Importance of Quality of Life in Patients with Non–Small-Cell Lung Cancer

The therapeutic options for patients with advanced non–small-cell lung cancer (NSCLC) are palliative. Therefore, the quality of life in oncology is considered as an endpoint in clinical trials, and several scales have been accepted for its measurement in parallel with other clinical determinations. However, its use in clinical practice is hindered by various obstacles that need to be overcome. In this article we examine the concept of the quality of life in patients with NSCLC, as well as giving an evaluation and interpretation of the results of various clinical trials. We describe the new technological methods used in daily clinical practice to measure the quality of life.     

Surgical Resection and Long-Term Survival for Octogenarians Who Undergo Surgery for Non–Small-Cell Lung Cancer

PurposeAn increasing proportion of newly diagnosed non–small-cell lung cancer (NSCLC) patients are octogenarians. It has been questioned whether older patients benefit from surgical resection of lung cancer to the same extent as younger patients.Patients and MethodsWe conducted a single-institution, retrospective analysis of patients newly diagnosed with NSCLC from 2000–2006, who underwent surgical resection of their lung cancer in Hoag Hospital. We compared resection and survival rates for patients who were age 80 years or older to younger cohorts and determined their stage distribution, rates of surgery, and actuarial survival by age-defined cohort. Of 1293 total patients, 17.2% were age 80 years or older; 36.1%, age 70–79 years; 29.2%, age 60–69 years; 12.9%, age 50–59 years; and 4.6%, under age 50. Of these patients, 482 underwent surgical resection. Surgical procedures included 400 lobectomies, 23 pneumonectomies, and 59 wedge resections.ResultsThe proportion of patients who had local disease at diagnosis was higher for octogenarians compared with younger patients (33.6% vs. 26.6%; P = .021), but the resection rate for octogenarians was lower (64% vs. 83%; P = .0003). For patients determined to have local- or regional-stage disease, resection rates were 52% versus 67.9% (P = .0007). However, survival curves for patients who underwent surgical resection were similar for all five cohorts with 5-year survival rates of 62%, 53%, 63%, 63%, and 79% from oldest to youngest.ConclusionNon–small-cell lung cancer patients < 80 years of age were less likely to undergo potentially curative surgery, but survival for octogenarians who did undergo surgical resection was comparable to younger age groups. Such patients should not be denied potentially curative surgery simply because of age.     

Brain Metastases in Non–Small-Cell Lung Cancer

Up to 50% of patients with advanced non-small-cell lung cancer will develop brain metastases at some point during their illness. These metastases cause a substantial burden in morbidity and mortality, which has motivated research and technological innovation over the past 2 decades. Surgery, radiotherapy, and systemic therapies have each played a role in management, with the greatest changes associated with the popularization of stereotactic radiosurgery. In this review, the evidence behind each modality used in the management of brain metastases for non–small-cell lung cancer patients is examined, and recommendations regarding the current standards of care and areas of future research focus are provided.     

Quality Indicators in Cancer Care: Development and Implementation for Improved Health Outcomes in Non–Small-Cell Lung Cancer

Non–Small-cell lung cancer (NSCLC) care is multidisciplinary and complex in nature. However, there are few quality indicators that are widely accepted by the physicians who treat lung cancer. Quality indicators developed by the American Society of Clinical Oncology and National Comprehensive Cancer Network exist for breast and colon cancer, but not yet for lung cancer. In this article we review the current state of quality indicators in oncology care in general and for NSCLC in particular. Proposed quality metrics focus on diagnosis and staging, timeliness of care, supportive care and patient satisfaction.     

Advanced Non–Small-Cell Lung Cancer in the Elderly

Systemic chemotherapy provides improvement in both survival and quality of life for patients with advanced non–small-cell lung cancer (NSCLC). Elderly patients have more comorbidities and tend to tolerate more poorly aggressive chemotherapy and radiation therapy than younger individuals. Our purpose in this article is to summarize recent studies of single-agent chemotherapy and combination regimens with cytotoxic or targeted therapies in the management of elderly patients with advanced NSCLC. We have reviewed the available evidence in the literature to gauge the results of therapy for elderly patients with lung cancer. We found that single-agent chemotherapy remains the standard of care for nonselected elderly patients. Retrospective analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with increased but acceptable toxicity for elderly patients. Therefore, the outcomes in the fit elderly mirror results observed in younger patients, although toxicity is generally greater.     

Novel Taxane Formulations and Microtubule-Binding Agents in Non–Small-Cell Lung Cancer

Antitubulin agents are among the most active drugs for the treatment of Non—Small-cell lung cancer. The taxanes paclitaxel and docetaxel are highly active and frequently used for adjuvant therapy after resection of localized disease and in combination with radiation for locally advanced disease and treatment of patients with advanced disease. Despite their benefits, these drugs have significant problems, including toxicity and limited efficacy. Recently, new taxane formulations and novel antitubulin agents have been developed. In some cases, these drugs have reduced toxicity with preserved efficacy. In other cases, these agents have potentially unique activity and have now advanced to late-stage trials. This review evaluates 2 novel paclitaxel formulations, albumin-bound paclitaxel and paclitaxel poliglumex. New antimicrotubulin agents, including the epothilones, colchicine-binding antivascular agents, and vinca alkaloids, are also discussed.     

Crizotinib in the Treatment of Non–Small-Cell Lung Cancer

An anaplastic lymphoma kinase (ALK) translocation giving rise to activated ALK tyrosine kinase is present in approximately 5% of non–small-cell lung cancers (NSCLCs). Crizotinib is an oral tyrosine kinase inhibitor targeting ALK, met proto-oncogene, and c-ros oncogene 1 (ROS1). It was recently approved in several countries for the treatment of patients with advanced, ALK-rearranged NSCLC. In 2012, results from the first phase III trial showing superiority of crizotinib compared with standard chemotherapy in second-line treatment of ALK-positive NSCLC were presented. Furthermore, crizotinib was recently shown to be active in ROS1-rearranged NSCLC. Here, we give an overview of the molecular pathogenesis of ALK-rearranged NSCLC, the pharmacokinetic and pharmacodynamic properties of crizotinib, and clinical trials of crizotinib for ALK-rearranged NSCLC.     

Current Data with Pemetrexed in Non–Small-Cell Lung Cancer

Pemetrexed (Alimta®) is a novel multitargeted antifolate that inhibits 3 enzymes involved in folate metabolism and purine and pyrimidine synthesis. These enzymes are thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide formyltransferase. This agent has broad antitumor activity in phase II trials in a wide variety of solid tumors. In non–small-cell lung cancer (NSCLC), single-agent activity has been documented in the first- and second-line settings. Promising activity has also been demonstrated when pemetrexed is combined with cisplatin and gemcitabine. A pivotal phase III study in mesothelioma has been presented, indicating the superiority of pemetrexed in combination with cisplatin versus cisplatin alone in this disease. Approval for pemetrexed in combination with cisplatin in advanced mesothelioma is expected within the next 12 months. This review discusses the activity of pemetrexed in NSCLC.