures. The second study found an overall 62.5% diagnostic. There are also a number of other series and non-randomized studies. The only randomized study was by Eberhardt et al (2007c) that compared the diagnostic yield of electromagnetic navigation bronchoscopy, endobronchial ultrasound and a combined procedure in 120 patients with peripheral lung lesions or solitary lung nodules on CT scans.  Eelectromagnetic navigation bronchoscopy had a lower diagnostic yield (59 %) than endobronchial ultrasound (69 %).  However, the combined procedure had a higher diagnostic yield (88 %) than either procedure alone.  There was significantly diminished diagnosic yield (29 %) in the lower lobes with electromagnetic navigation bronchoscopy.

The British Thoracic Society guidelines for advanced diagnostic and therapeutic flexible bronchoscopy in adults (Du Rand et al, 2011) said that electromagnetic bronchoscopy may be considered for the biopsy of peripheral lesions or to guide trans-bronchial needle aspiration for sampling mediastinal lymph nodes (grade D).  A grade “D” recommendation is based on evidence level 3 or level 4, or extrapolated evidence from studies rated as 2+ (level 3 refers to non-analytic studies, e.g., case reports, case series; level 4 refers to expert opinion; and level 2+ refers to well-conducted case-control or cohort studies with a low-risk of confounding, bias or chance, and a moderate probability that the relationship is causal). It is a fairly low level of confidence recommendation and not a USA guideline.

D.Makris et al, Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions ERJ June 1, 2007 vol. 29 no. 6 1187-1192

Andrew R. Haas Anil Vachani and Daniel H. Sterman  Advances in Diagnostic Bronchoscopy Am. J. Respir. Crit. Care Med. 2010 182:589-597

Eberhardt R, Anantham D, Ernst A, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions. Am J Respir Crit Care Med. 2007c;176:36-41.

Daryl Phillip Pearlstein  et al, Electromagnetic Navigation Bronchoscopy Performed by Thoracic Surgeons: One Center’s Early Success Ann. Thorac. Surg. 2012 93:944-950

Du Rand IA, Barber PV, Goldring J, et al; BTS Interventional Bronchoscopy Guideline Group. British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax. 2011;66(3)::iii1-iii21. Available at: http://www.brit-thoracic.org.uk/Portals/0/Guidelines/BronchoscopyGuidelines/BTS%20Advanced%20Bronchoscopy%20guideline%20November%202011.pdf.

For Lay version see here

]]> http://cancertreatmenttoday.org/electromagnetic-navigation-bronchoscopy-pro/feed/ 0 Irinotecan for brain metastases of breast and lung cancer -pro http://cancertreatmenttoday.org/irinotecan-for-brain-metastases-of-breast-cancer-pro/ http://cancertreatmenttoday.org/irinotecan-for-brain-metastases-of-breast-cancer-pro/#comments Fri, 09 Nov 2012 15:34:51 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=9818 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 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 an intracranial response rate 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.

 nccn.org, brain cancers, p.38

 Chou R, Chen A, Lau D.Complete response of brain metastases to irinotecan-based chemotherapy.ONCOLOGY. Vol. 22 No. 2

 
Yun Oh, MD et al, Systemic Therapy for Lung Cancer Brain Metastases: A Rationale for Clinical Trials
J Clin Neurosci. 2005 Apr;12(3):242-5.ONCOLOGY. Vol. 22 No. 2
 
Chou R, Chen A, Lau D: Complete response of brain metastases to irinotecan-based chemotherapy. J Clin Neurosci 12:242-245, 2005. Fujita A, Fukuoka S, Takabatake H, et al: Combination chemotherapy of cisplatin, ifosfamide, and irinotecan with rhG-CSF support in patients with brain metastases from non-small cell lung cancer. Oncology 59:291-295, 2000.For Lay version see here

]]> http://cancertreatmenttoday.org/irinotecan-for-brain-metastases-of-breast-cancer-pro/feed/ 0 Adjuvant chemo for NSCLC – pro http://cancertreatmenttoday.org/adjuvant-chemo-for-nsclc-pro/ http://cancertreatmenttoday.org/adjuvant-chemo-for-nsclc-pro/#comments Mon, 10 Sep 2012 17:54:11 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8205 on-small cell lung cancer is a frequent type of cancer, with approximately 1.2 million cases per year expected worldwide. A total of 20-30% of patients with early stage non-small cell lung cancer are amenable to radical surgery, although only 40-50% of these patients are cured. An improvement in survival has never been demonstrated for postoperative radiotherapy. However, a major step forward is several recent large randomized studies that have demonstrated improved survival with postoperative chemotherapy. It is quite clear that adjuvant chemotehrapy benefits patients with stage II and III lung cancers. Post-operative adjuvant chemotherapy carries a small survival benefit in those patients with complete resection of their lung cancer. This survival benefit is in the region of a 4% absolute survival advantage at 5 years. Thus, 25 patients require chemotherapy to save one life at 5 years. The data is mixed for stage 1. Several guidelines adressed the issue of stage. I review the data briefly.

The NCCN Non-Small Cell Lung Cancer (NSCLC) guidelines panel recommended use of adjuvant chemotherapy in those who have undergone surgery for stages I, II, and IIIA NSCLC. The panel’s decision to include this recommendation was based on the presentation of survival data from the International Adjuvant Lung Cancer Trial (IALT) at the American Society of Clinical Oncology annual meeting in 2003, and the subsequent publication of the IALT study findings in the Jan. 22, 2004 issue of the New England Journal of Medicine.

The IALT study findings indicated a 4%-5% survival advantage for those who received cisplatin- (Platinol, Bristol-Myers Squibb) based adjuvant chemotherapy for all stages of the disease.

It should be evident that no single regimen can be recommended exclusive of others, since each positive study used a different combination. For this reason NCCN NSCLE-D, 2017 mentions all these regimens, as well as premetrexate and cisplatin.

Patel MI and Wakelee HA (2011) Adjuvant chemotherapy for early stage non-small cell lung cancer. Front. Oncol. 1:45.

nccn.org, nonsmall cell lung cancer 2012

Le Chevalier T. Adjuvant chemotherapy for resectable non-small-cell lung cancer: where is it going? Ann Oncol. 2010 Oct;21 Suppl 7:vii196-8.

Arriagada R, Bergman B, Dunant A et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected nonsmall- cell lung cancer. N Engl J Med. 2004; 350:351-60.
Scagliotti GV, Fossati R, Torri V et al. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small cell lung cancer. J Natl Cancer Inst. 2003; 95:1453-61.
Kato H, Ichinose Y, Ohta M et al. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med. 2004; 350: 1713-21.
Hotta K, Matsuo K, Ueoka H et al. Role of adjuvant chemotherapy in patients with resected non-small-cell lung cancer: reappraisal with a meta-analysis of randomized controlled trials. J Clin Oncol. 2004; 22:3860-7.
Winton TL, Livingston R, Johnson D et al., for the National Cancer Institute of Canada Clinical Trials Group. A prospective randomised trial of adjuvant vinorelbine (VIN) and cisplatin (CIS) in completely resected stage 1B and II non small cell lung cancer (NSCLC) intergroup JBR. J Clin Oncol. 2004; 22:A7018.
Strauss GM, Herndon J, Maddaus MA et al. Randomized clinical trial of adjuvant chemotherapy with paclitaxel and carboplatin following resection in stage IB non-small cell lung cancer (NSCLC): report of cancer and leukemia group B (CALGB) protocol 9633. J Clin Oncol. 2004; 22:A7019.

Robinson LA, Wagner H Jr, Ruckdeschel JC. Treatment of stage IIIA non-small cell lung cancer. Chest 2003 Jan;123(1 Suppl):202S-20S. [109 references)

Douillard J, Rosell R, Delena M, Legroumellec A, Torres A, Carpagnano F. ANITA: phase III adjuvant vinorelbine and cisplatin versus observation in completely resected (stage I-III) non-small cell lung cancer patients: final results after 70-month median follow-up. J Clin Oncol 2005; 23 Suppl 16S: 624s.

Keller SM, Adak S, Wagner H, Herskovic A, Komaki R, Brooks BJ, Perry MC, Livingston RB, Johnson DH, for the Eastern Cooperative Oncology Group. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIA non-small-cell lung cancer. N Engl J Med 2000; 343: 1217-1222.

Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ 1995; 311: 899-909.

Pignon JP, Tribodet H, Scagliotti GV, Douillard JY, Shepherd FA, Stephens RJ, Le Chevalier T. Lung Adjuvant Cisplatin Evaluation (LACE): A pooled analysis of five randomized clinical trials including 4,584 patients. Proc Am Soc Clin Oncol 2006 Part I: abstr 7008.

Charlotte LoBuono. Lung cancer guidelines revised to include latest drugs. Drug Topics Apr. 5, 2004;148:32.

Scagliotti GV, Fossati R, Torri V, Crino L, Giaccone G, Silvano G, Martelli M, Clerici M, Cognetti F, Tonato M. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell lung cancer. J Natl Cancer Inst 2003; 95: 1453-1461.

Strauss GM, Herndon J, Maddaus MA, Johnstone DW, Johnson EA, Watson DM, Sugarbaker DJ, Schilsky RL, Green MR. Randomized clinical trial of adjuvant chemotherapy with paclitaxel and carboplatin following resection in Stage IB non-small cell lung cancer (NSCLC): Report of Cancer and Leukemia Group B (CALGB) Protocol 9633. Proc Am Soc Clin Oncol 2004; abstr 7019.

Strauss GM, Herndon JE, Maddaus MA, Johnstone DW, Johnson EA, Watson DM, Sugarbaker DJ, Schilsky RA, Vokes EE, Green MR. Adjuvant chemotherapy in stage IB non-small cell lung cancer (NSCLC): Update of Cancer and Leukemia Group B (CALGB) protocol 9633. Proc Am Soc Clin Oncol 2006 Part I: abstr 7007.

The International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. N Engl J Med 2004; 350: 351-360.

Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, Cormier Y, Goss G, Inculet R, Vallieres E, Fry W, Bethune D, Ayoub J, Ding K, Seymour L, Graham B, Tsao M, Gandara D, Kesler K, Demmy T, Shepherd F. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 2005; 352: 2589-2597.

Vansteenkiste JF, Schildermans RH. The future of adjuvant chemotherapy for resected non-small cell lung Expert Rev Anticancer Ther. 2005 Feb;5(1):165-75.cancer.

]]> http://cancertreatmenttoday.org/adjuvant-chemo-for-nsclc-pro/feed/ 0 Delay in diagnosis of lung cancer – pro http://cancertreatmenttoday.org/delay-in-diagnosis-of-lung-cancer-pro/ http://cancertreatmenttoday.org/delay-in-diagnosis-of-lung-cancer-pro/#comments Mon, 10 Sep 2012 17:47:40 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8200 Lung cancer is symptomatic in over 90% of patients. However, studies find that delays between reporting of symptoms and diagnosis are universal. In a recent Swedish study, 134 lung cancer patients were investigated prospectively. The median delay for the patients, i.e. from the first symptom(s) until the family doctor was contacted, was 21 days. From the first contact with the doctor until referral to the specialist the median time was 33 days. From the first visit to the specialist to diagnosis the median time was 9 days. The median time from first symptom(s) until treatment or the decision not to treat (the sum of all delays) was 189 days, i.e. 6 months. A large epidemiological survey from Poland in 561 lung cancer patients registered from 1995 to 1998, reported that the median delay caused by patients was 46 days. The median delay caused by doctors (time between first visit to the doctor and the date of diagnosis) was 65 days and the median time between diagnosis and therapy was an additional period of 30 days. Delays were significantly different from region to region. A retrospective audit of the time involved in the management of patients with lung cancer referred for consideration of surgery at the Royal Brompton Hospital in London has been previously carried out on 194 patients. The median interval between the onset of symptoms and their first chest radiograph was 39 days, and between the onset of symptoms and referral to a surgeon by a chest physician was 112 days. In conclusion, the2-month delay between the onset of the first symptom andthe first referral to a lung cancer specialist (a time course that includes both patient and family doctor delay) is somewhat longer than the average national delay (whose figure of 50 days also included the specialist delay) and roughly on line or somewhat better than reported internationally.

Detterbeck FC, Jones DR, Kernstine KH, Naunheim KS. Presentations of lung cancer with special treatment considerations. Chest 2003 Jan;123(1 Suppl):244S-58S. [56 references]

G. Buccheri and D. Ferrigno Lung cancer: clinical presentation and specialist referral time Eur Respir J 2004; 24:898-904

]]> http://cancertreatmenttoday.org/delay-in-diagnosis-of-lung-cancer-pro/feed/ 0 PET for restaging NSCLC – pro http://cancertreatmenttoday.org/pet-for-restaging-nsclc-pro/ http://cancertreatmenttoday.org/pet-for-restaging-nsclc-pro/#comments Mon, 10 Sep 2012 17:45:14 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8198 PET is clearly accepted for lung cancer staging while deciding on potentially operative therapy. For restaging, Medicare accepts it as follows: PET is covered for restaging: (1) after completion of treatment for the purpose of detecting residual disease, (2) for detecting suspected recurrence or metastasis, (3) to determine the extent of a known recurrence, or (4) if it could potentially replace one or more conventional imaging studies when it is expected that conventional study information is insufficient for the clinical management of the patient. Restaging applies to testing after a course of treatment is completed, and is covered subject to the conditions above.

The literature supports PET for restaging. PET has been investigated in 3 different scenarios: restaging after neoadjuvant therapy, early assessment of response to therapy, and restaging after completion of therapy. In the first scenario, PET could be used after induction chemotherapy or chemoradiation to evaluate for tumor resectability. Few studies have been performed to investigate the reliability of PET in assessing mediastinal “downstaging.” From the studies that are available, it appears that there is much variability in the results. Studies evaluating for a complete pathologic response appear to have high false-positive and false-negative rates. The second scenario was investigated in a study of 57 patients who were evaluated by PET 1 wk before and 3 wk after the first cycle of chemotherapy. It was found that a reduction in metabolic activity correlated closely with the final outcome of the therapy. An early metabolic response predicted better survival, and a poor response predicted disease progression within the first 3 cycles of chemotherapy. The impact of this evaluation on the morbidity and cost of nonresponding tumors suggests much merit in this strategy. The third scenario is the most commonly performed scenario for restaging. Multiple studies have demonstrated a high specificity for the characterization of viable tumor and scar tissue after therapy. Furthermore, Patz et al. have shown that 18F-FDG PET has prognostic value and correlates strongly with rates of survival of patients with treated lung cancer; patients with positive 18F-FDG PET results have a significantly worse prognosis than patients with negative results. Hicks et al. demonstrated a significant impact of PET on further management, with major changes being made in 63% of studied cases.

However, NCCN does not clearly recommend PET on p. MS-23-25 for restaging on therapy. SNM(Revised February 2011) does not recommend it for restaging either.
Results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer
J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1943 – 1951.

Patz EF, Jr, Lowe VJ, Hoffman JM, Paine SS, Harris LK, Goodman PC. Persistent or recurrent bronchogenic carcinoma: detection with PET and 2-[F-18]-2-deoxy-D-glucose. Radiology. 1994 May;191(2):379382.

Rodney J. Hicks, Role of  F-FDG PET in Assessment of Response in NonSmall Cell Lung Cancer J Nucl Med 2009; 50:31S–42S

T. Hazelton, L. Coppage Imaging for lung cancer restaging.
Seminars in Roentgenology, Volume 40, Issue 2, Pages 182-192

Tira Bunyaviroch, MD1 and R. Edward Coleman, MDP ET Evaluation of Lung Cancer* Journal of Nuclear Medicine Vol. 47 No. 3 451-469, 2006

http://www.snm.org/docs/PET_PROS/OncologyPracticeGuidelineSummary.pdf

Silvestri GA, Jett JR. Clinical aspects of lung cancer. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 47.

Wahl RL. Imaging. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingston;2008:chap 21.

Hochhegger B, Alves GR, Irion KL, et al. PET/CT imaging in lung cancer: indications and findings. J Bras Pneumol. 2015;41(3):264–274.

]]> http://cancertreatmenttoday.org/pet-for-restaging-nsclc-pro/feed/ 0 Irinotecan/Carboplatin/ pacalitaxel in NSCLC – pro http://cancertreatmenttoday.org/irinotecancarboplatin-pacalitaxel-in-nsclc-pro/ http://cancertreatmenttoday.org/irinotecancarboplatin-pacalitaxel-in-nsclc-pro/#comments Mon, 10 Sep 2012 17:43:36 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8196 Lung cancer is the leading cause of cancer death in the United States and in the world. In the United States, lung cancer ranks first in cancer deaths for both men and women. The 5-year survival rate is only 15%, but this has improved considerably from the 5% rate in the early 1960s. For many years, the standard therapy for patients with advanced, stage IIIB and IV non small-cell lung cancer (NSCLC) was best supportive care, which consisted of palliative radiotherapy, pain management, and other symptom management. The median survival for these patients was only 4 months, and more than 85% died in the first year after diagnosis. Cisplatin was the first drug that was shown to prolong the survival of patients with advanced lung cancer. Meta-analyses of randomized trials showed that cisplatin reduced the hazard rate of death by 26%, increased median survival from 4 to 6 months, and increased 1-year survival from 15% to 25%. Cisplatin-based therapy also relieved symptoms in the majority of patients and improved the quality of life as assessed by patients themselves. Still, further advances are desperately needed, as three fourths of the cisplatin-treated patients die within a year of diagnosis. Topoisomerase I inhibitors are a new class of chemotherapeutic agents introduced into lung cancer therapy during the 1990s. Irinotecan (CPT-11) was shown to be active in patients with both small-cell and non small-cell lung cancers. The activity of irinotecan in advanced NSCLC made it logical to combine irinotecan with the two platinums, cisplatin and carboplatin. The combination of irinotecan with cisplatin produced response rates of about 40% in phase II trials conducted in previously un-treated patients with advanced NSCLC. The median survival in these studies ranged from 6-8 months, and the 1-year survival rates ranged from 40%-60%. Because carboplatin is more convenient and better tolerated than cisplatin, a number of more recent phase II trials have evaluated the combination of irinotecan and carboplatin in patients with advanced NSCLC. These trials produced results similar to those achieved with irinotecan/cisplatin and with other two-drug combinations such as paclitaxel/carboplatin and gemcitabine/ cisplatin. The excellent activity of the two-drug combination or irinotecan and a platinum led to trials of three-drug combinations, such as irinotecan/carboplatin/paclitaxel. Preliminary results from these studies showed excellent survival, although the toxicity required some dosage reductions. Randomized trials will be necessary to determine whether such three-drug combinations will be preferred over standard two-drug combinations.

There is an open Study of Weekly Paclitaxel, Carboplatin and Irinotecan to Treat Lung Cancer, NCT00465907

http://clinicaltrials.gov/ct/show/NCT00465907;jsessionid=16A68B37C886918476C88E7BC671351B?order=30

Bunn PA. Irinotecan and platinums in the treatment of non small-cell lung cancer.Clin Lung Cancer. 2001 May;2 Suppl 2:S14-9.

nccn.org, non-small cell lung cancer

A. Y.-C. Chang, H. L. Lim, Weekly paclitaxel, carboplatin and irinotecan (PCI) in advanced non-small cell lung cancer (NSCLC). Abstract No: 2667 Proc Am Soc Clin Oncol 22: 2003 (abstr 2667)

]]> http://cancertreatmenttoday.org/irinotecancarboplatin-pacalitaxel-in-nsclc-pro/feed/ 0 Chemo in poor performance lung cancer – pro http://cancertreatmenttoday.org/chemo-in-poor-performance-lung-cancer-pro/ http://cancertreatmenttoday.org/chemo-in-poor-performance-lung-cancer-pro/#comments Mon, 10 Sep 2012 17:41:40 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8194 Poor performance status patients with advanced non-small cell lung cancer (NSCLC) have frequently been excluded from clinical trials due to the perception that they would have excessive treatment-related toxicity and a limited life expectancy. A recent retrospective review of two multicenter trials of patients who were treated with platinum-based chemotherapy for advanced NSCLC showed that patients with poor performance status treated with platinum based chemotherapy have a similar rate of toxicity compared to good performance status patients. Their overall survival was lower despite a similar response to chemotherapy. Current guidelines, do not advise platin based chemotherapy for patients in poor ECOG performance status, 3-4. In addition, this patient has brain mets, which is not a contraindication but does make benefit from chemotherapy less likely.

 

NCCN states: “New agents/ non-latinum combnations arereasonable alternatives if available phase I/II studies show activity and tolerable toxicity”. http://nccn.org/professionals/physician_gls/PDF/nscl.pdf

 

STINCHCOMBE Thomas E et al, Carboplatin-based chemotherapy in patients with advanced non-small cell lung cancer and a poor performance status Lung cancer 2006, vol. 51, no2, pp. 237-243

http://www.providence.org/Oregon/Health_Resource_Centers/Lung_Cancer/TOPtxguidelines.htm

 

NCCN.ORG, NSCLC

 

Lung Cancer Disease Site Group. Chemotherapy in stage IV (metastatic) non-small cell lung cancer. Toronto (ON): Cancer Care Ontario (CCO); 2005 Jan. 22 p. (Practice guideline report; no. 7-2). [28 references]

]]> http://cancertreatmenttoday.org/chemo-in-poor-performance-lung-cancer-pro/feed/ 0 Radiofrequency ablation for lung mets – pro http://cancertreatmenttoday.org/radiofrequency-ablation-for-lung-mets-pro/ http://cancertreatmenttoday.org/radiofrequency-ablation-for-lung-mets-pro/#comments Mon, 10 Sep 2012 17:40:27 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8192 Lay Summary: Radiofrequency Ablation of lung mets requires more study before it can considered standard of care.

The lung is the most common site for primary cancer worldwide as well as being a common site of metastases for various malignancies. Percutaneous radiofrequency ablation (RFA) is rapidly evolving as a new minimally invasive tool for the treatment of pulmonary tumors(1.2). Although such early experience appears promising, many questions regarding patient selection, radiofrequency ablation technique, effectiveness of ablation on lung tumors, radiographic follow-up, and survival remain unanswered. There are a number of published reports of its effectiveness but no larger studies and guidelines (from NHS in the UK) restricts it to special patient circumstances(3).

Recently, several more studies and reviews have appeared. However, there are still no guidelines that routinely recommend this procedure.

It is still under study: Study of Outcomes of Radiofrequency Ablation of Lung Tumors, NCT00280189 .
The purpose of this study is to assess short and long term outcomes after radiofrequency ablation (RFA) of pulmonary malignancies in patients who are not candidates for surgical resection. This study will evaluate the efficacy of RFA for the treatment of lung tumors by assessing its impact on local tumor control, progression free survival, overall survival, dyspnea score and quality of life (QOL).

1.Steinke K, Sewell PE, Dupuy D, Lencioni R, Helmberger T, Kee ST, Jacob AL, Glenn DW, King J, Morris DL. Pulmonary radiofrequency ablation–an international study survey.Anticancer Res. 2004 Jan-Feb;24(1):339-43.

2.Christophe L. Nguyen, MD, Walter J. Scott, MD * , Melvyn Goldberg, MD Radiofrequency Ablation of Lung Malignancies Ann Thorac Surg 2006;82:365-371

3.http://www.nice.org.uk/download.aspx?o=ipg185guidance

Other references:

Zhu JC, Yan TD, Glenn D, Morris DL. Radiofrequency ablation of lung tumors: feasibility and safety. Ann Thorac Surg 2009; 87:1023.
Pennathur A, Abbas G, Qureshi I, et al. Radiofrequency ablation for the treatment of pulmonary metastases. Ann Thorac Surg 2009; 87:1030.
Chua TC, Thornbury K, Saxena A, et al. Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases. Cancer 2010; 116:2106.
Lencioni R, Crocetti L, Cioni R, et al. Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). Lancet Oncol 2008; 9:621.
Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer. J Am Coll Surg 2010; 211:68.

]]> http://cancertreatmenttoday.org/radiofrequency-ablation-for-lung-mets-pro/feed/ 0 ALIMTA for squamous lung cancer – pro http://cancertreatmenttoday.org/alimta-for-squamous-lung-cancer-pro/ http://cancertreatmenttoday.org/alimta-for-squamous-lung-cancer-pro/#comments Mon, 10 Sep 2012 17:20:32 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8181 On September 26, 2008, the U. S. Food and Drug Administration (FDA) approved pemetrexed injection (Alimta Injection, Eli Lilly and Company) for use in combination with cisplatin therapy for the initial treatment of patients with locally advanced or metastatic non-squamous non-small cell lung cancer (NSCLC). Pemetrexed is not indicated for treatment of patients with squamous cell lung carcinoma.

A multicenter, randomized, open-label study in 1725 patients with stage IIIb/IV NSCLC who had not received prior chemotherapy was conducted to compare overall survival following treatment with pemetrexed plus cisplatin (AC) to gemcitabine plus cisplatin (GC). The median survival was 10.3 months in the AC arm and 10.3 months in the GC arm [adjusted hazard ratio 0.94 (95% CI: 0.84, 1.05)]. The median progression-free survival was 4.8 and 5.1 months for the AC and GC arms, respectively [adjusted hazard ratio 1.04 (95% CI: 0.94, 1.15)]. The overall response rates were 27.1% and 24.7% for the AC and GC arms, respectively.

A pre-specified analysis of the impact of NSCLC histology on overall survival was conducted in this trial. Clinically relevant differences in survival according to histology were observed. In the non-squamous cell NSCLC subgroup the median survival was 11.0 and 10.1 months in the AC and GC groups, respectively [unadjusted hazard ratio 0.84 (95% CI: 0.74, 0.96)]. However, in the squamous cell histology subgroup the median survival was 9.4 versus 10.8 months in the AC and GC groups, respectively [unadjusted hazard ratio 1.22 (95% CI: 0.99, 1.50)]. This unfavorable effect on overall survival associated with squamous cell histology observed with pemetrexed was also noted in a retrospective analysis of the single-agent trial of pemetrexed versus docetaxel in patients with stage III/ IV NSCLC after prior chemotherapy. Single-agent pemetrexed was approved in 2004 for this more heavily treated lung cancer population. Current product labeling has been revised to recommend that Alimta is also not indicated in patients with squamous cell lung cancer after prior chemotherapy.

 

FDA: http://www.fda.gov/CDER/Offices/OODP/whatsnew/Alimta.htm

]]> http://cancertreatmenttoday.org/alimta-for-squamous-lung-cancer-pro/feed/ 0 Sprycel for lung cancer – pro http://cancertreatmenttoday.org/sprycel-for-lung-cancer-pro/ http://cancertreatmenttoday.org/sprycel-for-lung-cancer-pro/#comments Mon, 10 Sep 2012 17:17:15 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8178 Sprycel is approved for 2nd line treatment of CML. Sprycel has been developed for the treatment of patients with BCR-ABL-positive CML and acute lymphoblastic leukemia (ALL); for the treatment of patients who fail Gleevec. Sprycel is approved by the U.S. Food and Drug Administration for treatment of patients who fail or are intolerant to Gleeevec.

There rare several trial of this agent for lung cancer, for example:Dasatinib in Advanced Non-small Cell Lung Cancer (NSCL) With Ex Vivo and In Vivo Assessment of Tumor Target Modulation, CT00858403 and Phase II Study of Dasatinib in Previously Treated Patients With Advanced NSCLC (TOP0801), NCT00787267 and others. At this time it looks like some apteints respond to this drug but the responsive subgroup needs to be better defined. A pashe II trial concluded: ” Dasatinib as a single agent has activity in a subset of patients with NSCLC.”

 

Borthakur G, Kantarjian HM, O/Brien SM, et al. Efficacy of dasatinib in patients (pts) with previously untreated chronic myelogenous leukemia (CML) in early chronic phase (CML-CP). Journal of Clinical Oncology. 2008;26:abstract 7013

J. M. Johnson, X. Tang, H. Tran, B. Saigal, J. Erasmus, J. Kurie, L. Hwang, Y. Oh, S. Lippman, D. J. Stewart; M. D. Anderson Cancer Center, Houston, TX; Fredrick Oncology Hematology Associates, Fredrick, MD Phase II study of dasatinib in non-small cell lung cancer (NSCLC).J Clin Oncol 27, 2009 (suppl; abstr e19015)

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