Locally-advanced Non-small Cell Lung Research Articles

Gefitinib versus docetaxel in patients with advanced non-small-cell lung cancer: a meta-analysis

Objective To evaluate the clinical efficacy and safety of gefitinib versus docetaxel in previously treated non-small cell lung cancer.Methods Literatures were searched on database like PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,China Journal Full Text Database,and Chinese Scientific Journals Full Text Database and Wanfang Database.All the relevant randomized controlled trials that gefitinib versus docetaxel in non-small cell lung cancer patients who have previously received chemotherapy were collected,and the quality of the included trials was assessed by Cochrane Systematic Review Handbook 5.0.2. Meta-analyses were conducted by RevMan 5.0 software. Results Four studies were involved and 2 257 patients were included.Meta-analysis showed that gefitinib can improve objective response rate and quality of life in local advanced non-small cell lung cancer patients who have previously received chemotherapy compared with docetaxel ( P ＜ 0.05) ； and it's low in the 3-4 level adverse reaction rate (P ＜ 0.05 ).But there was no significant difference in overall survival rate,symptoms improving rate and progression-free survival rate (P ＞ 0.05).Conclusions Gefitinib is superior to docetaxel in the objective response rate with local advanced or metastatic non-small cell lung cancer patients who have previously received chemotherapy.The quality of life of the patients is improved significantly.Because of it has high drug tolerance and high safety,gefitinib can be actively promoted application as a kind of current effective second-line drugs at present,but the survival aspect needs to be studied further. Key words: Lung neoplasms; Randomized controlled trial; Meta-analysis

The superiority of hybrid-volumetric arc therapy (VMAT) technique over double arcs VMAT and 3D-conformal technique in the treatment of locally advanced non-small cell lung cancer – A planning study

PurposeTo compare the dosimetric performance of three different treatment techniques – conformal radiotherapy (CRT), double arcs volumetric modulated arc therapy (RapidArc, RA) and Hybrid-RapidArc (H-RA) for locally-advanced non-small cell lung cancer (NSCLC). Material and methodsCRT, RA and H-RA plans were optimized for 24 stage III NSCLC patients. The target prescription dose was 60Gy. CRT consisted of 5–7 coplanar fields, while RA comprised of two 204o arcs. H-RA referred to two 204o arcs plus 2 static fields, which accounted for approximately half of the total dose. The plans were optimized to fulfill the departmental plan acceptance criteria. ResultsRA and H-RA yielded a 20% better conformity compared with CRT. Lung volume receiving >20Gy (V20) and mean lung dose (MLD) were the lowest in H-RA (V20 1.7% and 2.1% lower, MLD 0.59Gy and 0.41Gy lower than CRT & RA respectively) without jeopardizing the low-dose lung volume (V5). H-RA plans gave the lowest mean maximum spinal cord dose (34.4Gy, 3.9Gy<CRT and 2.2Gy<RA plans) and NTCP of lung. Higher average MU per fraction (addition 52.4MU) was observed with a reduced treatment time compared with CRT plans. ConclusionThe H-RA technique was superior in dosimetric outcomes for treating locally-advanced NSCLC compared to CRT and RA.

Transitory Blocking of Pulmonary Artery and Veins as a Novel Strategy in Pulmonary Surgery: An Experimental Study in a Rabbit Model

Backgrounds: Transitory blocking of the pulmonary artery and veins is now being applied in the treatment of local advanced non-small cell lung cancer in our department. We performed this study to establish a pulmonary vessel blocking model in rabbits and investigate the features of lung ischemia-reperfusion injury. Methods: 126New Zealand rabbits were randomized into 3 groups: group I, sham group; group II, left pulmonary artery blocking, and group III, left pulmonary artery and veins blocking. The physiological data as well as the blood and tissue samples were harvested at the time of thoracotomy, at 1 h after ischemia and 1, 2, 4, 6 and 24 h after reperfusion, respectively. Lung injury was assessed histologically by determining the levels of malondialdehyde, superoxide dismutase, myeloperoxidase and water content. Results: The hemodynamics were stable in all three groups. The levels of malondialdehyde, myeloperoxidase, and water content of lung tissue were all significantly increased in groups II and III when compared with group I at 1, 2, 4 and 6 h after reperfusion. They almost all returned to baseline at 24 h after reperfusion. However, there was no significant difference observed between groups II and III at either time point. A similar change in the process of lung ischemia-reperfusion injury was observed under light and electron microscopes in group II and in group III. Conclusions: The features of lung ischemia-reperfusion injury were similar when blocking the pulmonary artery and veins compared with blocking the pulmonary artery alone. Moreover, it might be safe to block the pulmonary vessels within 1 h during pulmonary surgery.

Clinical Observation of Erlotinib in the Treatment of Advanced Non-small Cell Lung Cancer: A Report of 92 Eases.

Erlotinib, a selective inhibitor of epidermal growth factor receptor tyrosine kinase, has been approved effective in local advanced or metastatic non-small cell lung cancer (NSCLC). The aim of this study was to evaluate the efficacy and safety of erlotinib for the treatment of advanced NSCLC. Ninety-two patients with advanced NSCLC who had failed or not tolerated or refused chemotherapy received 150 mg oral doses of erlotinib once daily until the disease progression or intolerable toxicity. Among the 92 NSCLC patients, 2 patient got complete response (2.2%), 22 partial response (23.9%), 48 stable disease (52.2%) and 20 progressive disease (21.7%). The overall response rate and the disease controlled rate of erlotinib was 26.1% (24/92) and 78.3% (72/92), respectively. The response rate of erlotinib were significantly higher in rash and ECOG 0-1 than no rash and ECOG >= 2. The disease controlled rate of erlotinib was significantly higher in female and non-smokers than male and smokers (P<0.05). The response rate of erlotinib did not show significant differences within pathological type or previous treatment. The most common side effects were rash and diarrhea with 84.8% and 31.5%, respectively, but usually were mild. Erlotinib is effective and safe in the treatment of advanced NSCLC patients.

8LBA Biomarker evaluation in the randomized, double-blind, placebo-controlled, Phase IIIb ATLAS Trial, comparing bevacizumab (B) therapy with or without erlotinib (E), after completion of chemotherapy with B for the treatment of locally-advanced, recurrent, or metastatic non-small cell lung cancer (NSCLC)

8LBA Biomarker evaluation in the randomized, double-blind, placebo-controlled, Phase IIIb ATLAS Trial, comparing bevacizumab (B) therapy with or without erlotinib (E), after completion of chemotherapy with B for the treatment of locally-advanced, recurrent, or metastatic non-small cell lung cancer (NSCLC)

Recurrent Erlotinib-Induced Interstitial Lung Disease on Non-Small Cell Lung Cancer

1, Ⓡ ) has been considered to be a new, promising oral chemotherapy agent for local advanced or metastatic non-small cell lung cancer (NSCLC). Erlotinib is regarded as relatively safe, but interstitial lung disease (ILD) related to erlotinib has been reported on an infrequent basis in Asia. We report an histologically confirmed case of recurrent erlotinib-induced ILD. Although, the patient was highly responsive to the first erlotinib treatment, the therapy was discontinued due to erlotinib-induced ILD. After intravenous high dose methylpredinisolone treatment, ILD was improved rapidly by radiologic studies, but the particular lung cancer re-emerged. We restarted the patient erlotinib on low-dose oral methylpredinisolone, resulting in a recurrence of erlotinib-induced ILD. Our case suggests that re-administration of erlotinib should be performed on a limited basis in patients that have developed ILD on previous use, even if a therapeutic effect can be estimated.

Association of ATM Single Nucleotide Polymorphisms with Local Advanced Non-small Cell Lung Cancer Patients Treated with Radiotherapy

To examine the possible relationship between single nucleotide polymorphisms (SNPs) in DNA repair, apoptosis and inflammatory cytokine genes with clinical outcomes of patients with local advanced non-small cell lung cancer (NSCLC) treated with radiotherapy.

The Prognostic Value of 18F-FDG Uptake by using Serial PET/CT in Patients with Local Advanced Non-small Cell Lung Cancer

The Prognostic Value of 18F-FDG Uptake by using Serial PET/CT in Patients with Local Advanced Non-small Cell Lung Cancer

Combined modality therapy for local advanced non-small cell lung cancer

This paper reviews the latest developments in radiotherapy, chemotherapy and chemoradiotherapy for local advanced non-small cell lung cancer in the past years. Radiotherapy, includes conventional fractionated radiotherapy, accelerated hyperf-raction radiotherapy and three-dimensional radiotherapy etc.Chemotherapy, includes the analysis of effects of various chemotherapeutic regimens, recommending the reasonable methods of chemotherapy and chemoradiotherapy and the development of molecular targeted therapy. Sequential chemoradiotherapy and concurrent chemoradiotherapy show advantagement chemoradiotherapy on the local control rate and survival rate. Key words: Carcinoma, non-small-cell lung; Radiotherapy; Drug therapy; Combined modality therapy

Predictive factors of gefitinib response and survival in Chinese patients with local advanced or metastatic non-small cell lung cancer

Gefitinib, a selective inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase, has been approved effective in local advanced or metastatic non-small cell lung cancer (NSCLC), with the equivalent response rate to that of chemotherapy in Asian patients. Asian ethnicity, gender, smoking history, adenocarcinoma histology were remarkably associated with gefitinib response and survival. However, predictive factors of gefitinib response and survival are still unclear in Asian population. In this study, we retrospectively reviewed the data of 153 Chinese NSCLC patients who received a single agent of gefitinib with the purpose of identifying the potential predictive factors of gefitinib response and survival. Tumor response, survival and the clinicopathologic factors of 153 NSCLC patients treated between November of 2003 and June of 2004 were collected retrospectively from the multicenter clinical trial in China. Pearson Chi-square test and Logistic regression test were performed respectively as univariate and multivariate analyses of gefitinib response. Overall survivals between groups with different predictive factors were compared by log-rank tests. Multivariate analysis was performed to identify factors that independently predict for survival. A total of 153 patients were included in this analysis. Objective response rate was statistically significant higher in patients with younger age (≤65 years) and longer interval from diagnosis to gefitinib treatment (≥6 months) in multivariate analysis (P < 0.05). The median follow-up duration was 10.0 months (0.5-16.8). The median survival was 10.3 months (95% CI: 8.1-12.6) and 1-year survival was 44.1%. Significant independent predictive factors associated with longer survival in multivariate analysis were good performance status (score 0-1), controlled disease (CR+PR+SD) to most recent chemotherapy and controlled disease to gefitinib (P < 0.05). Gefitinib is effective in local advanced or metastatic NSCLC patients who failed to chemotherapy in Chinese population. In Chinese NSCLC population, younger age (≤65 years) and longer interval from diagnosis to gefitinib treatment (≥6 months) were predictive factors in multivariate analysis for gefitinib response; good performance status (score 0-1), controlled disease to most recent chemotherapy and controlled disease to gefitinib were independent prognostic factors for survival.

Effects of Amifostine on Acute and Late Toxicity of Radiotherapy and Concurrent Chemotherapy for Local Advanced Non-Small Cell Lung Cancer

Effects of Amifostine on Acute and Late Toxicity of Radiotherapy and Concurrent Chemotherapy for Local Advanced Non-Small Cell Lung Cancer

6548 POSTER Phase II study of sunitinib malate (SU) as consolidation therapy in patients (pts) with locally-advanced or metastatic non-small cell lung cancer (NSCLC)

6548 POSTER Phase II study of sunitinib malate (SU) as consolidation therapy in patients (pts) with locally-advanced or metastatic non-small cell lung cancer (NSCLC)

Effect of neoadjuvant chemotherapy using paclitaxel combined with carboplatin on advanced non-small cell lung cancer

ObjectiveTo assess the therapeutic effectiveness of preoperative neoadjuvant chemotherapy using a combination of paclitaxel and carboplatin on local advanced non-small cell lung cancer (NSCLC).MethodsTwenty-five patients with advanced NSCLC were treated with paclitaxel and carboplatin for 2 to 4 cycles before undergoing tumor resection and then postoperative chemotherapy/radiotherapy therapy for 2 to 4 cycles.ResultsFollowing neoadjuvant chemotherapy, the most prominent side-effect was bone marrow restraint. The overall response rate of preoperative chemotherapy was 56%. The mean survival time was 26.5 months, with 1-, 2-and 5-year survival rates of 55%, 25%, and 16%, respectively. All NSCLC patients survived the perioperative period. Conclusion: Preoperative neoadjuvant chemotherapy combining paclitaxel and carboplatin produced minimal side-effect while increasing the probability that advanced NSCLC patients would be able to undergo surgery thus improving their prognosis.

Controveries in treatment of resectable local advanced non-small cell lung cancer

Controveries in treatment of resectable local advanced non-small cell lung cancer