New Drugs in the Palliative Chemotherapy of Advanced Non-Small-Cell Lung Cancer

Non-small cell lung cancer (NSCLC) represents almost 80-85% of lung cancer cases. It is the most frequent malignancy after skin cancer. The therapeutic options for stage IV of disease consider histology, molecular characteristics, age, performance status, comorbidities, and not in the lust, patient�s option. This paper presents the case of a male patient, 73 years old, smoker, presented and treated in May 2016 in the Sf. Ap. Andrei Emergency Clinical Hospital Galati. The first sign of disease was inguinal and obturator right lymph node metastases whose histopathological test revealed metastases from malignant melanoma. Immunohistochemical tests (IHC) indicated undifferentiated carcinoma with lung as starting point, (Ck7 (+), TTF1 (+)). Thorax, abdominal and pelvic computed tomography (CT) imaging not evidenced space replacement processes in lung, but with mediastinal, right obturator and inguinal adenopathy. From personal pathological history we retain basocellular carcinoma in lumbar region, treated with surgery in 2009. It was initiated palliative chemotherapy and radiotherapy with remission of obturator and inguinal adenopathy, and at 9 months from diagnosis the Positron Emission Tomography (PET-CT) evidenced primary lung tumor situated in right superior lobe (RSL). At the present, patient is alive performing palliative chemotherapy. This case presented diagnostic and treatment issues, being a challenge for multidisciplinary team. We are mentioning the paucity of literature data regarding cases of primary tumors situated upper diaphragm which metastases in inguinal lymph nodes.

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Current Status and Future Perspectives of Liquid Biopsy in Small Cell Lung Cancer

Biomedicines ◽

10.3390/biomedicines9010048 ◽

2021 ◽

Vol 9 (1) ◽

pp. 48

Author(s):

Patricia Mondelo-Macía ◽

Jorge García-González ◽

Luis León-Mateos ◽

Adrián Castillo-García ◽

Rafael López-López ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Liquid Biopsy ◽

Small Cell ◽

New Drugs ◽

Current Status ◽

Small Cell Lung ◽

Tumor Biopsy ◽

Future Utility

Approximately 19% of all cancer-related deaths are due to lung cancer, which is the leading cause of mortality worldwide. Small cell lung cancer (SCLC) affects approximately 15% of patients diagnosed with lung cancer. SCLC is characterized by aggressiveness; the majority of SCLC patients present with metastatic disease, and less than 5% of patients are alive at 5 years. The gold standard of SCLC treatment is platinum and etoposide-based chemotherapy; however, its effects are short. In recent years, treatment for SCLC has changed; new drugs have been approved, and new biomarkers are needed for treatment selection. Liquid biopsy is a non-invasive, rapid, repeated and alternative tool to the traditional tumor biopsy that could allow the most personalized medicine into the management of SCLC patients. Circulating tumor cells (CTCs) and cell-free DNA (cfDNA) are the most commonly used liquid biopsy biomarkers. Some studies have reported the prognostic factors of CTCs and cfDNA in SCLC patients, independent of the stage. In this review, we summarize the recent SCLC studies of CTCs, cfDNA and other liquid biopsy biomarkers, and we discuss the future utility of liquid biopsy in the clinical management of SCLC.

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Phase II study of amonafide: results of treatment and lessons learned from the study of an investigational agent in previously untreated patients with extensive small-cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1990.8.3.390 ◽

1990 ◽

Vol 8 (3) ◽

pp. 390-395 ◽

Cited By ~ 21

Author(s):

W K Evans ◽

E A Eisenhauer ◽

Y Cormier ◽

J Ayoub ◽

R Wierzbicki ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Trial Design ◽

Eastern Cooperative Oncology Group ◽

Vena Cava ◽

Small Cell ◽

New Drugs ◽

Small Cell Lung ◽

Investigational Agent

Thirteen previously untreated patients with extensive small-cell lung cancer (SCLC) were treated with the investigational agent amonafide in a dose of 300 mg/m2 intravenously (IV) over 1 hour daily for 5 consecutive days. No responses were seen in 12 eligible patients. Myelosuppression was only occasionally seen. Other toxicities included diaphoresis, chest pain, local irritation at the injection site, arthralgias, nausea and vomiting, and neuromuscular problems. There were two early deaths, both attributable to tumor progression with resultant obstruction of a vital structure. Ten patients crossed over to alternate active therapy (etoposide [VP-16]-cisplatin) and five responded. The median survival time (MST) of the whole group of treated patients was 31 weeks. In future trials of investigational new drugs in previously untreated SCLC, we recommend that patients with the following characteristics be excluded: Eastern Cooperative Oncology Group (ECOG) performance status 2, 3, and 4; superior vena cava (SVC) obstruction; any major paraneoplastic syndrome; serious comorbid illness; and extensive hepatic involvement by tumor. The trial design should include prompt crossover to active alternative therapy, such as VP-16 and cisplatin, for disease progression or for failure to respond after two treatment cycles. Also, the trial design should use an early stopping rule based on interest in identifying only very active agents with a minimum response rate of 30%.

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