Stage IIIB Cancer Research Articles

Motexafin Gadolinium (MGd) is Active as a Single Agent and in Combination with Pemetrexed and Docetaxel in Advanced Non–Small-Cell Lung Cancer (NSCLC) Patients who Failed Platinum-Based Chemotherapy: Early Results of 3 Phase II Trials

<h3>Background</h3> Motexafin gadolinium is a tumor-selective antineoplastic agent that disrupts redox-dependent pathways by targeting oxidative stress-related proteins such as thioredoxin reductase, which is often overexpressed in non–small-cell lung cancer (NSCLC) and is associated with a poor prognosis. Inhibition of thioredoxin reductase reverses tumor phenotype in lung carcinoma cells in vitro and in vivo. Three trials are under way to evaluate motexafin gadolinium as a single agent (PCYC-0227) and in combination with pemetrexed (PCYC-0228) and docetaxel (PCYC-0229) for second-line treatment of NSCLC. <h3>Patients and Methods</h3> For all 3 trials, patients with locally advanced or metastatic NSCLC with or without brain metastases, Eastern Cooperative Oncology Group performance status 0/1, and who had received 1 previous platinum agent–based chemotherapy regimen with or without kinase inhibitor were eligible. Treatments were as follows: for PCYC-0227, patients were randomized to receive intravenous motexafin gadolinium 10 mg/kg per week (group A) or motexafin gadolinium 15 mg/kg per week (group B). For PCYC-0228, patients received motexafin gadolinium 15 mg/kg and pemetrexed 500 mg/m² on day 1. For PCYC-0229, patients received motexafin gadolinium 10 mg/kg and docetaxel 75 mg/m² on day 1. For all 3 trials, treatment was given in 21-day cycles and response was evaluated by Response Evaluation Criteria in Solid Tumor every 6 weeks. <h3>Results</h3> PCYC-0227 had 58 evaluable patients with a median age of 62 years (range, 4185 years) with locally advanced (14%) or metastatic (86%) tumors (adenocarcinoma [48%], squamous-cell [14%], large cell [9%] or other NSCLC [29%]) received 1-12 cycles (mean, 3.3 cycles) of motexafin gadolinium. The most common grade ≥ 3 adverse events (AEs) were hypophosphatemia (24.1%), fatigue (10.3%), and dyspnea (8.6%). Fifty-eight patients were evaluable for response, with a response rate of 5.3% (3 partial responses: 2 in group A, and 1 in group B), and 31.6% had stable disease (SD). Median time to progression was 7 weeks. Median survival was 8.1 months (95% confidence interval [CI], 6.2-11.6 months), with 1-year survival of 27%. For PCYC-0228: 27 patients with a median age of 64 years (range, 51-83 years), with stage IIIB (7.4%), stage IV (59.3%) or recurrent (33.3%) cancers (squamous [41%], adenocarcinoma [30%], or other NSCLC [29%]) received 1-9 cycles (mean, 3.1 cycles) of motexafin gadolinium/pemetrexed. The most common grade ≥ 3 AEs were pneumonia (11.1%), thrombocytopenia (11.1%), and fatigue (11.1%). Of 20 patients with response data, 17 (85%) have SD (of whom 10 are still on treatment), and 3 (15%) had progressive disease. Median survival and time to progression have not been reached. One-year survival is estimated at 69%. For PCYC-0229: 24 patients, median age of 62 years (range, 41 -85 years), with locally advanced (35%) or metastatic (65%) disease (squamous cell [50%], adenocarcinoma [35%], or other NSCLC [15%]) received 1-7 cycles (mean, 3.2 cycles) of motexafin gadolinium/docetaxel. The most common grade ≥ 3 AEs were neutropenia (20.8%), asthenia (16.7%) and febrile neutropenia (12.5%). Of 14 patients with response data, 13 (86.7%) have SD (of whom 4 are still on treatment), and 1 had progressive disease (6.7%). Median survival was 8.2 months (95% CI, 3.9 months, not reached). One-year survival is 20%. <h3>Conclusion</h3> Motexafin gadolinium appears active as a single agent and for second-line treatment of patients with NSCLC with advanced or metastatic disease that has failed previous platinum agent–based chemotherapy. The single-agent response and survival rates are comparable with other approved agents. Motexafin gadolinium in combination with pemetrexed or docetaxel is well tolerated and resulted in a high percentage of patients with SD, many of whom are still on treatment and might convert to responders with ongoing therapy.

2351: Outcome Following Radiotherapy for Stage IIIB and IVA Cervix Cancer

To report the long-term outcome following radiotherapy with curative intent for stage IIIB and IVA carcinoma of the cervix. This is a retrospective review of 91 consecutive patients treated with radiotherapy with curative intent at the University of Florida between January 1980 and December 2003 for stage IIIB (84 patients) or IVA (7 patients) carcinoma of the cervix. All 91 patients were treated with a combination of external beam radiotherapy delivered to a median dose of 60 Gy (range, 40 to 70.3 Gy) to the pelvis and low-dose rate brachytherapy. Patients were treated with either one ∼72 hour implant (68%) or two ∼48 hour implants (32%). The implants were either interstitial, intracavitary, or a combination of the two depending on the patient’s anatomy. Thirty-three patients (36%) received at least one interstitial implant either alone or in combination with an intracavitary implant. The median dose from the interstitial implants was 27.6 Gy to the periphery of the implant. The remaining 64% of patients received only intracavitary implants. The median dose from the intracavitary implants was 25.1 Gy to Point A. Chemotherapy was delivered to 13 patients (14%). The median follow-up for surviving patients was 8.8 years. The 5- and 10-year Kaplan-Meier estimates of local control, regional control, locoregional control, relapse-free survival, and overall survival were 53% and 53%, 55% and 47%, 34% and 29%, 30% and 26%, and 29% and 21%, respectively. Ninety percent of recurrences were detected within 2 years after treatment. The pattern of failure was as follows: 60% of all failures were local (+/- regional or distant recurrence), 29% were regional (pelvic and/or para-aortic nodes +/- distant recurrence), and 11% were distant failures alone. Seventeen percent of the failures were in the para-aortic nodes (+/- distant sites) with no evidence of failure in the pelvis. Our data suggested that elective irradiation of the para-aortic nodes decreased failures in the para-aortic nodes (0% for patients who received elective para-aortic irradiation vs. 13% for patients who did not), but this difference was not statistically significant. A wide range of demographic, treatment, and technical factors were evaluated with univariate and multivariate analysis with the endpoint being relapse-free or overall survival. No factor was found to be statistically significant. Therapy complications were scored using the RTOG grading system; the overall severe late complication rate was 13% (grades 3–5). This series is one of the most mature in the literature. With long-term follow-up, approximately one-third of patients with stage IIIB or IVA cervix cancer are cured with a 15% complication rate. Our series demonstrates what can be achieved without chemotherapy since 86% of the patients were treated with radiotherapy alone. As long-term results become available, it will be important to compare our results to those from series with combined modality therapy.

A Phase II Trial of Isolated Limb Infusion With Melphalan and Dactinomycin for Regional Melanoma and Soft Tissue Sarcoma of the Extremity

Isolated limb infusion (ILI) is a minimally invasive technique of delivering regional chemotherapy in patients with advanced melanoma or soft tissue sarcoma of the limb. Reports from Australia of efficacy similar to that of isolated limb perfusion prompted us to conduct a phase II trial to evaluate the efficacy and safety of ILI. Eligible patients had American Joint Committee on Cancer stage IIIB or IIIC melanoma or unresectable soft tissue sarcoma of the limb. Angiographic catheters were positioned just above the knee or elbow of the extremity. General anesthesia was performed, a proximal tourniquet was inflated, and a normothermic, low-flow, hypoxic infusion of melphalan and dactinomycin was circulated through the involved limb for 20 minutes. The tumor response was assessed by using standard criteria at 3 months. Morbidity was determined in the hospital and at 2, 6, and 12 weeks. Twenty-five patients were accrued to the trial, and 32 ILIs were performed (8 patients had 2 ILIs); 1 patient was not treated. Of the 22 assessable patients, 11 (50%) had a significant response at 3 months: 23% of patients had a complete response, and 27% of patients had a partial response. The median duration of complete response was 1 year (range, 6-32 months). Morbidity was acceptable. Peak morbidity occurred at 2 weeks and was considered moderate in most patients. Limb edema and erythema were common. No patient developed compartment syndrome or required amputation. ILI is well tolerated. Half of the patients experienced a complete or partial response.

Prognostic value of response to external radiation in stage IIIB cancer cervix in predicting clinical outcomes: A retrospective analysis of 556 patients from India

Background and purpose To evaluate the prognostic significance of response to external beam radiation (EBRT) in predicting the clinical outcomes in stage IIIB cancer cervix and to find out factors affecting response to EBRT. Patients and methods This retrospective study included 556 patients of cancer cervix stage IIIB treated between 1996 and 2001 with EBRT (46 Gy/23fx/4.5 weeks) followed by intracavitary radiotherapy (ICRT). At the end of EBRT, response to EBRT was grouped as ‘no gross residual tumor’(NRT) or ‘gross residual tumor’(GRT). Results Follow up ranged from 2 to 93 months with a median of 36 months. Median dose to point A was 81 Gy. At the end of EBRT, 393 patients (70.7%) attained NRT response. NRT responders had significantly better 5 year pelvic control, disease free survival (DFS) and overall survival (OS) than those who had a GRT response (75.6 vs. 54.6%; 60.6 vs. 31.9% and 62.6 vs. 33.7%, respectively; all P values <0.0001). Apart from response to EBRT, overall treatment time also has emerged as an independent factor to affect all clinical outcomes in multivariate analysis but age had significant impact on pelvic control only. Age was the only factor, which significantly influenced the response to EBRT in univariate as well as multivariate analysis ( P=<0.001, OR=1.973, 95% C.I. 1.357–2.868). Patients with age more than 50 years had more NRT response (77%) than patients with age less than 50 years (63.8%). Conclusions Patients who attain NRT response to EBRT will have an impressive long term pelvic control, DFS and OS in stage IIIB cancer cervix. Older patients (≥50 years) attain significantly higher NRT rates than younger patients.

Heart failure following left-sided pneumonectomy in a patient with known pectus excavatum — successful treatment using the Ravitch procedure

A rare case of a patient with progressive dyspnoea due to atrial compression between ascending and descending aorta is demonstrated. After neoadjuvant chemoradiation for a locally advanced nonsmall cell lung cancer stage IIIb, he had a left-sided pneumonectomy. The underlying problem for cardiac compression was the extreme mediastinal shift reinforced by a congenital pectus excavatum. Our treatment was a Ravitch procedure with fair result.

Pelvic radiotherapy in patients with hydronephrosis in stage IIIB cancer of the cervix: Renal effects and the optimal timing for urinary diversion?

Background and purpose. Many patients with Stage IIIB cervix cancer (Ca) and hydronephrosis will require ureteral stenting. The timing is important as delays or prolonged overall treatment times adversely affect outcome. Our aim was to measure the effect of pelvic radiotherapy (R/T) on renal function and identify a subset of patients at high risk of acute urinary obstruction during R/T. Patients and methods. From 1/1/2000 to 1/1/2002, all patients with Stage IIIB cervix Ca and hydronephrosis were analysed retrospectively. To quantify the impact of pelvic R/T, all eligible patients from 1/7/2002–1/7/2004 had prospectively recorded baseline biochemistry, creatinine clearance and renal ultrasounds; these were repeated weekly to detect any change in renal function or degree of hydronephrosis. Results. 13 eligible patients were analysed retrospectively, 5 with unilateral hydronephrosis with 40% requiring urinary diversion (UD). 8 had bilateral hydronephrosis, with 75% requiring UD; 50% before R/T and 35% during R/T. Average creatinine clearance (CrCl) was 74 mL/min (1.24 mL/s) in unilateral hydronephrosis , bilateral = 52 mL/min (0.87 mL/s), in those stented during R/T it was < 40 mL/min (0.67 mL/s). The resulting break in R/T was 6 and 19 days. In the prospective study, 5 patients were eligible and 4 consented. 75% had unilateral hydronephrosis and did not require UD with an average CrCl = 71 mL/min (1.19 mL/s). 1 patient with bilateral hydronephrosis had a CrCl of < 20 mL/min (0.33 mL/s) with bilateral stents placed before R/T. Conclusions. Patients with bilateral hydronephrosis and a low CrCl < 50 mL/min (0.84 mL/s) should be considered for elective UD prior to R/T. Pelvic R/T did not induce any deterioration in renal function or degree of hydronephrosis.

Malignant schwannoma of the upper mediastinum originating from the vagus nerve

BackgroundMalignant schwannoma of the upper mediastinum originating from the vagus nerve is extremely rare.Case presentationA 46-year-old female was admitted for a left cervical mass which was associated with both hoarseness and Horner's syndrome. Chest computed tomography showed a mass extending from the left upper mediastinum to the left supraclavicular area. A fine needle aspiration cytological examination suggested primary lung cancer stage IIIB large cell carcinoma. After administering induction chemo-radiotherapy, a complete surgical resection was performed. The tumor was found to involve both the left vagus nerve and the left sympathetic nerve. Histological examination of the resected specimen revealed the tumor to be malignant schwannoma.ConclusionDespite incorrect preoperative diagnosis, the multimodality treatment administered in this case, including induction chemo-radiotherapy and surgery, proved to be effective.

Response to External Radiation; Can It Predict the Clinical Outcomes in Stage IIIB Cancer Cervix? A Retrospective Analysis of 556 Patients

Purpose/Objective: Even though chemo radiation has become the standard of care in the management of cancer cervix, majority of cancer cervix stage IIIB patients are still treated with radiotherapy alone in developing countries like India due to poor tolerance to chemo radiation and financial constraints of patients. This retrospective analysis was done to evaluate the prognostic significance of response to external beam radiation (EBRT) in predicting the clinical outcomes in stage IIIB cancer cervix and to find out factors affecting response to EBRT.

37 Gemcitabine (G) as a single drug versus gemcitabine plusvinorelbine (GV) for non-small cell lung cancer (NSCLC) stage IIIB and IV

37 Gemcitabine (G) as a single drug versus gemcitabine plusvinorelbine (GV) for non-small cell lung cancer (NSCLC) stage IIIB and IV

O-105 Pharmacogenomic study of docetaxel and cisplatin in patients with non-small cell lung cancer (NSCLC) stages IIIb (with malignant pleural effusion) and IV

O-105 Pharmacogenomic study of docetaxel and cisplatin in patients with non-small cell lung cancer (NSCLC) stages IIIb (with malignant pleural effusion) and IV

Surgery after multimodality treatment for non-small-cell lung cancer

Neoadjuvant treatment for Locally advanced non-small-cell lung cancer (NSCLC) stage IIIA and IIIB promises higher resection rates because of a reduction of the primary tumour and sterilisation of mediastinal nodes ("downstaging"). In this study we analyse the perioperative course and the long-term survival of patients with trimodality treatment. Between 03/1991 and 12/2002, 392 patients with NSCLC underwent resection after induction treatment. Included were 266 males and 126 females, age 55.8 +/- 9 (28-74), of whom 218 were stage-IIIA patients, 174 were stage-IIIB patients. Induction treatment included 3 courses of chemotherapy with cisplatin/etoposide or cisplatin/paclitaxel, followed by one course of chemotherapy with cisplatin/etoposide as well as hyperfractionated accelerated radiotherapy of the primary tumour and the mediastinal nodes with 45 Gy, followed by surgery. Before induction treatment all patients underwent mediastinoscopy. In patients with N3 disease mediastinoscopy was repeated before surgery. Resections included 133 pneumonectomies (34%), 15 bilobectomies (4%), 55 sleeve lobectomies (14%), 168 lobectomies (42.5%), 6 segmentectomies (1,5%), and 15 explorative thoracotomies (4%). In-hospital mortality rates amounted to 4.6% (18 patients) while postoperative morbidity ran up to 46% (180 patients). Morbidity and mortality rates were significantly higher in patients with Karnofsky status lower than 80% and patients older than 65 years. Bronchopleural fistulas occurred in 16 patients (3.2%). The protection of the bronchial stump or anastomosis with viable tissue, like pericardial fat, proves to be a significant factor for the reduction of septic complications. For NSCLC, the 5- and 7-year survival rates were 36% and 31%, respectively, for stage IIIA, and 26% for stage IIIB. This intensive trimodality treatment proves to be feasible. Treatment-related toxicities are overall moderate and acceptable. Accurate cardiopulmonary evaluation before surgery and reinforcement of bronchial stump or anastomosis can contribute to reducing complications. Induction treatment demonstrated a "downstaging effect", so that a clear trend for organ-sparing resection was observed. Long-term survival rates for selected groups look very promising when compared to historical controls.

High dose epirubicin and cyclophosphamide in breast cancer stage IIIB

Introduction The aim of the study was to test the combination of high-dose 4-epiadriamycin (4-epi) with cyclophosphamide in treatment-naive, stage IIIB breast cancer patients.

Secondary leukaemia after cure for locally advanced NSCLC: Alkylating type secondary leukaemia after induction therapy with docetaxel and carboplatin for NSCLC IIIB

Specific cytogenetic alterations in t-MDS and t-AML are associated with different chemotherapeutic agents, such as loss of chromosomal material from #5 and #7 with alkylators. No data have been published on secondary leukemias following the taxane docetaxel. We report a patient, who being in long-term remission after docetaxel-based induction chemotherapy with docetaxel and carboplatin, surgery and adjuvant radiotherapy for non-small cell lung cancer stage IIIB, developed a t-MDS and subsequently a t-AML 40 months after start of therapy. The t-MDS was characterised by a complex aberrant karyotype including monosomy #13 and partial monosomies of #5 and #7. This is the first report in the literature of t-MDS after docetaxel chemo-radiotherapy, implicating a possible association of docetaxel with alkylator type t-MDS and t-AML. The case will be discussed in the context of a review of the current literature.

182 The clinical implications of radiotherapy on renal function in patients with hydronephrosis in stage IIIB cancer of the cervix

182 The clinical implications of radiotherapy on renal function in patients with hydronephrosis in stage IIIB cancer of the cervix

P-604 Multicenter German/French phase-II trial of induction-CTx followed by concurrent CTx/RTx +/- surgery (S) in locally far advanced inoperable non-small-cell lung cancer (NSCLC) stages IIIA(N2) and IIIB - preliminary results of toxicity and efficacy including a newer induction-CTx regimen

P-604 Multicenter German/French phase-II trial of induction-CTx followed by concurrent CTx/RTx +/- surgery (S) in locally far advanced inoperable non-small-cell lung cancer (NSCLC) stages IIIA(N2) and IIIB - preliminary results of toxicity and efficacy including a newer induction-CTx regimen

P-239 Optimizing chemoradiation (CTx/RTx) with epoetin-alpha support: Phase-II trial of induction CTx followed by concurrent CTx/RTx +/- surgery (S) in locally far advanced non-small-cell lung cancer stages IIIA and IIIB (LAD-NSCLC)

P-239 Optimizing chemoradiation (CTx/RTx) with epoetin-alpha support: Phase-II trial of induction CTx followed by concurrent CTx/RTx +/- surgery (S) in locally far advanced non-small-cell lung cancer stages IIIA and IIIB (LAD-NSCLC)

Venous thromboembolism among patients with advanced lung cancer randomized to prinomastat or placebo, plus chemotherapy

Two clinical trials have suggested that the combination of vascular endothelial growth factor inhibitor with chemotherapy is associated with venous thromboembolism (VTE). This retrospective cohort study investigates whether a similar association exists when matrix metalloproteinase inhibitor (prinomastat) is combined with chemotherapy. Patients (n=1,023) with stage IIIB, IV, or recurrent non-small cell lung cancer (NSCLC) were followed during 2 randomized, double-blind trials of prinomastat versus placebo orally bid, plus gemcitabine/cisplatin (GC) or paclitaxel/carboplatin (PC). VTE included deep venous thrombosis (DVT) or pulmonary embolism (PE) confirmed by imaging or autopsy. Risks identified in univariate analysis (incidence densities compared by t test) were confirmed in multivariate analysis (proportional hazards model). During 7,500.3 patient-months, 58 VTE (31 PE, 27 isolated DVT) were confirmed in 54 patients. On univariate analysis, VTE was associated with central venous catheter placed within 3 months, 15 mg prinomastat plus GC, and to a lesser extent, 15 mg prinomastat plus PC, baseline performance status, and histologic type. VTE incidence was not increased by 15 mg prinomastat alone (post-discontinuation of chemotherapy), by chemotherapy plus placebo, or by 5 or 10 mg prinomastat plus chemotherapy. On multivariate analysis,VTE hazards (95% confidence interval) were 5.69 (2.61, 12.40) with recently placed central catheter, 2.78 (1.42, 5.43) with 15 mg prinomastat plus GC, and 2.06 (0.98, 4.31) with 15 mg prinomastat plus PC; performance status and histology were nonsignificant. We can conclude that combined treatment with 15 mg prinomastat plus chemotherapy approximately doubles the hazard of VTE among patients with advanced NSCLC.

A modified technique for high-dose-rate intracavitary brachytherapy in advanced cancer of the cervix

Purpose To develop a modified technique for high-dose-rate intracavitary brachytherapy in cervical cancer stage IIIb. Methods and materials Cervical carcinoma FIGO Stage III accounts for >60% of all cervical cancers with radiation being the mainstay of treatment for most patients. After external beam radiation therapy (EBRT), the cervix is often flush with the vagina and the shape of the vagina may be conical with its apex at the external os level. All patients receive 2 applications with HDR brachytherapy. At the first application after the placement of the central tandem, only one ovoid is inserted and the other ovoid is replaced by a rubber tube, and the applicator assembly is fixed as usual. The contralateral ovoid is inserted at the subsequent application. Results To date, 21 locally advanced cervical cancer patients have been treated using this technique. In these patients, the mean dose to right and left Point A was 93% (range, 86–100%; median, 93%) and 95% (range, 90–100%; median, 95%), respectively. The variation of doses to the contralateral Point A was 1–14%. The mean dose to the rectal and bladder mucosa was 62% (range, 43–80%; median, 64%) and 80% (range, 50–110%; median, 71%), respectively. Conclusion This modified HDR intracavitary technique may prove an alternative for centers where interstitial brachytherapy for cancer of the cervix is not available.

Neovastat, a naturally occurring multifunctional antiangiogenic drug, in phase III clinical trials

Recent studies have indicated that bone marrow angiogenesis is increased in multiple myeloma, suggesting that treatment with an antiangiogenic agent might be useful. Among the new antiangiogenic drugs in development, Neovastat (Æ-941; Æterna Laboratories, Quebec City, Canada) can be classified as a naturally occurring multifunctional antiangiogenic agent. It has a marked inhibitory effect on the formation of blood vessels in the chicken embryo vascularization assay (EVT) and endothelial cell proliferation. Furthermore, in vivo experiments showed that oral administration of Neovastat blocks the formation of blood vessels in Matrigel implants containing basic fibroblast growth factor (bFGF). The antiangiogenic activity of Neovastat was found to be associated with two mechanisms of action. In addition to the inhibition of the matrix metalloproteinase activities (MMP-2, MMP-9, and MMP-12), Neovastat inhibits vascular endothelial growth factor (VEGF) binding to endothelial cells, VEGF-dependent tyrosine phosphorylation, and VEGF-induced vascular permeability in mice. Neovastat was also found to have a significant antitumor activity. Oral administration of Neovastat in mice with subcutaneous grafted breast cancer (DA3) cells showed a significant reduction in tumor volume. Neovastat also decreased the number of lung metastases in the Lewis lung carcinoma model. Interestingly, the effect of Neovastat was additive to cisplatin in this model. Furthermore, no treatment-related mortality or loss of body weight was observed. Also, toxicology studies in rats and monkeys demonstrate no dose-limiting toxicity or target organ damage after 1 year of chronic exposure, thus suggesting that Neovastat could be safely administered in humans. Four clinical studies have been conducted to establish the dosing, safety, and early efficacy of Neovastat administered orally. In the oncology field, 482 patients have received Neovastat, of which 146 with solid tumors were exposed to the drug for more than 6 months. Two phase III clinical trials are currently underway. A phase III double-blind placebo-controlled study is being conducted to evaluate the efficacy of Neovastat in addition to induction chemotherapy/radiotherapy combined modality treatment in patients with unresectable non-small cell lung cancer stage IIIA and IIIB. A second phase III randomized, doubleblind placebo-controlled study evaluates the efficacy of Neovastat as a monotherapy in metastatic renal cell carcinoma patients who have progressed following a first-line immunotherapy. Neovastat efficacy is also being evaluated in a registration phase II trial in patients with early relapse or refractory multiple myeloma.

Hand–foot syndrome associated with short infusions of combination chemotherapy with gemcitabine and vinorelbine

The hand-foot syndrome (palmar-plantar erythrodysesthesia) is a side-effect which is associated with several cytotoxic agents (e.g. 5-fluorouracil, UFT, capecitabine, cytarabine, doxorubicin, liposomal-encapsulated doxorubicin). An association with a prolonged infusion of high doses of vinorelbine has also been described. To date a hand-foot syndrome after gemcitabine or short infusions of vinorelbine has not been reported before. The patient described here had a non-small-cell lung cancer stage IIIB disease and developed a hand-foot syndrome after short infusions of standard-dose chemotherapy of a combination with gemcitabine and vinorelbine.