1,721,400 research outputs found
Emerging role of gefitinib in the treatment of non-small-cell lung cancer (NSCLC)
No full textM Tiseo, M Bartolotti, F Gelsomino, P BordiMedical Oncology Unit, University Hospital of Parma, Parma, ItalyAbstract: Most patients with non-small-cell lung cancer (NSCLC) present with advanced disease and their long-term prognosis remains poor. Epidermal growth factor receptor (EGFR)-targeted therapies, such as gefitinib, have been subjected to comprehensive clinical development. Several phase II and III trials evaluated the clinical efficacy of gefitinib as monotherapy in pretreated patients with advanced NSCLC, as well as both monotherapy and combined with chemotherapy in chemotherapy-naive patients. A phase III trial (ISEL) in heavily pretreated advanced NSCLC patients demonstrated some improvement in survival with gefitinib compared with placebo; however, the difference was not statistically significant within the overall population. A large phase III trial in pretreated patients (INTEREST) demonstrated the non-inferiority of gefitinib in comparison with docetaxel for overall survival, together with an improved quality of life and tolerability profiles. In a large phase III trial (IPASS) in Asian chemotherapy-naive, never or former light-smoker patients with adenocarcinoma, gefitinib was more effective than carboplatin–paclitaxel in prolonging progression-free survival, particularly in patients harboring EGFR gene mutations. Gefitinib was a generally well tolerated treatment, with skin rash and diarrhea being the most common treatment adverse events. As a result, gefitinib is expected to have a large impact on the management of patients with advanced NSCLC, in particular in EGFR mutated patients.Keywords: non-small-cell lung cancer, gefitinib, EGF
Granulocyte growth factors in the treatment of non-small cell lung cancer (NSCLC)
No full textNeutropenia and subsequent infections are common events that limit treatment of non-small cell lung cancer (NSCLC). Granulocyte growth factors (G- and GM-CSF) have been introduced in clinical practice and their use has yielded a reduction of the infection risk related to chemotherapy and a dose increase of drug delivery. Randomized clinical trials have shown that granulocyte colony-stimulating factors and, more recently, the longer-acting pegylated granulocyte colony-stimulating factor (pegfilgrastim) effectively reduce the incidence and severity of neutropenia and of its complications. Recommendations for the use of haematopoietic colony-stimulating factors from the American Society of Clinical Oncology (ASCO) have been published in 1994 and updated in 1996, 1997 and 2000. Recently, moreover, National Comprehensive Cancer Network (NCCN) guidelines for the myeloid growth factors in cancer treatment make available. Chemotherapy-associated myelosuppression is a major limitation of anticancer therapy also in early stage, local advanced and metastatic NSCLC. Recently, dose-dense chemotherapy has been shown to improve the outcome in early stage breast cancer and non-Hodgkin's lymphoma. However, few randomized trials have been reported on chemotherapy with or without granulocyte growth factors as primary prophylaxis in NSCLC. Presently, there is no evidence for a benefit in response rate and survival from the use of granulocyte growth factors as support of chemotherapy, in particular, for locally advanced and metastatic NSCLC. In clinical practice, the role of granulocyte growth factors for NSCLC treatment should be limited following the guidelines. An appropriate use of granulocyte growth factors may reduce the overall cost of treatment and improve the quality of life, important aims in the treatment of patients with local advanced or metastatic NSCLC. In the future, we need to identify patients who can benefit from granulocyte growth factors for optimize the schedule and doses, in advanced disease and also, after the recent positive results of adjuvant chemotherapy, in early stages. This review summarizes the present knowledge on the use of granulocyte growth factors in NSCLC. © 2005 Elsevier Ireland Ltd. All rights reserved
Current Status of Second-Line Treatment and Novel Therapies for Small Cell Lung Cancer
No full textDespite high response rates to first-line standard treatment, the great majority of patients with small cell lung cancer (SCLC) will relapse and succumb to their disease rather quickly. In the context of salvage therapy, symptom palliation and quality-of-life improvements, besides survival prolongation, are primary treatment endpoints. A variety of single-agent and multi-agent chemotherapy regimens have been tested with limited success in patients with recurrent SCLC. A number of combination regimens have demonstrated high response rates in second-line settings, but these can be considered only for patients with good performance status. Treatment outcome depends on many factors, including type of response to first-line therapy, treatment-free interval, and performance status. Currently, topotecan represents an effective, tolerable therapeutic option and is the only agent approved for this indication. The management of patients with recurrent disease remains an area of active research. This review provides an update of clinical research on second-line chemotherapy of SCLC and of recent results obtained with novel molecular targeted approaches in both first- and second-line therapy
Chemotherapy in the treatment of thymic tumors
No full textThymic tumors, including thymoma and thymic carcinoma, are mainly treated with surgical resection. The majority of patients with thymic tumors present with early stage and are cured with surgical excision with or without post-operative radiation. For the patients who present with unresectable stage III or IV disease, or for the patients who experience recurrence, chemotherapy can play a significant role in ensuring long-term survival and offering palliation. Thymic tumors are chemo-sensitive with optimal responses achieved with cisplatin-based combinations. A multimodality approach including chemotherapy and post-operative radiation can improve complete resection rates and longterm outcomes in locally advanced tumors. Patients with disseminated thymic tumors can have significant disease response and symptom palliation when treated with chemotherapy. Durable responses can be obtained both in metastatic and recurrent settings. Second-line treatments are available and novel therapies are currently being explored. This review provides an update of available evidence about the treatment of thymic tumors with chemotherapy. © Springer-Verlag 2008
Cisplatin or carboplatin in the treatment of non-small cell lung cancer: A comprehensive review
No full textCisplatin has a pivotal role in the treatment of non-small cell lung cancer (NSCLC). However, it is associated with a number of serious and unpleasant side effects (nausea-vomiting, myelo-suppression, neuro-toxicity and renal function impairment). To overcome these limitations, most clinicians have turned towards the use of the cisplatin analog carboplatin, which is associated with a lower incidence of toxicity. Although carboplatin and cisplatin have a similar mechanism of action and pre-clinical spectrum of activity, it is still unclear whether they actually have the same clinical efficacy in all types of tumors. While for some tumors, such as ovarian cancer, equivalent efficacy has been convincingly proven, for others, such as germ cell and headneck tumors, there is some evidence that carboplatin is inferior to cisplatin. It has never been convincingly proven that carboplatin and cisplatin have the same efficacy in the treatment of NSCLC. This review provides an update of available evidences about this important scientific question
Second-line chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC)
No full textAn increasing number of patients with advanced non-small cell lung cancer (NSCLC) progressing after front-line chemotherapy are still in good performance status and willing to receive further treatment. Several drugs have been tested in this setting of treatment, but the only agent registered world-wide for second-line chemotherapy of advanced NSCLC is docetaxel. This drug, at dose of 75 mg/m(2) every three weeks, has been the standard of care as second-line chemotherapy since 2000, based on two trials that reported improved survival times and quality of life when comparing with best supportive care (TAX 317) and with ifosfamide or vinorelbine (TAX 320). Docetaxel, given at this dose and schedule, resulted in significant haematological toxicity, with many patients at risk for neutropenic fever. Pemetrexed is a novel multitargeted antifolate agent with single-agent activity in first- and second-line treatment of NSCLC. In a phase III study in 571 patients pemetrexed, comparing with docetaxel in second-line chemotherapy, demonstrated clinically equivalent therapeutic outcomes, but a more favourable haematological toxicity profile, with fewer episodes of neutropenia, neutropenic fever, and infections and less use of granulocyte colony-stimulating factor support. Others several agents have been evaluated for the second-line treatment of patients with non-small cell lung cancer, but no comparative phase III studies with docetaxel has been carried out. The epidermal growth factor receptor-tyrosine kinase inhibitors gefitinib (ZD1839, Iressa) and erlotinib (OSI 774, Tarceva) have been evaluated in the second- and third-line setting. Both drugs have demonstrated interesting response rates and toxicity profile and, in particular, erlotinib evidenced a survival advantage of 2 months respect placebo in recent phase III trial. Future developments are likely to value poli-chemotherapy or combination chemotherapy with EGFR tyrosine kinase inhibitors in second-line treatment of advanced NSCLC
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