Speciality
Spotlight

 




 


Oncology


 

 





Lung
Cancer

  

  • Kawahara
    M, Ushijima S, Kamimori T, et al [ Natl Kinki Central
    Hosp for Chest Diseases, Osaka, Japan; Osaka Prefectural
    Habikino Hosp, Osaka, Japan; Natl Cancer Research Inst,
    Tokyo]

    Second
    Primary Tumors  in
    More Than-2-Year Disease-Free Survivors of Small Cell
    Lung Cancer in Japan: The Role of Smoking Cessation

    Br
    J Cancer 78: 409-412, 1998

           

    This
    study of survival i.e. beyond 2 years after treatment
    for small cell lung cancer were followed for relapse or
    occurrence of a second primary tumor [ SPT]. These
    patient had a significantly increased risk of SPT but
    the risk substantially decreased if they quit smoking.

            

  • Stewart
    LA, for the PORT Meta-analysis Trialists Group [ MRC
    Cancer Trials  Office, Cambridge, England]

    Postoperative
    Radiotherapy in Non-Small-Cell Lung Cancer[ NSCLC]:
    Systematic Review and Meta-analysis of Individual
    patient Data from Nine Randomized Controlled Trials

    Lancet
    352: 257-263, 1998

          

    Adjuvant
    radiotherapy following a potentially resectable lung
    cancer is of doubtful value. This meta-analysis has
    tried to evaluate the role of radiotherapy in such a
    setting.

          

    Postoperative
    radiotherapy was administered to patients with Stage I and 
    II

          

    NSCLC
    clearly had an adverse effect on survival.
    Although there was no adverse effect on patients
    with stage III, N2 disease, No group of patients with
    NSCLC benefited from postoperative radiotherapy.

          

    The 5 year survival rate was 51.3 %  in delayed
    node dissection versus 61.7% with immediate node
    dissection, prognosis was poorest for those in patients
    with regional nodes that became clinically and
    histologically positive during follow-u[

           


    The interpretation of this study suggest that those with
    micrometastasis in the lymph node if not  resected
    had poor prognosis and hence identification of sentinel
    lymph node would be benefical.


            

  • Quekel
    LGBA, Kessels AGH, Goei R, et al

    Miss Rate of Lung Cancer on the Chest Radiograph in Clinical Practice

    Chest 115: 720-724, 1999

        

    Despite best efforts, some Non Small Cell Lung Cancer [NSCLC] tumours are missed on chest radiographs. The miss rate for these tumours and the resultant implications for prognosis were evaluated. 

       

    Medical records and chest radiographs were retrospectively reviewed for 396 patients who were treated for primary
    NSCLC. Two independent radiologists reviewed all chest radiographs to determine whether any lesions had been missed in earlier radiographs, if a previously missed lesion was identified, a third independent radiologist confirmed its presence. 

      

    The time between the first appearance of the lesion on the chest radiograph and the date of histopathologic diagnosis was calculated to measure the delay in diagnosis. Findings showed that NSCLC presented as a nodular lesion in 259 of the 396 patients [65.4%]; the lesion was definitely missed in 49 [19%]; in fact the lesion was missed twice on consecutive chest radiographs in 16 patients and 6 patients it was missed 3 times or more.

       

    Location of the tumour did not influence the miss rate. However superimposing structures were significantly more common in the patients with missed lesions [71% vs 2%]. Additionally missed lesions were significantly smaller [median diameters 16 vs 40 mms]; most of the lesions 10 mms or less were missed in 71%.

       

    The median delay in the diagnosis of missed lesions was 472 days which was significantly longer than the 29 days for diagnosis of detected lesions. The extra delay resulted in the conversion of the tumours from stage T1 to T2 in 21 patients with missed lesions [43%]. Of the remaining 28 patients with missed lesions 22 continued to remain in stage T1 and 6 in stage T2.

       

    The authors conclude that miss rate of 19% [in other reported series from 20% to 50%] has a definite impact on prognosis and therefore remains a cause of concern.

           

  • Moskal TL, Dougherty TJ, Urschel JD, et al [Rosewell Park Cancer Inst, Buffalo, NY]

    Operation and Photodynamic Therapy for Pleural Mesothelioma: 6-Year Follow-up

    Ann Thorac Surg 66: 1128-1133, 1998

       

    This study of 40 patients with malignant pleural mesothelioma [MPM] underwent surgical resection followed by immediate intracavitary photo dynamic therapy. In patients with stage I & II pleural mesothelioma. Surgery and PDT offers good survival results. More effective treatments are required for stage III or IV disease.


      

  • Yahata N, Ohyashiki K, Ohyashiki
    JH, et al [Tokyo Med College; Univ of Texas, Dallas]

    Telomerase Activity in Lung Cancer Cells Obtained from bronchial Washings

    J Natl Cancer Inst 90: 684-690, 1998

      

    Telomerase which are components of the chromosomal ends containing nucleotide protects them from sticking to each other. Shortening of the length of telomere is activated by telomerase which is an intracellular reverse transcriptase with an RNA component. Experimental studies indicate that failure of telomerase to shorten progressively with each cell division lead to cellular immortalization a critical step in cancer progression.

        

    In this Japanese study telomerase activity from the bronchial washing were assayed. Telomerase activity was detected in bronchial washings from the majority of lung cancer patients. The editor comments that utility of such a concept for early detections, essentially at a premalignant level.

      

  • Choe DH, Lee
    JH, Lee BH, et al [ Korea Cancer Ctr Hosp, Seoul]

    Obliteration of the Pulmonary Vein in Lung Cancer : Significance in Assessing Local Extent with CT

    J Comput Assist Tomogr 22: 587-591, 1998

       

    The lung tumor growth though the pulmonary veins intra pericardially or in the [L] atrium is uncommon. The obliteration of the superior pulmonary vein on CT in patients with lung tumor strongly suggests intrapericardial tumor extension through the pulmonary vein. Identifying this type of growth preoperatively is essential in planning surgical treatment as it may result in systemic tumor embolization with fatal consequences with manipulation or ligation of the involved pulmonary vein. Inferior pulmonary vein obliteration is a less reliable indicator of intrapericardial extension.

       

  • P
    Boffetta, G Pershangen, K-H Jockel, et al (Interrnatl
    Ageny for Research on Cancer, Lyon, France, Karolinska
    INst, Stockholm; Inst for Med Informatics, Essen,
    Germany; et al)

    Cigar and Pipe Smoking and Lung Cancer Risk: A
    Multicenter Study from Europe.

    J Natl Cancer Inst 91: 697-701, 1999

        

    The association between the consumption of tobacco
    products other than cigarettes and lung cancer risk has
    not been well studied. The authors have presented 
    a case-control study of this relationship.

       

    The case group comprised 5621 men with lung cancer in
    comparison with controlled group which included 7255 men
    without lung cancer. The lung cancer odds ratio for
    smoking cigars and cigarillos only was 9, whereas the
    odds ratio for smoking a pipe only was 7.9 as compared
    to that of cigarettes being 14.9. A dose-response
    relationship for duration of use and cumulative
    consumption for cigars and cigarillos as well as for
    pipe tobacco was noted. The dose-response associations
    between lung-cancer risk and either smoking duration or
    mean and cumulative consumption were comparable for
    cigar and cigarillo smoking, pipe smoking, and cigarette
    smoking.

       

    The study concluded that cigars, cigarillos and pipe
    tobacco may have a carcinogenic effect on the lung that
    is comparable to that of cigarettes.

        

  • Gregory P, Kalemkerian, Muhammad A. Ali, Kavita Luthra, et al (Department of Medicine, Division of Hematology and Oncology, Wayne State University, Detroit, Michigan, and The Barbara Ann Karmanos, Cancer Institute, Detroit, Michigan)

    A Phase II study of Weekly Alternating Chemotherapy in Extensive-Stage Small Cell Lung Cancer

    Cancer Investigation 2001 Vol. 19 (3) Pg. 234-238

       

    Treatment strategies for extensive stage small cell lung cancer (SCLC) have been non cross resistant or dose intense chemotherapy. Despite the recent development in oncology, the long term prognosis of patients with extensive stage disease remains poor. In the present study 18 untreated patients with extensive stage SCLC received cyclophosphamide, etoposide and cisplatin on day 1, vincristine day 8 and ifosfamide on days 8 and 9. 

      

    In most of the patients dose delay and dose reductions was required, 67% had objective response with a median duration of response 18 weeks. 

       

    Median survival was 33 weeks. Although the results achieved were comparable with other previous studies (standard, alternating and weekly regimens). The toxicity requiring frequent dose delay/reductions have negative impact on quality of life and suggest this regimen cannot be recommended outside a clinical trial.

        

  • D.
    Rinaldi, N. Lormand, J. Brierre, J. Cole et al (Louisiana Oncology Associates, Lafayette, Louisiana) 

    A Phase I-II Trial of Topotecan and Gemcitabine in Patients with Previously Treated, Advanced Non-small Cell Lung Cancer (LOA-3) (NSCLC)

    Cancer Investigation 2001 Vol. 19 (5) Pg. 467-474

             

    Topotecan and gemcitabine are promising agents for patients with advanced NSCLC, both agents have preclinical and clinical activity and hence a combination with dose escalation was studied in 19 patients. 17 patients had measurable disease. Partial response was possible in 18%, 33% had disease stabilization.

             

    The median survival of entire group was 10 months and 6 patients were alive for 1 year from initiation of this combination. The current treatment was more effective in patients with adenocarcinoma.

             

    The MTD and doses recommended for phase II clinical trials of topotecan and gemcitabine as per the current schedule are 0.75 and 40 mg/m2 day 1-5 and day 1 and 5 respectively.

          

  • Rusin M, Butkiewicz D, Malusecka E, et al (Inst of Oncology, Gliwice, Poland; Silesian Med Academy, Zabrze, Poland; NIH, Bethesda, Md; et al)

    Molecular Epidemiological Study of Non-Small Cell Lung Cancer (NSCLC) From an Environmentally Polluted Region of Poland

    Br J Cancer 80: 1445-1452, 1999

            


    The p53 tumor suppressor gene codes for protein that regulates expression of different genes which affects several cellular functions.

          


    This study of forty-five tumor specimens from patient with NSCLC from 1991-95 underwent immunohistochemical examination, mutation analysis of the p53 gene and genotyping of GSTM1, CYP2D6 and CXP1A1, genetic polymorphisms. 

          


    Those exposed to coal derived substances had G to T transversions in the 298 codon of p53. Whereas never smokers from Silesia with lung cancer had a higher rate of G:C – T:A transversions. Thus authors have provided information about specific exposures leading to distinguishing mutations within target tumor suppressor genes.

            

  • Henschke CI, McCauley DI, Yankelevitz DF, et al (Cornell Univ, New York; New York Univ; McGill Univ, Montreal, Canada)

    Early Lung Cancer Action Project: Overall Design and Findings From Baseline Screening 

    Lancet 354: 99-105, 1999

          


    This study included 1000 subjects above 60 years and had a smoking history of 10 pack-years were screened by chest radiography and low-dose CT.

         

    Small pulmonary nodules were detected 3 fold higher with CT than chest radiograph. 23 of the 27 CT detected cancers were stage I at time of detection. Having low-dose CT greatly improves identification of small, noncalcified nodules and early stage lung cancer.

           

  • Gupta NC, Graeber GM, Bishop HA (West Virginia Univ, Morgantown)

    Comparative Efficacy of Positron Emission Tomography With Fluorodeoxyglucose in Evaluation of Small (<1 cm), Intermediate (1 to 3 cm), and Large (>3 cm) Lymph Node Lesions

    Chest 117: 773-778, 2000

           


    Mediastinal lymph nodes smaller than 1 cm in size are not identified by CT scan. This study of 118 patients with known or suspected cancer lung (non small cell) underwent PET-FDG and CT studies. 15/17 mediastinal lymph nodes less than a cm and having cancerous involvement were detected by PET scanning and 2 lymph nodes less than 1 cm showed uptake by PET scan were not involved with cancer on pathologic examination thus PET imaging is 80% sensitive and 95% specific, more accurate than CT scan for staging the mediastinum in patients with lung cancer.

           

  • Yokoi K, Kamiya N, Matsuguma H, et al (Tochigi Cancer Ctr, Utsunomiya, Japan) 

    Detection of Brain Metastasis in Potentially Operable Non-Small Cell Lung Cancer (NSCLC): A Comparison of CT and MRI

    Chest 115: 714-719, 1999

          


    This study performed on 155 patients with potentially resectable NSCLC in each group underwent CT scan or MRI brain for screening there is a low yield (1% – 5%) of identifying brain metastases by CT on MRI brain.

           


    MRI identified smaller lesions earlier in the course of their evaluation and follow-up and half were single. The clinical benefit of this early identification is not proven and hence such extensive testing in patients of NSCLC after resection in absence of symptoms or signs is not justifiable at the present
    juncture.

              

  • Okada M, Tsubota N, Yoshimura M, et al (Hyogo Med Ctr for Adults, Akashi City, Japan) 

    Role of Pleural Lavage Cytology Before Resection for Primary Lung Carcinoma 

    Ann Surg 229: 579-584, 1999

            

    This study of 482 patients with lung cancer without pleural effusion underwent cytology of pleural lavage immediately after thoracotomy. 

            

    The authors discovered that a positive pleural lavage cytology was seen only in adenocarcinoma and those with positive cytology had a poor 5 year survival compared with the patients who did not have positive pleural cytology.

           

  • Fujisawa T, Iizasa T, Saitoh Y, et al (Chiba Univ, Japan)

    Smoking Before Surgery Predicts Poor Long-term Survival in Patients With Stage I Non-Small-cell Lung Carcinomas (NSCLC)

    J Clin Oncol 17: 2086-2091, 1999

          

    This study of 369 patients with stage I NSCLC who underwent complete resections of disease underwent evaluations for clinical factors and cigarette smoking characteristic. Multivariate analysis revealed age and cigarette smoking were independent predictors of overall survival. 

         

    Disease specific survival rates worsened with increasing pack years of cigarette smoking. Those with more than 30 pack years were likely to have a recurrence or die of causes other than cancer. The editors comment that if their observations are verified then this subgroup of patients (more than 30 pack years smoking) should be considered for adjuvant chemotherapy.

           

  • de Perrot M, Licker M, Bouchardy C, et al (Univ Hosp of Geneva; Geneva Cancer Registry) 

    Sex Differences in Presentation, Management, and Prognosis of Patients With Non-Small Cell Lung Carcinoma (NSCLC)

    J Thorac Cardiovasc Surg 119: 21-26, 2000

           

    This study of 1037 patients of NSCLC who underwent thoracotomy were reviewed with clinical and therapeutic information such as age, preoperative symptoms, bronchoscopy findings, tobacco use, surgical procedure, histologic type, disease stage, adjuvant therapy, postoperative complications, and long-term outcome.

          

    The cigarette consumption was significantly higher in males than females and men were more likely to have squamous carcinoma whereas more women had adenocarcinoma.

          

    This overall mean survival was significantly greater for women than for men. Women with stage I and II live above 30% longer than men with early stage lung cancer, but not for stages III and IV. Further research is required to explain these findings.

         

  • Nelson
    HH, Christiani DC, Mark EJ, et al (Harvard School of Public Health, Boston; Harvard Med School, Boston; Univ of California, San Francisco)


    Implications and Prognostic Value of K-ras Mutation for Early-Stage Lung Cancer in Women 


    J Natl Cancer Inst 91: 2032-2038, 1999

             

    This study of 365 patients with recently diagnosed lung cancer and had undergone potentially curative resection were studied.

             

    The mutation status of K-ras codon 12 in tumor DNA, restricted to adenocarcinoma was studied by molecular techniques.

              

    Female sex smokers and adenocarcinoma was more often associated with K-ras mutation and multivariate analysis confirmed a shorter survival for those with K-ras mutations.

            

  • van Rens MTM, Brutel de la Riviere A, Elbers HRJ, et al (Sint Antonius Hosp, Nieuwegein, The Netherlands)

    Prognostic Assessment of 2,361 Patients Who Underwent Pulmonary Resection for Non-Small Cell Lung Cancer (NSCLC), Stage
    I, II, and IIIA

    Chest 117: 374-379, 2000

           

    In this study survival after lung resection was retrospectively examined in patients with primary NSCLC in stages
    I, II and IIIA. The 5-year survival rate was 63% for stage
    IA, 40% for stage IB, 52% for stage IIA and 33% for stage
    IIB and 19% for stage IIIA.

          

    Patients older than 65 years do not live as long as younger than 65 years. The present analysis also confirmed similar survival rates for patients with T2NOMO and T1NIMO. This study also brought out the poor survival of patients with
    IB to IIIA and these are the candidates for adjuvant and nonadjuvant studies.

            

  • Okumura M, Miyoshi S, Takeuchi Y, et al (Osaka Univ, Japan; Osaka Chuo Hosp, Japan; Nagoya City Univ, Aichi, Japan; et al)

    Results of Surgical Treatment of Thymomas With Special Reference to the Involved Organs 

    J Thorac Cardiovasc Surg 117: 605-613, 1999

          

    This study of 194 patients with thymoma who had undergone resection with or without chemotherapy or radiotherapy were evaluated as regards to specific organ involvement. 

           

    Masaoka staging system and involvement of great vessels were both independent predictors of survival in patients with thymoma.

            

  • Pisters
    KMW, for the Bimodality Lung Oncology Team (BLOT) (UMTD Anderson Cancer Ctr, Houston)

    Induction Chemotherapy Before Surgery for Early-Stage Lung Cancer: A Novel Approach 

    J Thorac Cardiovasc Surg 119: 429-439, 2000

          

    This multicenter phase II trial consisting of 94 patients with non-small-cell lung cancer (NSCLC) received preoperative chemotherapy with paclitaxel and carboplatinum, two courses followed by surgery and 3 more courses.

          

    Induction chemotherapy produced 56% responses. Pathologic analysis revealed complete responses in 6 patients. Those patients whose pathologic stage was less than clinical stage had a better 1 and 2 year survival than vice versa.

             

    Hence induction chemotherapy improved survival in early stage lung cancer (T2, T3 and/or N1 nodes) as per this study.

           

  • Fry WA, Phillips JL, Menck HR (Northwestern Univ, Evanston, III; National Cancer Data Base, Chicago; American College of Surgeons, Chicago)

    Ten-Year Survey of Lung Cancer Treatment and Survival in Hospitals in the United States: A National Cancer Data Base Report

    Cancer 86: 1867-1876, 1999 

             


    This study of 713,043 patients of lung cancer were evaluated by the demographic tumor data and treatment information from National Cancer Data Base. The overall 10-year survival relative risk was 7%. Disease stage was predictive of survival.

           


    The overall survival of patients with lung cancer is poor except for those with stage I non small cell lung cancer and over the years the histology has drifted in favor of adenocarcinoma and more patients with stage III and IV receiving chemotherapy and that women live longer than men.

            

  •  Tirelli U, for the Italian Cooperative Group on AIDS and Tumors (Aviano Cancer Ctr, Italy)

    Lung Carcinoma in 36 Patients With Human Immunodeficiency Virus Infection 

    Cancer 88: 563-569, 2000

            


    This is the largest study of 36 HIV positive patients with lung cancer and compared with 102 patients with lung cancer only.

            


    These patients were younger than most patients with lung cancer and underlying pulmonary infection were common.

            


    The histology and stage distribution were similar in both cohorts. Most of the patients with HIV and lung cancer died of lung cancer rather than HIV infections. 

           


    The median survival time was 5 months, which is much shorter than in the other cohort.

           

  • Sawyer TE, Bonner JA, Gould PM, et al (Mayo Clinic and Mayo Found, Rochester, Minn)

    Predictors of Subclinical Nodal Involvement in Clinical Stages I and II Non-Small Cell Lung Cancer (NSCLC): Implications in the Inoperable and Three-Dimensional Dose-Escalation Settings

    Int J Radiat Oncol Biol Phys 43: 965-970, 1999 

            

    This study of 346 consecutive patients with NSCLC with preoperative CT scan without N2/N3 involvement and those following surgery with N1/N2 or loco-regional recurrence (LRR) were included.

             

    A positive result of preoperative bronchoscopy, higher grade and large tumors tended to have a greater risk of subclinical nodal involvement and a significantly higher N1/N2/LRR incidence and they concluded that for patients with inoperable NSCLC and positive preoperative bronchoscopy results, mediastinal radiation therapy is recommended particularly if the tumor is
    large.

            

  • Furuse K, for the West Japan Lung Cancer Group (Natl Kinki Central Hosp for Chest Diseases, Japan; et al)

    Phase III Study of Concurrent Versus Sequential Thoracic Radiotherapy in Combination With Mitomycin, Vindesine, and Cisplatin in Unresectable Stage III Non-Small-Cell Lung Cancer

    J Clin Oncol 17: 2692-2699, 1999 

             


    This study in locally advanced lung cancer compared sequential versus concurrent chemotherapy with mitomycin, vindesine, and cisplatinum along with local radiotherapy.

           


    There were 84% responses in the concurrent group and 66.4% in the sequential group. The survival and 5-year survival were better in concurrent group. 

           


    The incidence of esophageal toxicity was the same, but the concurrent group had higher
    myelosuppression.

            

  • Garver RI Jr, Zorn GL, Wu X, et al (Univ of Alabama, Birmingham; UAB Hosp, Birmingham, Ala)

    Recurrence of Bronchioloalveolar Carcinoma in Transplanted Lungs

    N Engl J Med 340: 1071-1074, 1999 

           


    Organ transplantation is not considered a realistic form of treatment for patients with cancer.

          


    This study of seven patients with unresectable bronchioloalveolar carcinoma who underwent lung transplantation as the other treatment modalities have very poor results. Four out of seven transplanted patients had recurrence in the lung that was transplanted. 

          


    The essential question put in by the editor is this the best use of donor lung? given the other conditions for which transplant could be
    considered.

          

  • Cullen
    MH, Billingham LJ, Woodroffe CM, et al (Univ Hosp Birmingham, England; Univ of Birmingham, England; Univ College Hosps Trust, London; et al)

    Mitomycin, Ifosfamide, and Cisplatin (MIC) in Unresectable Non-Small-Cell Lung Cancer: Effects on Survival and Quality of Life

    J Clin Oncol 17: 3188-3194, 1999

           

    This study has combined the two large phase III trials assessing the role of MIC in non-small-cell lung cancer. MIC improved the survival in both studies. The analysis revealed the benefit in metastatic disease and MIC when administered concurrently with RT also had survival advantage than only RT arm.

          

    The quality of life score as assessed by EORTC questionnaire assessing symptoms also showed an improvement in patients treated with chemotherapy.

           

  • Bonomi P, Kim K, Fairclough D, et al (Rush-Presbyterian St Luke’s Med Ctr, Chicago; Illinois Oncology Research Association, Peoria; Northwestern Univ, Evanston, III; et al)

    Comparison of Survival and Quality of Life in Advanced Non-Small-Cell Lung Cancer Patients Treated With Two Dose Levels of Paclitaxel Combined With Cisplatin Versus Etoposide With Cisplatin: Results of an Eastern Cooperative Oncology Group Trial

    J Clin Oncol 18: 623-631, 2000

          

    This study of 599 patients with non-small-cell lung cancer who had received prior chemotherapy were randomized with 75
    mg/m2 cisplat and 135 mg/m2 paclitaxel (PC) or 250
    mg/m2 paclitaxel (PCG) or cisplat plus etoposide (EC) group.

          

    The patient with PC or PCG lived a median 2 months longer than EC group. The quality of life analysis revealed only a slight advantage for paclitaxel group. The two fold higher dose (PCG) of paclitaxel did not further improve the survival.

          

  • Shepherd FA, Dancey J, Ramlau R, et al (Univ of Toronto; London Regional Cancer Ctr, Ontario; Regional Hosp of Lung Disease and Tuberculosis, Poznan, Poland; et al)

    Prospective Randomized Trial of Docetaxel Versus Best Supportive Care in Patients With Non-Small-Cell Lung Cancer (NSCLC) Previously Treated With Platinum-Based Chemotherapy

    J Clin Oncol 18: 2095-2103, 2000

          

    This study of 85 patients with stage IIIB/IV NSCLC pretreated with cisplatinum based chemotherapy and now with recurrence underwent quality of life (QOL) questionnaire and then randomization to docetaxel 75
    mg/m2 or 100 mg/m2

          

    The patients treated with docetaxel lived longer than the patients with best supportive care median of 7 months compared with 4.6 months and with better measures of QOL.

           

  • Font A, Moyano AJ, Puerto JM, et al (Univ Hosp Germans Trias i Pujol, Barcelona; Hosp Ramon y Cajal, Madrid; Hosp Infanta Cristina, Badajoz, Spain; et al)

    Increasing Dose Intensity of Cisplatin-Etoposide in Advanced Non-Small Cell Lung Carcinoma: A Phase III Randomized Trial of the Spanish Lung Cancer Group

    Cancer 85: 855-863, 1999

           

    This study of 126 patients of non small cell lung cancer (NSCLC) received cisplat 35
    mg/m2 + etoposide 200 mg/m2, day 1 to 3 every 4 weeks (dose intense) without or with G-CSF on day 4-13 every 3 weeks (dose dense).

          

    There was no improvement in survival or in response rate between the dose intense or dose dense arm. This shows that modest increases in dose intensity are not associated with any major gain.

           

    This holds good for bone marrow transplantation also where dose is increased by factor 2 or 3 is not useful. The authors commented that it would be more valuable to analyze issue of concentration of drugs over time or area under the curve as a more important variable.

          

  • Sethi T, Rintoul RC, Moore SM, et al (Univ of Edinburgh, Scotland; Univ of Michigan, Ann Arbor)

    Extracellular Matrix Proteins Protect Small Cell Lung Cancer Cells Against Apoptosis: A Mechanism For Small Cell Lung Cancer Growth And Drug Resistance In Vivo

    Nat Med 5: 662-668, 1999

       

    Resistance to chemotherapy is one of the main problems with small cell lung cancer (SCLC).

      

    The extracellular matrix was identified by immunohistochemical staining for fibronectin (Fn), laminin (Ln), collagen IV, and
    tenascin.

      

    The presence of Ln, Fn, or collagen IV significantly diminished the sensitivity of SCLC to cytotoxic agents such as doxorubicin, cisplatinum, etoposide and
    cyclophosphamide.

      

    These findings were then correlated with small cohort of 15 patients with SCLC. Those with extensive matrix did poorly. Thus extracellular matrix may account for preventing chemotherapy induced apoptosis.

         

  • Thatcher N, for the Medical Research Council Lung Cancer Working Party (Med Research Council Clinical Trials Unit, London; et al)

    Improving Survival Without Reducing Quality of Life in Small-Cell Lung Cancer (SCLC) Patients by Increasing the Dose-Intensity of Chemotherapy With Granulocyte Colony-Stimulating Factor Support: Results of a British Medical Research Council Multicenter Randomized Trial

    J Clin Oncol 18: 395-404, 2000

       

    This study of 403 patients with SCLC who received doxorubicin, cyclophosphamide and etoposide (ACE) such as day 1, 40 mg/m2 doxorubicin, 1 gm/m2 cyclophosphamide and 120 mg/m2 etoposide IV infusion on day 1 and 240 mg/m2 by mouth on day 2, 3 were compared with the control group (C) which received every 3 weeks and with G-CSF (G), the ACE was administered every 2 weeks.

       

    The overall response rates were similar but complete response was higher in group G and a significantly better survival.

      

    Their findings are in contrast to widely reported finding in two other studies where there was no improvement in dose escalation for patients with SCLC. The editor comments this difference could be explained by the absence of limited stage disease patients in these two studies.

       

  • Auperin A, for the Prophylactic Cranial Irradiation Overview Collaborative Group (Institut Gustave-Roussy, Villejuif, France; et al)

    Prophylactic Cranial Irradiation (PCI) for Patients With Small-Cell Lung Cancer in Complete Remission

    N Engl J Med 341: 476-484, 1999

       

    Patients with small cell lung cancer have high propensity for brain metastases, from 10% at the time of diagnosis to 50% at 2 years.

      

    This is a metaanalysis of 987 patients with small cell lung cancer (SCLC) who were in complete remission and were randomized to either PCI or no
    PCI.

       

    Those who received PCI had significantly improved survival and reduced risk of brain metastasis. There was a 5.4% increase in absolute survival at 3 years to 20.7%.

         

  • Fonseca R, O’Neill BP, Foote RL, et al (Mayo Clinic, Rochester, Minn)

    Cerebral Toxicity in Patients Treated for Small Cell Carcinoma of the Lung

    Mayo Clin Proc 74: 461-465, 1999

        

    This study of patients with small cell lung cancer, who received prophylactic cranial irradiation (PCI) were compared with those who did not.

        

    Patients with PCI had higher leukoencephalopathy and the most common signs and symptoms were changes in intellectual capacity memory and motor abilities.

       

    The editor comments that higher rate of leukoencephalopathy in this study were due to simultaneous use of chemotherapy and radiotherapy (PCI), thereby altering of permeability of CNS to chemotherapy by radiotherapy could have enhanced the CNS injury.

       


 

 



 

 

Speciality Spotlight

 

 

Lung Cancer
  

  • Kawahara M, Ushijima S, Kamimori T, et al [ Natl Kinki Central Hosp for Chest Diseases, Osaka, Japan; Osaka Prefectural Habikino Hosp, Osaka, Japan; Natl Cancer Research Inst, Tokyo]
    Second Primary Tumors  in More Than-2-Year Disease-Free Survivors of Small Cell Lung Cancer in Japan: The Role of Smoking Cessation
    Br J Cancer 78: 409-412, 1998
           
    This study of survival i.e. beyond 2 years after treatment for small cell lung cancer were followed for relapse or occurrence of a second primary tumor [ SPT]. These patient had a significantly increased risk of SPT but the risk substantially decreased if they quit smoking.
            

  • Stewart LA, for the PORT Meta-analysis Trialists Group [ MRC Cancer Trials  Office, Cambridge, England]
    Postoperative Radiotherapy in Non-Small-Cell Lung Cancer[ NSCLC]: Systematic Review and Meta-analysis of Individual patient Data from Nine Randomized Controlled Trials
    Lancet 352: 257-263, 1998
          
    Adjuvant radiotherapy following a potentially resectable lung cancer is of doubtful value. This meta-analysis has tried to evaluate the role of radiotherapy in such a setting.
          
    Postoperative radiotherapy was administered to patients with Stage I and  II
          
    NSCLC clearly had an adverse effect on survival. Although there was no adverse effect on patients with stage III, N2 disease, No group of patients with NSCLC benefited from postoperative radiotherapy.
          
    The 5 year survival rate was 51.3 %  in delayed node dissection versus 61.7% with immediate node dissection, prognosis was poorest for those in patients with regional nodes that became clinically and histologically positive during follow-u[
           
    The interpretation of this study suggest that those with micrometastasis in the lymph node if not  resected had poor prognosis and hence identification of sentinel lymph node would be benefical.

            

  • Quekel LGBA, Kessels AGH, Goei R, et al
    Miss Rate of Lung Cancer on the Chest Radiograph in Clinical Practice
    Chest 115: 720-724, 1999
        
    Despite best efforts, some Non Small Cell Lung Cancer [NSCLC] tumours are missed on chest radiographs. The miss rate for these tumours and the resultant implications for prognosis were evaluated. 
       
    Medical records and chest radiographs were retrospectively reviewed for 396 patients who were treated for primary NSCLC. Two independent radiologists reviewed all chest radiographs to determine whether any lesions had been missed in earlier radiographs, if a previously missed lesion was identified, a third independent radiologist confirmed its presence. 
      
    The time between the first appearance of the lesion on the chest radiograph and the date of histopathologic diagnosis was calculated to measure the delay in diagnosis. Findings showed that NSCLC presented as a nodular lesion in 259 of the 396 patients [65.4%]; the lesion was definitely missed in 49 [19%]; in fact the lesion was missed twice on consecutive chest radiographs in 16 patients and 6 patients it was missed 3 times or more.
       
    Location of the tumour did not influence the miss rate. However superimposing structures were significantly more common in the patients with missed lesions [71% vs 2%]. Additionally missed lesions were significantly smaller [median diameters 16 vs 40 mms]; most of the lesions 10 mms or less were missed in 71%.
       
    The median delay in the diagnosis of missed lesions was 472 days which was significantly longer than the 29 days for diagnosis of detected lesions. The extra delay resulted in the conversion of the tumours from stage T1 to T2 in 21 patients with missed lesions [43%]. Of the remaining 28 patients with missed lesions 22 continued to remain in stage T1 and 6 in stage T2.
       
    The authors conclude that miss rate of 19% [in other reported series from 20% to 50%] has a definite impact on prognosis and therefore remains a cause of concern.
           

  • Moskal TL, Dougherty TJ, Urschel JD, et al [Rosewell Park Cancer Inst, Buffalo, NY]
    Operation and Photodynamic Therapy for Pleural Mesothelioma: 6-Year Follow-up
    Ann Thorac Surg 66: 1128-1133, 1998
       
    This study of 40 patients with malignant pleural mesothelioma [MPM] underwent surgical resection followed by immediate intracavitary photo dynamic therapy. In patients with stage I & II pleural mesothelioma. Surgery and PDT offers good survival results. More effective treatments are required for stage III or IV disease.
      

  • Yahata N, Ohyashiki K, Ohyashiki JH, et al [Tokyo Med College; Univ of Texas, Dallas]
    Telomerase Activity in Lung Cancer Cells Obtained from bronchial Washings
    J Natl Cancer Inst 90: 684-690, 1998
      
    Telomerase which are components of the chromosomal ends containing nucleotide protects them from sticking to each other. Shortening of the length of telomere is activated by telomerase which is an intracellular reverse transcriptase with an RNA component. Experimental studies indicate that failure of telomerase to shorten progressively with each cell division lead to cellular immortalization a critical step in cancer progression.
        
    In this Japanese study telomerase activity from the bronchial washing were assayed. Telomerase activity was detected in bronchial washings from the majority of lung cancer patients. The editor comments that utility of such a concept for early detections, essentially at a premalignant level.
      

  • Choe DH, Lee JH, Lee BH, et al [ Korea Cancer Ctr Hosp, Seoul]
    Obliteration of the Pulmonary Vein in Lung Cancer : Significance in Assessing Local Extent with CT
    J Comput Assist Tomogr 22: 587-591, 1998
       
    The lung tumor growth though the pulmonary veins intra pericardially or in the [L] atrium is uncommon. The obliteration of the superior pulmonary vein on CT in patients with lung tumor strongly suggests intrapericardial tumor extension through the pulmonary vein. Identifying this type of growth preoperatively is essential in planning surgical treatment as it may result in systemic tumor embolization with fatal consequences with manipulation or ligation of the involved pulmonary vein. Inferior pulmonary vein obliteration is a less reliable indicator of intrapericardial extension.
       

  • P Boffetta, G Pershangen, K-H Jockel, et al (Interrnatl Ageny for Research on Cancer, Lyon, France, Karolinska INst, Stockholm; Inst for Med Informatics, Essen, Germany; et al)
    Cigar and Pipe Smoking and Lung Cancer Risk: A Multicenter Study from Europe.
    J Natl Cancer Inst 91: 697-701, 1999
        
    The association between the consumption of tobacco products other than cigarettes and lung cancer risk has not been well studied. The authors have presented  a case-control study of this relationship.
       
    The case group comprised 5621 men with lung cancer in comparison with controlled group which included 7255 men without lung cancer. The lung cancer odds ratio for smoking cigars and cigarillos only was 9, whereas the odds ratio for smoking a pipe only was 7.9 as compared to that of cigarettes being 14.9. A dose-response relationship for duration of use and cumulative consumption for cigars and cigarillos as well as for pipe tobacco was noted. The dose-response associations between lung-cancer risk and either smoking duration or mean and cumulative consumption were comparable for cigar and cigarillo smoking, pipe smoking, and cigarette smoking.
       
    The study concluded that cigars, cigarillos and pipe tobacco may have a carcinogenic effect on the lung that is comparable to that of cigarettes.
        

  • Gregory P, Kalemkerian, Muhammad A. Ali, Kavita Luthra, et al (Department of Medicine, Division of Hematology and Oncology, Wayne State University, Detroit, Michigan, and The Barbara Ann Karmanos, Cancer Institute, Detroit, Michigan)
    A Phase II study of Weekly Alternating Chemotherapy in Extensive-Stage Small Cell Lung Cancer
    Cancer Investigation 2001 Vol. 19 (3) Pg. 234-238
       
    Treatment strategies for extensive stage small cell lung cancer (SCLC) have been non cross resistant or dose intense chemotherapy. Despite the recent development in oncology, the long term prognosis of patients with extensive stage disease remains poor. In the present study 18 untreated patients with extensive stage SCLC received cyclophosphamide, etoposide and cisplatin on day 1, vincristine day 8 and ifosfamide on days 8 and 9. 
      
    In most of the patients dose delay and dose reductions was required, 67% had objective response with a median duration of response 18 weeks. 
       
    Median survival was 33 weeks. Although the results achieved were comparable with other previous studies (standard, alternating and weekly regimens). The toxicity requiring frequent dose delay/reductions have negative impact on quality of life and suggest this regimen cannot be recommended outside a clinical trial.
        

  • D. Rinaldi, N. Lormand, J. Brierre, J. Cole et al (Louisiana Oncology Associates, Lafayette, Louisiana) 
    A Phase I-II Trial of Topotecan and Gemcitabine in Patients with Previously Treated, Advanced Non-small Cell Lung Cancer (LOA-3) (NSCLC)
    Cancer Investigation 2001 Vol. 19 (5) Pg. 467-474
             
    Topotecan and gemcitabine are promising agents for patients with advanced NSCLC, both agents have preclinical and clinical activity and hence a combination with dose escalation was studied in 19 patients. 17 patients had measurable disease. Partial response was possible in 18%, 33% had disease stabilization.
             
    The median survival of entire group was 10 months and 6 patients were alive for 1 year from initiation of this combination. The current treatment was more effective in patients with adenocarcinoma.
             
    The MTD and doses recommended for phase II clinical trials of topotecan and gemcitabine as per the current schedule are 0.75 and 40 mg/m2 day 1-5 and day 1 and 5 respectively.
          

  • Rusin M, Butkiewicz D, Malusecka E, et al (Inst of Oncology, Gliwice, Poland; Silesian Med Academy, Zabrze, Poland; NIH, Bethesda, Md; et al)
    Molecular Epidemiological Study of Non-Small Cell Lung Cancer (NSCLC) From an Environmentally Polluted Region of Poland
    Br J Cancer 80: 1445-1452, 1999
            
    The p53 tumor suppressor gene codes for protein that regulates expression of different genes which affects several cellular functions.
          
    This study of forty-five tumor specimens from patient with NSCLC from 1991-95 underwent immunohistochemical examination, mutation analysis of the p53 gene and genotyping of GSTM1, CYP2D6 and CXP1A1, genetic polymorphisms. 
          
    Those exposed to coal derived substances had G to T transversions in the 298 codon of p53. Whereas never smokers from Silesia with lung cancer had a higher rate of G:C – T:A transversions. Thus authors have provided information about specific exposures leading to distinguishing mutations within target tumor suppressor genes.
            

  • Henschke CI, McCauley DI, Yankelevitz DF, et al (Cornell Univ, New York; New York Univ; McGill Univ, Montreal, Canada)
    Early Lung Cancer Action Project: Overall Design and Findings From Baseline Screening 
    Lancet 354: 99-105, 1999
          
    This study included 1000 subjects above 60 years and had a smoking history of 10 pack-years were screened by chest radiography and low-dose CT.
         
    Small pulmonary nodules were detected 3 fold higher with CT than chest radiograph. 23 of the 27 CT detected cancers were stage I at time of detection. Having low-dose CT greatly improves identification of small, noncalcified nodules and early stage lung cancer.
           

  • Gupta NC, Graeber GM, Bishop HA (West Virginia Univ, Morgantown)
    Comparative Efficacy of Positron Emission Tomography With Fluorodeoxyglucose in Evaluation of Small (<1 cm), Intermediate (1 to 3 cm), and Large (>3 cm) Lymph Node Lesions
    Chest 117: 773-778, 2000
           
    Mediastinal lymph nodes smaller than 1 cm in size are not identified by CT scan. This study of 118 patients with known or suspected cancer lung (non small cell) underwent PET-FDG and CT studies. 15/17 mediastinal lymph nodes less than a cm and having cancerous involvement were detected by PET scanning and 2 lymph nodes less than 1 cm showed uptake by PET scan were not involved with cancer on pathologic examination thus PET imaging is 80% sensitive and 95% specific, more accurate than CT scan for staging the mediastinum in patients with lung cancer.
           

  • Yokoi K, Kamiya N, Matsuguma H, et al (Tochigi Cancer Ctr, Utsunomiya, Japan) 
    Detection of Brain Metastasis in Potentially Operable Non-Small Cell Lung Cancer (NSCLC): A Comparison of CT and MRI
    Chest 115: 714-719, 1999
          
    This study performed on 155 patients with potentially resectable NSCLC in each group underwent CT scan or MRI brain for screening there is a low yield (1% – 5%) of identifying brain metastases by CT on MRI brain.
           
    MRI identified smaller lesions earlier in the course of their evaluation and follow-up and half were single. The clinical benefit of this early identification is not proven and hence such extensive testing in patients of NSCLC after resection in absence of symptoms or signs is not justifiable at the present juncture.
              

  • Okada M, Tsubota N, Yoshimura M, et al (Hyogo Med Ctr for Adults, Akashi City, Japan) 
    Role of Pleural Lavage Cytology Before Resection for Primary Lung Carcinoma 
    Ann Surg 229: 579-584, 1999
            
    This study of 482 patients with lung cancer without pleural effusion underwent cytology of pleural lavage immediately after thoracotomy. 
            
    The authors discovered that a positive pleural lavage cytology was seen only in adenocarcinoma and those with positive cytology had a poor 5 year survival compared with the patients who did not have positive pleural cytology.
           

  • Fujisawa T, Iizasa T, Saitoh Y, et al (Chiba Univ, Japan)
    Smoking Before Surgery Predicts Poor Long-term Survival in Patients With Stage I Non-Small-cell Lung Carcinomas (NSCLC)
    J Clin Oncol 17: 2086-2091, 1999
          
    This study of 369 patients with stage I NSCLC who underwent complete resections of disease underwent evaluations for clinical factors and cigarette smoking characteristic. Multivariate analysis revealed age and cigarette smoking were independent predictors of overall survival. 
         
    Disease specific survival rates worsened with increasing pack years of cigarette smoking. Those with more than 30 pack years were likely to have a recurrence or die of causes other than cancer. The editors comment that if their observations are verified then this subgroup of patients (more than 30 pack years smoking) should be considered for adjuvant chemotherapy.
           

  • de Perrot M, Licker M, Bouchardy C, et al (Univ Hosp of Geneva; Geneva Cancer Registry) 
    Sex Differences in Presentation, Management, and Prognosis of Patients With Non-Small Cell Lung Carcinoma (NSCLC)
    J Thorac Cardiovasc Surg 119: 21-26, 2000
           
    This study of 1037 patients of NSCLC who underwent thoracotomy were reviewed with clinical and therapeutic information such as age, preoperative symptoms, bronchoscopy findings, tobacco use, surgical procedure, histologic type, disease stage, adjuvant therapy, postoperative complications, and long-term outcome.
          
    The cigarette consumption was significantly higher in males than females and men were more likely to have squamous carcinoma whereas more women had adenocarcinoma.
          
    This overall mean survival was significantly greater for women than for men. Women with stage I and II live above 30% longer than men with early stage lung cancer, but not for stages III and IV. Further research is required to explain these findings.
         

  • Nelson HH, Christiani DC, Mark EJ, et al (Harvard School of Public Health, Boston; Harvard Med School, Boston; Univ of California, San Francisco)
    Implications and Prognostic Value of K-ras Mutation for Early-Stage Lung Cancer in Women 
    J Natl Cancer Inst 91: 2032-2038, 1999
             
    This study of 365 patients with recently diagnosed lung cancer and had undergone potentially curative resection were studied.
             
    The mutation status of K-ras codon 12 in tumor DNA, restricted to adenocarcinoma was studied by molecular techniques.
              
    Female sex smokers and adenocarcinoma was more often associated with K-ras mutation and multivariate analysis confirmed a shorter survival for those with K-ras mutations.
            

  • van Rens MTM, Brutel de la Riviere A, Elbers HRJ, et al (Sint Antonius Hosp, Nieuwegein, The Netherlands)
    Prognostic Assessment of 2,361 Patients Who Underwent Pulmonary Resection for Non-Small Cell Lung Cancer (NSCLC), Stage I, II, and IIIA
    Chest 117: 374-379, 2000
           
    In this study survival after lung resection was retrospectively examined in patients with primary NSCLC in stages I, II and IIIA. The 5-year survival rate was 63% for stage IA, 40% for stage IB, 52% for stage IIA and 33% for stage IIB and 19% for stage IIIA.
          
    Patients older than 65 years do not live as long as younger than 65 years. The present analysis also confirmed similar survival rates for patients with T2NOMO and T1NIMO. This study also brought out the poor survival of patients with IB to IIIA and these are the candidates for adjuvant and nonadjuvant studies.
            

  • Okumura M, Miyoshi S, Takeuchi Y, et al (Osaka Univ, Japan; Osaka Chuo Hosp, Japan; Nagoya City Univ, Aichi, Japan; et al)
    Results of Surgical Treatment of Thymomas With Special Reference to the Involved Organs 
    J Thorac Cardiovasc Surg 117: 605-613, 1999
          
    This study of 194 patients with thymoma who had undergone resection with or without chemotherapy or radiotherapy were evaluated as regards to specific organ involvement. 
           
    Masaoka staging system and involvement of great vessels were both independent predictors of survival in patients with thymoma.
            

  • Pisters KMW, for the Bimodality Lung Oncology Team (BLOT) (UMTD Anderson Cancer Ctr, Houston)
    Induction Chemotherapy Before Surgery for Early-Stage Lung Cancer: A Novel Approach 
    J Thorac Cardiovasc Surg 119: 429-439, 2000
          
    This multicenter phase II trial consisting of 94 patients with non-small-cell lung cancer (NSCLC) received preoperative chemotherapy with paclitaxel and carboplatinum, two courses followed by surgery and 3 more courses.
          
    Induction chemotherapy produced 56% responses. Pathologic analysis revealed complete responses in 6 patients. Those patients whose pathologic stage was less than clinical stage had a better 1 and 2 year survival than vice versa.
             
    Hence induction chemotherapy improved survival in early stage lung cancer (T2, T3 and/or N1 nodes) as per this study.
           

  • Fry WA, Phillips JL, Menck HR (Northwestern Univ, Evanston, III; National Cancer Data Base, Chicago; American College of Surgeons, Chicago)
    Ten-Year Survey of Lung Cancer Treatment and Survival in Hospitals in the United States: A National Cancer Data Base Report
    Cancer 86: 1867-1876, 1999 
             
    This study of 713,043 patients of lung cancer were evaluated by the demographic tumor data and treatment information from National Cancer Data Base. The overall 10-year survival relative risk was 7%. Disease stage was predictive of survival.
           
    The overall survival of patients with lung cancer is poor except for those with stage I non small cell lung cancer and over the years the histology has drifted in favor of adenocarcinoma and more patients with stage III and IV receiving chemotherapy and that women live longer than men.
            

  •  Tirelli U, for the Italian Cooperative Group on AIDS and Tumors (Aviano Cancer Ctr, Italy)
    Lung Carcinoma in 36 Patients With Human Immunodeficiency Virus Infection 
    Cancer 88: 563-569, 2000
            
    This is the largest study of 36 HIV positive patients with lung cancer and compared with 102 patients with lung cancer only.
            
    These patients were younger than most patients with lung cancer and underlying pulmonary infection were common.
            
    The histology and stage distribution were similar in both cohorts. Most of the patients with HIV and lung cancer died of lung cancer rather than HIV infections. 
           
    The median survival time was 5 months, which is much shorter than in the other cohort.
           

  • Sawyer TE, Bonner JA, Gould PM, et al (Mayo Clinic and Mayo Found, Rochester, Minn)
    Predictors of Subclinical Nodal Involvement in Clinical Stages I and II Non-Small Cell Lung Cancer (NSCLC): Implications in the Inoperable and Three-Dimensional Dose-Escalation Settings
    Int J Radiat Oncol Biol Phys 43: 965-970, 1999 
            
    This study of 346 consecutive patients with NSCLC with preoperative CT scan without N2/N3 involvement and those following surgery with N1/N2 or loco-regional recurrence (LRR) were included.
             
    A positive result of preoperative bronchoscopy, higher grade and large tumors tended to have a greater risk of subclinical nodal involvement and a significantly higher N1/N2/LRR incidence and they concluded that for patients with inoperable NSCLC and positive preoperative bronchoscopy results, mediastinal radiation therapy is recommended particularly if the tumor is large.
            

  • Furuse K, for the West Japan Lung Cancer Group (Natl Kinki Central Hosp for Chest Diseases, Japan; et al)
    Phase III Study of Concurrent Versus Sequential Thoracic Radiotherapy in Combination With Mitomycin, Vindesine, and Cisplatin in Unresectable Stage III Non-Small-Cell Lung Cancer
    J Clin Oncol 17: 2692-2699, 1999 
             
    This study in locally advanced lung cancer compared sequential versus concurrent chemotherapy with mitomycin, vindesine, and cisplatinum along with local radiotherapy.
           
    There were 84% responses in the concurrent group and 66.4% in the sequential group. The survival and 5-year survival were better in concurrent group. 
           
    The incidence of esophageal toxicity was the same, but the concurrent group had higher myelosuppression.
            

  • Garver RI Jr, Zorn GL, Wu X, et al (Univ of Alabama, Birmingham; UAB Hosp, Birmingham, Ala)
    Recurrence of Bronchioloalveolar Carcinoma in Transplanted Lungs
    N Engl J Med 340: 1071-1074, 1999 
           
    Organ transplantation is not considered a realistic form of treatment for patients with cancer.
          
    This study of seven patients with unresectable bronchioloalveolar carcinoma who underwent lung transplantation as the other treatment modalities have very poor results. Four out of seven transplanted patients had recurrence in the lung that was transplanted. 
          
    The essential question put in by the editor is this the best use of donor lung? given the other conditions for which transplant could be considered.
          

  • Cullen MH, Billingham LJ, Woodroffe CM, et al (Univ Hosp Birmingham, England; Univ of Birmingham, England; Univ College Hosps Trust, London; et al)
    Mitomycin, Ifosfamide, and Cisplatin (MIC) in Unresectable Non-Small-Cell Lung Cancer: Effects on Survival and Quality of Life
    J Clin Oncol 17: 3188-3194, 1999
           
    This study has combined the two large phase III trials assessing the role of MIC in non-small-cell lung cancer. MIC improved the survival in both studies. The analysis revealed the benefit in metastatic disease and MIC when administered concurrently with RT also had survival advantage than only RT arm.
          
    The quality of life score as assessed by EORTC questionnaire assessing symptoms also showed an improvement in patients treated with chemotherapy.
           

  • Bonomi P, Kim K, Fairclough D, et al (Rush-Presbyterian St Luke’s Med Ctr, Chicago; Illinois Oncology Research Association, Peoria; Northwestern Univ, Evanston, III; et al)
    Comparison of Survival and Quality of Life in Advanced Non-Small-Cell Lung Cancer Patients Treated With Two Dose Levels of Paclitaxel Combined With Cisplatin Versus Etoposide With Cisplatin: Results of an Eastern Cooperative Oncology Group Trial
    J Clin Oncol 18: 623-631, 2000
          
    This study of 599 patients with non-small-cell lung cancer who had received prior chemotherapy were randomized with 75 mg/m2 cisplat and 135 mg/m2 paclitaxel (PC) or 250 mg/m2 paclitaxel (PCG) or cisplat plus etoposide (EC) group.
          
    The patient with PC or PCG lived a median 2 months longer than EC group. The quality of life analysis revealed only a slight advantage for paclitaxel group. The two fold higher dose (PCG) of paclitaxel did not further improve the survival.
          

  • Shepherd FA, Dancey J, Ramlau R, et al (Univ of Toronto; London Regional Cancer Ctr, Ontario; Regional Hosp of Lung Disease and Tuberculosis, Poznan, Poland; et al)
    Prospective Randomized Trial of Docetaxel Versus Best Supportive Care in Patients With Non-Small-Cell Lung Cancer (NSCLC) Previously Treated With Platinum-Based Chemotherapy
    J Clin Oncol 18: 2095-2103, 2000
          
    This study of 85 patients with stage IIIB/IV NSCLC pretreated with cisplatinum based chemotherapy and now with recurrence underwent quality of life (QOL) questionnaire and then randomization to docetaxel 75 mg/m2 or 100 mg/m2
          
    The patients treated with docetaxel lived longer than the patients with best supportive care median of 7 months compared with 4.6 months and with better measures of QOL.
           

  • Font A, Moyano AJ, Puerto JM, et al (Univ Hosp Germans Trias i Pujol, Barcelona; Hosp Ramon y Cajal, Madrid; Hosp Infanta Cristina, Badajoz, Spain; et al)
    Increasing Dose Intensity of Cisplatin-Etoposide in Advanced Non-Small Cell Lung Carcinoma: A Phase III Randomized Trial of the Spanish Lung Cancer Group
    Cancer 85: 855-863, 1999
           
    This study of 126 patients of non small cell lung cancer (NSCLC) received cisplat 35 mg/m2 + etoposide 200 mg/m2, day 1 to 3 every 4 weeks (dose intense) without or with G-CSF on day 4-13 every 3 weeks (dose dense).
          
    There was no improvement in survival or in response rate between the dose intense or dose dense arm. This shows that modest increases in dose intensity are not associated with any major gain.
           
    This holds good for bone marrow transplantation also where dose is increased by factor 2 or 3 is not useful. The authors commented that it would be more valuable to analyze issue of concentration of drugs over time or area under the curve as a more important variable.
          

  • Sethi T, Rintoul RC, Moore SM, et al (Univ of Edinburgh, Scotland; Univ of Michigan, Ann Arbor)
    Extracellular Matrix Proteins Protect Small Cell Lung Cancer Cells Against Apoptosis: A Mechanism For Small Cell Lung Cancer Growth And Drug Resistance In Vivo
    Nat Med 5: 662-668, 1999
       
    Resistance to chemotherapy is one of the main problems with small cell lung cancer (SCLC).
      
    The extracellular matrix was identified by immunohistochemical staining for fibronectin (Fn), laminin (Ln), collagen IV, and tenascin.
      
    The presence of Ln, Fn, or collagen IV significantly diminished the sensitivity of SCLC to cytotoxic agents such as doxorubicin, cisplatinum, etoposide and cyclophosphamide.
      
    These findings were then correlated with small cohort of 15 patients with SCLC. Those with extensive matrix did poorly. Thus extracellular matrix may account for preventing chemotherapy induced apoptosis.
         

  • Thatcher N, for the Medical Research Council Lung Cancer Working Party (Med Research Council Clinical Trials Unit, London; et al)
    Improving Survival Without Reducing Quality of Life in Small-Cell Lung Cancer (SCLC) Patients by Increasing the Dose-Intensity of Chemotherapy With Granulocyte Colony-Stimulating Factor Support: Results of a British Medical Research Council Multicenter Randomized Trial
    J Clin Oncol 18: 395-404, 2000
       
    This study of 403 patients with SCLC who received doxorubicin, cyclophosphamide and etoposide (ACE) such as day 1, 40 mg/m2 doxorubicin, 1 gm/m2 cyclophosphamide and 120 mg/m2 etoposide IV infusion on day 1 and 240 mg/m2 by mouth on day 2, 3 were compared with the control group (C) which received every 3 weeks and with G-CSF (G), the ACE was administered every 2 weeks.
       
    The overall response rates were similar but complete response was higher in group G and a significantly better survival.
      
    Their findings are in contrast to widely reported finding in two other studies where there was no improvement in dose escalation for patients with SCLC. The editor comments this difference could be explained by the absence of limited stage disease patients in these two studies.
       

  • Auperin A, for the Prophylactic Cranial Irradiation Overview Collaborative Group (Institut Gustave-Roussy, Villejuif, France; et al)
    Prophylactic Cranial Irradiation (PCI) for Patients With Small-Cell Lung Cancer in Complete Remission
    N Engl J Med 341: 476-484, 1999
       
    Patients with small cell lung cancer have high propensity for brain metastases, from 10% at the time of diagnosis to 50% at 2 years.
      
    This is a metaanalysis of 987 patients with small cell lung cancer (SCLC) who were in complete remission and were randomized to either PCI or no PCI.
       
    Those who received PCI had significantly improved survival and reduced risk of brain metastasis. There was a 5.4% increase in absolute survival at 3 years to 20.7%.
         

  • Fonseca R, O’Neill BP, Foote RL, et al (Mayo Clinic, Rochester, Minn)
    Cerebral Toxicity in Patients Treated for Small Cell Carcinoma of the Lung
    Mayo Clin Proc 74: 461-465, 1999
        
    This study of patients with small cell lung cancer, who received prophylactic cranial irradiation (PCI) were compared with those who did not.
        
    Patients with PCI had higher leukoencephalopathy and the most common signs and symptoms were changes in intellectual capacity memory and motor abilities.
       
    The editor comments that higher rate of leukoencephalopathy in this study were due to simultaneous use of chemotherapy and radiotherapy (PCI), thereby altering of permeability of CNS to chemotherapy by radiotherapy could have enhanced the CNS injury.
       

 

 

 

By |2022-07-20T16:41:25+00:00July 20, 2022|Uncategorized|Comments Off on Lung Cancer

About the Author: