High-dose etoposide therapy for extensive small cell lung cancer: a Cancer and Leukemia Group B Study

Twenty-one previously untreated patients with extensive small cell lung cancer were treated with etoposide, 400 mg/m2/day for 3 consecutive days. Myelosuppression was severe, with a treatment-related death rate of 28%. Five partial responses were achieved. High-dose etoposide as given in this study produced unacceptable toxicity and no complete responses.     

Chemotherapy in advanced non-small cell lung cancer

Although patients with advanced non-small cell lung cancer (NSCLC) cannot be cured, cytotoxic chemotherapy in patients with reasonable performance status can improve overall survival and quality of life. No one regimen has demonstrated superior efficacy results, and platinum-based doublets remain the current standard of care. The toxicity profiles of acceptable regimens differ, allowing treatment to be tailored to a specific patient. The duration of first-line chemotherapy should not exceed four to six cycles. Second- and third-line treatment regimens also have established survival benefits, which has led to increasing improvements in overall survival for patients with advanced NSCLC. Treatment approaches in patients with borderline performance status remain controversial. Although the optimal treatment approach for elderly patients has not yet been established, it is clear that the elderly do benefit from chemotherapy, and fit elderly patients can be treated with the same regimens as younger patients. It is critical that all patients with advanced NSCLC be referred to medical oncologists. Patients considering chemotherapy must have a clear understanding of the expected benefits, limitations, and toxicities.     

Gefitinib in advanced non-small cell lung cancer

BACKGROUND: Gefitinib is an oral, selective epidermal growth factor receptor (EGFR) inhibitor that has activity in non-small cell lung cancer (NSCLC). AIM: To evaluate the tolerability, safety-profile and response of single agent gefitinib in patients with advanced stage NSCLC. METHODS: Twenty-seven patients of good performance status with stage IIIB or IV NSCLC were entered on the study at the Sydney Cancer Centre. Gefitinib was prescribed at an oral dose of 250 mg daily, as a continuous dose. Radiological evaluation of indicator lesions occurred at baseline and were repeated every 2-3 months until disease progression. Toxicity was graded using standard measures at baseline and at every month. RESULTS: The response rate was 17% in the patients eligible for evaluation. Symptom improvement was observed in 75% of patients. No patients withdrew because of adverse events. Toxicity was observed in 15 patients and consisted mainly of rash (59%), which was usually mild in severity. CONCLUSION: Gefitinib is active in NSCLC. It is well tolerated with minimal side-effects. Symptomatic improvement was found in the majority of patients treated with gefitinib. There may be a role for gefitinib in the palliation of symptoms in patients with advanced NSCLC.     

Cetuximab in advanced non-small cell lung cancer

Non-small cell lung cancer (NSCLC) remains a major problem in the western civilization and developing countries. Since most patients with NSCLC have advanced disease at diagnosis, to date, chemotherapy, with third-generation platinum-based doublets, represents the standard of care. Advances in the knowledge of tumour biology and mechanisms of oncogenesis has granted the singling out of several molecular targets for NSCLC treatment. Epidermal growth factor receptor (EGFR), a member of ErbB family, is one of the most studied target. Cetuximab is a chimeric (human-murine) monoclonal antibody directed against the extracellular domain of the EGFR that blocks ligand (TGF-alpha, EGF) access to the receptor. In the present paper we discuss about the activity, tolerability and efficacy of cetuximab, the EGFR monoclonal blocking antibody with the largest amount of clinical data being available on the treatment of advanced NSCLC.     

The treatment of advanced non-small cell lung cancer

PURPOSE OF REVIEW: The management of advanced non-small cell lung cancer remains disappointing and difficult. At least 65% of patients present with either locally advanced inoperable disease (stage IIIB) or with distant metastases (stage IV disease). The average age of newly diagnosed lung cancer patients is approaching 68 years and they represent a difficult group to palliate without causing treatment-related symptoms. This article examines the current status of chemotherapy as a primary therapy and evaluates the treatments of choice in terms of efficacy, toxicity, survival, and impact on quality of life. In particular, it reviews the recommendations for chemotherapy in the elderly and for those with a poor performance status. The role of the newer growth factor-inhibiting agents is also discussed. RECENT FINDINGS: Chemotherapy prolongs the survival of patients with advanced non-small cell lung cancer compared with best supportive care alone by 3 to 6 months, with the newer generation of agents producing slightly better survival statistics and some improvement in quality of life. Better performance status patients always do better than those with a poor status, and they tolerate therapy better. The new growth-modifying agents do not as yet have a clear-cut role in therapy, but promise both to improve our understanding of how to inhibit tumor growth and to identify which patients may respond to these agents. SUMMARY: The treatment of advanced non-small cell lung cancer remains difficult and disappointing. New effective agents are urgently needed.     

Management of advanced non-small cell lung cancer: current trends

Carcinoma of the lung continues to be the leading cause of cancer-related deaths for Americans. Major efforts have been made in the treatment of advanced non-small cell lung cancer; chemotherapy and investigations in the last decade have yielded a number of new agents and combinations. Despite progress with newer agents for the treatment of non-small cell lung cancer, only 14% of patients with the disease are alive 5 years after the initial diagnosis. Toward improving the outcome of patients with advanced non-small cell lung cancer, a few trends can be identified. These include further work on combination chemotherapy, the introduction of novel biologic agents into treatment, and predicting which patients will respond to chemotherapy. These trends are discussed in this review.     

Changing paradigm in advanced and metastatic non-small cell lung cancer

Lung cancer is the most common cancer worldwide. Approximately 18% of all deaths related to cancer are associated with lung cancer. Management of non-small cell lung cancer (NSCLC) has been changing rapidly in last few years. For patients with unresectable non-metastatic disease, maintenance durvalumab is now given after offering chemo-radiation concurrently based on the result from the PACIFIC trial. Management of metastatic disease greatly depends on the status of sensitizing driver mutation and PD-L1 level of the tumor cells. In this review article, we will summarize the outcome of various clinical trials and will provide the most up-to-date information on the management of patients with advanced and metastatic NSCLC.