Modified gemcitabine regime in advanced lung cancers

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17148-17148
Author(s):  
S. Agarwal ◽  
P. Agarwal
Keyword(s):  
Lung Cancer ◽  
Median Survival ◽  
Treatment Modality ◽  
Advanced Lung Cancer ◽  
Patient Acceptance ◽  
Complete Regression ◽  
Partial Regression ◽  
Lung Cancers ◽  
Poor Patient ◽  
Established Treatment

17148 Background: Gemcitabine is established treatment modality for NSCLC. However it’s introduction on day 8 is sometimes delayed because of low counts or poor patient acceptance because of effects of d1 dose. Methods: We have used gemcitabine 10000 mg/m2 as d1,d10 regimen in 32 patients of advanced lung cancer incombination with either cisplatin or carboplatin .Colony stimulating factors were required in 2 patients. Results: The patients tolerated the chemotherapy (4 to 6 cycles) satisfactorily and none of the patient required delaying of the d10 therapy. Complete regression was seen in 2 patients,partial regression in 22 patients.the median survival was 10.2 months. Conclusions: The d1–10 schedule of gemcitabine based chemotherapry is safe,effective and better tolerated then the d1-d8 schedule. No significant financial relationships to disclose.

scholarly journals Making Checkpoint Inhibitors Part of Treatment of Patients With Locally Advanced Lung Cancers: The Time Is Now

2020 ◽  
pp. e159-e170
Author(s):  
Mark G. Kris ◽  
Corinne Faivre-Finn ◽  
Tiana Kordbacheh ◽  
Jamie Chaft ◽  
Jia Luo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Checkpoint Inhibitors ◽  
Locally Advanced ◽  
Local Therapy ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Concurrent Chemoradiation ◽  
Stage Iii ◽  
Advanced Lung Cancer ◽  
Lung Cancers

The PACIFIC trial of durvalumab administered for 1 year to patients with stage III lung cancers has set a new standard of care. PACIFIC established the role of immune checkpoint inhibitors (ICIs) for individuals with inoperable and unresectable locally advanced lung cancers that achieve disease control from concurrent chemoradiation. For patients with resectable and operable disease, ICIs administered before surgery, either alone (JHU/MSK, LCMC3, and NEOSTAR) or in combination with chemotherapy (Columbia/MGH and NADIM), have yielded high rates of major pathologic response in resection specimens, an outcome measure that correlates with improved progression-free survival and overall survival. These results have brought forth the dilemma of how to choose the optimal local therapy—either definitive concurrent chemoradiation or surgery—to use with an ICI for patients with stage III lung cancers that are both operable and resectable. Here, we review the data that support the use of each local therapy. Recent successes have also raised the possibility that using ICIs in patients with earlier stages of lung cancer will enhance curability. Randomized trials are underway; however, until they read out, physicians must choose between local and systemic therapies on the basis of the information we have today. Research demonstrates that using surgery, radiation, chemotherapy, and ICIs improve all efficacy outcomes and curability. All modalities should be considered in every patient with locally advanced lung cancer. It is imperative that a multimodality discussion that includes the possible addition of ICIs takes place to choose the best modality and sequence of therapies for each patient.

Pathology Issues in Thoracic Oncology: Histologic Characterization and Tissue/Plasma Genotyping May Resolve Diagnostic Dilemmas

2017 ◽  
pp. 619-629
Author(s):  
Ibiayi Dagogo-Jack ◽  
Andreas Saltos ◽  
Alice T. Shaw ◽  
Jhanelle E. Gray
Keyword(s):  
Lung Cancer ◽  
Diagnostic Algorithm ◽  
Advanced Lung Cancer ◽  
Liquid Biopsies ◽  
Lung Cancers ◽  
Primary Lung Tumors ◽  
Metastatic Lung ◽  
Mixed Histology

Lung cancer is a heterogeneous diagnosis that encompasses a spectrum of histologic and molecular subgroups. A paradigm shift favoring selection of treatment based on histologic and molecular makeup has positively affected prognosis for patients with metastatic lung cancer, with select patients experiencing durable responses to treatment. However, prognosis remains poor for the majority of patients. Furthermore, oncologists are increasingly faced with challenging dilemmas related to histopathologic and molecular characterization of tumors, both at diagnosis and during treatment. In this review, we focus on three particular challenges: (1) management of mixed histology tumors, a particularly aggressive group of lung cancers, (2) distinguishing multiple primary lung tumors from intrapulmonary metastases, and (3) incorporation of liquid biopsies into the diagnostic algorithm and subsequent follow-up of patients with advanced lung cancer. This review will summarize the existing literature and highlight the potential for molecular genotyping to help refine approaches to each of these challenges.

Paclitaxel by 96-hour continuous infusion in combination with cisplatin: a phase I trial in patients with advanced lung cancer.

1997 ◽  
Vol 15 (2) ◽  
pp. 735-743 ◽  
Author(s):  
M S Georgiadis ◽  
B S Schuler ◽  
J E Brown ◽  
L V Kieffer ◽  
S M Steinberg ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Continuous Infusion ◽  
Median Survival ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Survival Duration ◽  
Small Cell Lung ◽  
Median Survival Duration

PURPOSE To determine the maximum-tolerated dose (MTD) of paclitaxel administered by 96-hour continuous infusion in combination with cisplatin, to determine if the addition of granulocyte colony-stimulating factor (G-CSF) permits significant paclitaxel dose escalation, and to assess the toxicity and preliminary activity of this combination in patients with advanced lung cancer. PATIENTS AND METHODS Fifty patients with untreated lung cancer were enrolled: 42 had advanced non-small-cell lung cancer (NSCLC) and eight had extensive-stage small-cell lung cancer (SCLC). Patients received paclitaxel doses of 100 to 180 mg/m2/96 hours and cisplatin doses of 60 to 80 mg/m2 as a single 30-minute bolus injection at the end of the paclitaxel infusion. RESULTS Two of six patients experienced dose-limiting neutropenia at a dose of paclitaxel 140 mg/m2/96 hours and cisplatin 80 mg/m2. With G-CSF support, one of three patients experienced both dose-limiting mucositis and fatal neutropenic sepsis at a dose of paclitaxel 180 mg/m2/96 hours and cisplatin 80 mg/m2. Significant peripheral neuropathy developed in five patients and occurred after six or more cycles of therapy. Thirty-three of 42 patients with NSCLC had measurable disease; the objective response rate was 55%, with two complete responses and 16 partial responses. For all 42 patients with NSCLC, the median time to progression and median survival duration were 5 months and 10 months, respectively. The actuarial 1-year survival rate was 41%. Of eight SCLC patients, four responded to therapy, and the median survival duration for all SCLC patients was 11 months. CONCLUSION The MTD without G-CSF is paclitaxel 120 mg/m2/96 hours and cisplatin 80 mg/m2, and the MTD with G-CSF is paclitaxel 160 mg/m2/96 hours and cisplatin 80 mg/m2. Infusional paclitaxel with cisplatin is well tolerated and active in patients with advanced NSCLC.

Lung Cancer: Lymphadenopathy and Extrapulmonary Involvement

Chest Imaging ◽  
2019 ◽  
pp. 275-280
Author(s):  
Ryo E. C. Benson
Keyword(s):  
Lung Cancer ◽  
Distant Metastases ◽  
Lymph Node Involvement ◽  
Advanced Lung Cancer ◽  
Mediastinal Lymphadenopathy ◽  
Lung Cancers ◽  
Abdominal Organs ◽  
Wall Structures ◽  
Pet Ct ◽  
Upper Abdominal

Lymphadenopathy and extrapulmonary involvement may be presenting manifestations of advanced lung cancer. Central tumors such as squamous cell carcinomas and small cell carcinomas often exhibit ipsilateral hilar and mediastinal lymphadenopathy. Metastatic lymphadenopathy may exhibit subtle findings on radiography but is readily identified on CT, MRI and PET-CT. Lymphadenopathy in the setting of lung cancer portends a poorer prognosis compared with lung cancer without lymph node involvement. The differential diagnosis includes reactive lymphadenopathy from infection, granulomatous lymphadenopathy from sarcoidosis and malignant lymphadenopathy from metastatic disease and lymphoma. Advanced lung cancer may exhibit extrapulmonary involvement as the first manifestation of disease. Central lung cancers may directly invade the mediastinum and its organs and vessels. Peripheral lung cancers may invade the adjacent chest wall structures. Pleural and pericardial involvement may also occur and often manifests with effusion. Metastases to upper abdominal organs may be identified on chest CT. PET-CT allows identification of distant metastases.

Monoclonal Immunoradiometric Assay and Polyclonal Radioimmunoassay Compared for Measuring Neuron-Specific Enolase in Patients with Lung Cancer

1992 ◽  
Vol 38 (5) ◽  
pp. 748-751 ◽  
Author(s):  
J J Body ◽  
M Paesmans ◽  
J P Sculier ◽  
G Dabouis ◽  
G Bureau ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Neuron Specific Enolase ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
Specific Tumor ◽  
Highly Correlated ◽  
Specific Tumor Marker ◽  
Dilution Curves

Abstract Neuron-specific enolase (NSE) is the most sensitive and specific tumor marker for small-cell lung cancer (SCLC). We evaluated a new monoclonal IRMA (Sangtec) for NSE and compared it with a polyclonal RIA (Pharmacia) in patients with SCLC or other lung cancers (NSCLC). We measured NSE concentrations in 100 healthy subjects (NI group), 100 patients with benign pulmonary diseases (BPD group), and 194 patients with advanced lung cancer (97 SCLC and 97 NSCLC). Intra- and interassay CVs were less than 7% for both assays, and dose-dilution curves paralleled their respective standard curves. Values measured by both assays were highly correlated in all groups. NSE concentrations were significantly (P less than 0.001) lower by IRMA than by RIA in NI and BPD groups. The upper 95th percentile values for NSE in the NI group were 11.7 micrograms/L in the RIA and 9.2 micrograms/L in the IRMA. In NSCLC, the values were significantly (P less than 0.05) lower by IRMA but the percentage of subjects with increased values was higher (vs the NI group, 31% for RIA and 44% for IRMA, P less than 0.005). Diagnostic sensitivity for SCLC was improved with IRMA: 83% of values with RIA and 93% with IRMA were increased above the NI group values (P less than 0.005); the corresponding values for SCLC vs BPD were 81% and 89% (P less than 0.05). NSE values measured in 39 patients with SCLC after chemotherapy were more often increased and were significantly higher with the IRMA than with the RIA (P less than 0.005).

scholarly journals Clinical and molecular factors that impact the efficacy of first-line crizotinib in ROS1-rearranged non-small-cell lung cancer: a large multicenter retrospective study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yongchang Zhang ◽  
Xiangyu Zhang ◽  
Ruiguang Zhang ◽  
Qinqin Xu ◽  
Haiyan Yang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Retrospective Study ◽  
Brain Metastasis ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Driver Mutations ◽  
Advanced Lung Cancer ◽  
First Line ◽  
Lung Cancers ◽  
Chemotherapy Patients

Abstract Background ROS1-rearranged lung cancers benefit from first-line crizotinib therapy; however, clinical and molecular factors that could affect crizotinib efficacy in ROS1-rearranged lung cancers are not yet well-elucidated. Our retrospective study aimed to compare the efficacy of chemotherapy and crizotinib in the first-line treatment of ROS1-rearranged advanced lung cancer and evaluate various clinical and molecular factors that might impact crizotinib efficacy in real-world practice. Methods Treatment responses, survival outcomes, and patterns of disease progression were analyzed for 235 patients with locally advanced to advanced disease who received first-line chemotherapy (n = 67) or crizotinib (n = 168). Results The overall response rate was 85.7% (144/168) for first-line crizotinib and 41.8% (28/67) for chemotherapy. Patients treated with first-line crizotinib (n = 168) had significantly longer median progression-free survival (PFS) than chemotherapy (n = 67) (18.0 months vs. 7.0 months, p < 0.001). Patients harboring single CD74-ROS1 (n = 90) had significantly shorter median PFS with crizotinib than those harboring non-CD74 ROS1 fusions (n = 69) (17.0 months vs. 21.0 months; p = 0.008). Patients with baseline brain metastasis (n = 45) had a significantly shorter PFS on first-line crizotinib than those without brain metastasis (n = 123) (16.0 months vs. 22.0 months; p = 0.03). At progression, intracranial-only progression (n = 40), with or without baseline CNS metastasis, was associated with longer median PFS than those with extracranial-only progression (n = 64) (19.0 months vs. 13.0 months, p < 0.001). TP53 mutations were the most common concomitant mutation, detected in 13.1% (7/54) of patients with CD74-ROS1 fusions, and 18.8% (6/32) with non-CD74 ROS1 fusions. Patients with concomitant TP53 mutations (n=13) had significantly shorter PFS than those who had wild-type TP53 (n = 81) (6.5 months vs. 21.0 months; p < 0.001). PFS was significantly shorter for the patients who harbored concomitant driver mutations (n = 9) (11.0 months vs 24.0 months; p = 0.0167) or concomitant tumor suppressor genes (i.e., TP53, RB1, or PTEN) (n = 25) (9.5 months vs 24.0 months; p < 0.001) as compared to patients without concomitant mutations (n = 58). Conclusion Our results demonstrate that baseline brain metastatic status and various molecular factors could contribute to distinct clinical outcomes from first-line crizotinib therapy of patients with ROS1-rearranged lung cancer. Clinical trials registration CORE, NCT03646994

Electronic Prompt to Improve Outpatient Code Status Documentation for Patients With Advanced Lung Cancer

2013 ◽  
Vol 31 (6) ◽  
pp. 710-715 ◽  
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Emily R. Gallagher ◽  
Vicki A. Jackson ◽  
Inga T. Lennes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Medical Center ◽  
Primary Outcome Measure ◽  
Advanced Lung Cancer ◽  
Two Phase ◽  
Lung Cancers ◽  
Code Status ◽  
Phase Study ◽  
E Mail ◽  
Historical Controls

Purpose Rates of documentation of end-of-life care preferences in the medical record remain low, even among patients with incurable malignancies. We therefore conducted a two-phase study to develop and assess the effect of electronic prompts to encourage oncology clinicians to document code status in the outpatient electronic health record (EHR) of patients with advanced lung cancers. Patients and Methods To determine the optimal delivery, content, and timing of the electronic prompt, we first facilitated focus groups with oncology clinicians at an affiliated medical center. Given this feedback, we developed e-mail reminders timed to the start of each new chemotherapy regimen. Between July 2009 and January 2011, 102 eligible patients with incurable lung cancer were approached, and 100 agreed to participate. We compared e-mail prompt participants (EPPs) with a cohort of 100 consecutive historical controls who began therapy for incurable lung cancer at least 1 year before the start of this study. The primary outcome measure was clinician documentation of code status in the EHR. Results EPPs were similar to historical controls, with no significant differences in demographic or clinical characteristics. At 1-year follow-up, 33.7% (n = 33/98) of EPPs had a code status documented in the outpatient EHR compared with 14.5% (n = 12/83) of historical controls (P = .003). Mean time to code status documentation was significantly shorter in EPPs (8.6 months [95% CI, 7.6 to 9.5]) compared with controls (10.5 months [95% CI, 9.8 to 11.3]; P = .004). Conclusion e-mail prompts may improve the rate and timing of code status documentation in the EHR and warrant further investigation.

Enhancing 18F-FDG-PET/CT analysis in lung cancer patients

2015 ◽  
Vol 54 (06) ◽  
pp. 247-254 ◽  
Author(s):  
A. Kapfhammer ◽  
T. Winkens ◽  
T. Lesser ◽  
A. Reissig ◽  
M. Steinert ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Image Fusion ◽  
Chest Wall ◽  
Fdg Pet ◽  
Ct Image ◽  
Lung Cancers ◽  
Pet Ct ◽  
Peripheral Lung ◽  
Fdg Pet Ct ◽  
Tumour Infiltration

SummaryAim: To retrospectively evaluate the feasibility and value of CT-CT image fusion to assess the shift of peripheral lung cancers with/-out chest wall infiltration, comparing computed tomography acquisitions in shallow-breathing (SB-CT) and deep-inspiration breath-hold (DIBH-CT) in patients undergoing FDG-PET/ CT for lung cancer staging. Methods: Image fusion of SB-CT and DIBH-CT was performed with a multimodal workstation used for nuclear medicine fusion imaging. The distance of intrathoracic landmarks and the positional shift of tumours were measured using semitransparent overlay of both CT series. Statistical analyses were adjusted for confounders of tumour infiltration. Cutoff levels were calculated for prediction of no-/infiltration. Results: Lateral pleural recessus and diaphragm showed the largest respiratory excursions. Infiltrating lung cancers showed more limited respiratory shifts than non-infiltrating tumours. A large respiratory tumour-motility accurately predicted non-infiltration. However, the tumour shifts were limited and variable, limiting the accuracy of prediction. Conclusion: This pilot fusion study proved feasible and allowed a simple analysis of the respiratory shifts of peripheral lung tumours using CT-CT image fusion in a PET/CT setting. The calculated cutoffs were useful in predicting the exclusion of chest wall infiltration but did not accurately predict tumour infiltration. This method can provide additional qualitative information in patients with lung cancers with contact to the chest wall but unclear CT evidence of infiltration undergoing PET/CT without the need of additional investigations. Considering the small sample size investigated, further studies are necessary to verify the obtained results.

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