Neoadjuvant chemotherapy of locally advanced non-small cell lung cancer

Neoadjuvant chemotherapy of locally advanced non-small cell lung cancer

228 Abstracts/Lung Cancer infiltrating lymphocytes, ranging from 4 to 70 billion cells, were reinfused intravenously 4 to weeks after operation. In...

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infiltrating lymphocytes, ranging from 4 to 70 billion cells, were reinfused intravenously 4 to weeks after operation. Interleukin-2 was administered subcutaneously at escalating doses for 2 weeks and then at reduced doses for 2 to 3 months. Median survival was 14 months. and the 2- year survival was 40%. Three patients remain alive and disease-free at more than 2 years after operation. Two of these patients did not have complete resection at thoracotomy. Multivariate analysis showed no correlation between the factor of incomplete resection and survival. Intrathoracic recurrence without concomitant distant failure was documented in two patients only and none of the patients with incomplete resection (12 cases) had relapse within the thorax. The present experience demonstrates that adoptive immunotherapy may be applied with safety in patients operated on for stage III non-small- cell lung cancer and suggests that it can be useful, notably in patients with locally advanced disease. Radiotherapy plus carboplatin and teniposide in patients with brain metastases from non small cell lung cancer Pronzato P, Bruna F, Neri E, Roveri D, Trabucchi A, Vanoli M et al. Isr. Nazionole Ricerco sul Cancro, Lisle Benedetto,XT IO, 16132 Geneva. Anticancer Res 1995;15:517-9. Background. The role of chemotherapy alone or added lo radiation treatment for the palliation of multiple, unresectable brain metastases from non small cell lung cancer (NSCLC), is not yet well defined. Carboplatin and teniposide, however, are an interesting combination in this setting since they are active in NSCLC and because of encouraging results against brain metastases in other tumor types. Methods. Twenty patients with brain metastases from NSCLC were treated with whole brain irradiation (total dose of 45 Gy) and chemotherapy (carboplatin, 300 mg/sm on day 1 and teniposide, 60 m&m on days 1, 2 and 3). Results. Nine patients (45%) showed a complete remission of neurologic symptoms, and 7 (35%) an improvement. Neurologic signs disappeared in 8 patients (40%) and improved in 7 (35%). Three patients (15%) had partial (50%) regression of brain metastases at CT scan, and also showed response in other tumor sites. One other patient had a response ofchest and liver lesions, while the cerebral metastases remained stable. Median survival was 7 months with a range of I-9 months. Toxicity was mild, with no toxic deaths. Conclusions. Aggressive treatment can be taken into consideration also in the case of NSCLC patients with brain metastases and negative prognostic features. Their participation in clinical trials should be encouraged, since this will allow definition of the contribution of combined radiotherapy, chemotherapy and supportive care to the quality and duration of the patient’s life.

Neoadjuvant chemotherapy of locally advanced non-small cell lung cancer Pujol J-L, Le Chevalier T, Ray P, Gautier V, Rouanet R Arriagada R et al. Hopital de Arnaud Villeneuve, Centre Hosp. Regional/ Universifaire. 34295 Montpellier Cedex 5. Lung Cancer (Ireland) 1995;12:Suppl l:S107-18. Neoadjuvant chemotherapy was tested in non-small cell lung cancer in an attempt to increase the resectability of the tumor and to treat the microscopic metastatic disease known to be responsible for the majority offailures in surgically treated patients. This review deals with published trials. Most of them are feasibility studies in Stage III NSCLC. Obviously, the heterogeneity ofeligibility criteria &om one study to another prevents general conclusions on the usefulness of neoadjuvant chemotherapy. However, it is possible to conclude that neoadjuvant chemotherapy has an antitumor activity: the majority of the studies report a 60% objective response rate including a significant number of complete responses and a 50% complete resection rate. Neoadjuvant chemotherapy does not

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increase morbidity after surgery except when it is combined with preoperative radiation therapy. At the time of writing, one Phase III randomized study comparing neoadjuvant chemotherapy followed by surgery with surgery alone has been published. This study concludes that the combined modality treatment improves the survival of patients with locally advanced non-small cell lung cancer. Taken as a whole, the literature deserves further studies to determine the place of neoadjuvant chemotherapy in lung cancer.

Multimodality therapy in unresected stage III non-small cell lung cancer: The American Cooperative Groups’ experience Green MR. Cancer Center Clinic, Universi& oJCalifornia, 200 West Arbor Drive, San Diego, CA 92103-8421. Lung Cancer (Ireland) 1995;12:Suppl l:S87-S94. Since the mid-1980s. the American Cooperative Cancer Treatment Groups (Cancer and Leukemia Group B, Eastern Cooperative Oncology Group, North Central Cancer Treatment Group, Radiation Therapy Oncology Group, Southwest Oncology Group) have performed several multimodality trials exploring combinations of chemotherapy and radiation in patients with Stage III non-small cell lung cancer. The initial trials had a sequential design with induction chemotherapy followed by radiation. Later trials have emphasized concurrent chemoradiation with or without induction chemotherapy. These trials have begun to have an impact on what is considered ‘standard’ therapy for patients with Stage III non-small cell lung cancer (NSCLC).

A phase II trial of combined chemotherapy and surgery in stage IIIA non-small cell lung cancer Darwish S, Minotti V, Crino L, Rossetti R, Fiaschini P, Maranzano E et al, Department ofMedical Oncology, Policlinico, 06122 Perugia. Lung Cancer (Ireland) 1995;12:Suppl l:Sll-S78. A poor prognosis for patients with Stage IIIA clinical N2 treated by surgery alone has led clinical researchers to find a new treatment modality to improve the curative potential of surgery. Many Phase II trials have been carried out with induction chemo- or chemoradiotherapy prior to surgery. From June 1988 lo July 1991.46 patients with non-small cell lung cancer (NSCLC) Stage IIIA clinical N2 entered a Phase II induction-chemotherapy trial. Patients received 2-3 cycles of high-dose cisplatin and etoposide. Forty-five were evaluable for response; the response rate was 82% (37/45: 3 CR, 34 PR). Toxicity was primarily hematologic. Surgical resection was performed in 35 patients; radical resection was possible in 28 patients (62%); three patients were incompletely resected and two patients were only explored. Three deaths were surgery-related. Median survival was 24.5 months with a 2-year survival of 53%. Cisplatin with etoposide is an active and safe induction chemotherapy regimen for NSCLC Stage IIIA N2 with a high response rate. The median survival seems to be prolonged and therefore. randomized trials are needed to compare this approach with other treatment modalities.

Effectiveness and toxicity of preoperative therapy in Stage IIIA non-small cell lung cancer including the Memorial SloanKettering experience with induction MVP in patients with bulky mediastinal lymph node metastases (Clinical N2) Kris MG, Pisters KMW. Ginsberg Rl, Rigas JR Miller VA. Grant SC et al. Memorial Sloan-Kettering Cancer Ct,: 1275 York Avenue, New York, NY 10021. Lung Cancer (Ireland) 1995;12:Suppl l:S47-S57. The use of preoperative chemotherapy with mitomycin, vinblastine and cisplatin (Mvp) has led to improved complete resection rates and survival in Stage IIIA non-small cell lung cancer with bulky, ipsilateral.