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12th World Conference on Lung Cancer; Sept 2–6, 2007; Seoul, South Korea
Conference Watch
12th World Conference on Lung Cancer; Sept 2-6, 2007; Seoul, South Korea Pemetrexed plus cisplatin Pemetrexed plus cisplatin (PC) has similar efficacy to gemcitabine plus cisplatin (GC) in previously untreated patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) and has fewer toxic effects according to findings from a non-inferiority phase III study. Giorgio Scagliotti (Turin, Italy) and colleagues randomly assigned 1725 patients to one of the two treatment combinations. Overall survival for patients assigned PC was non-inferior to GC (10·3 vs 10·3 months [hazard ratio (HR) 0·94; 95% CI 0·84– 1·05]). Febrile neutropenia, alopecia, and grade 3 to 4 haematological toxic effects were significantly less frequent in the PC group, whereas grade 3 to 4 nausea and anorexia were significantly less frequent in the GC group.
Neoadjuvant chemotherapy? Addition of neoadjuvant platinumbased chemotherapy does not improve overall survival compared with surgery alone in patients with resectable NSCLC, according to findings from a multicentre trial. Marianne Nicolson (Aberdeen, UK) and colleagues randomly assigned 519 patients to surgery alone or to three cycles of platinumbased chemotherapy before surgery. Although neoadjuvant chemotherapy resulted in a good response (4% complete response and 45% partial response), and led to about 13% of patients being down-staged, more patients in the chemotherapy group developed brain metastases. No difference in overall survival was noted between the two groups (HR 1·02; 95% CI 0·80–1·31). Median 5-year survival in the surgeryalone group was 45% compared with 44% in the neoadjuvant chemotherapy group.
No benefit with docetaxel Docetaxel added to cisplatin plus etoposide does not improve survival 876
compared with cisplatin plus etoposide alone in patients with inoperable, stage III NSCLC. Furthermore, the addition of docetaxel leads to an increased risk of hospitalisation and premature death, according to a phase III study by Nasser Hanna (Indianapolis, IN, USA) and co-workers. 243 patients were treated with cisplatin plus etoposide concurrently with chest radiotherapy. Patients who did not progress were randomly assigned to docetaxel or to observation. However, the trial was stopped early after an analysis of 203 patients, due to evidence of futility. After a median follow-up of 25·6 months, 28·8% of patients assigned docetaxel were hospitalised compared with 8·1% of those in the observation group. 5·5% of those assigned docetaxel died. Progressionfree survival was 12·3 vs 12·9 months (p=0·9412) and median survival was 21·6 months vs 24·2 months (p=0·9402) for the docetaxel group and observation group, respectively.
Doublet for SCLC Andreas Hermes and colleagues from Germany, Norway, and Sweden noted that irinotecan plus carboplatin leads to improved overall survival compared with oral etoposide plus carboplatin and does not compromise quality of life (QoL) in patients with extensive-stage small-cell lung cancer (SCLC). 220 patients were randomly assigned to one of the two treatment groups. Median overall survival was 214 days in the etoposide group compared with 255 days in the irinotecan group (p=0·04; HR 1·34, 95% CI 1·01–1·79) and 1-year survival was 28% vs 35%, respectively. Seven patients in the etoposide group and 18 in the irinotecan group had a complete response (p=0·02). Grade 3 to 4 haematological toxic effects and QoL scores over time did not differ significantly between the groups.
Carbon-ion radiotherapy Japanese researchers have shown that carbon-beam radiotherapy has efficacy in patients with stage I NSCLC and might be a useful treatment modality for those who are poor candidates for surgery. In a phase II trial, Masayuki Baba and colleagues from Chiba, Japan, treated 129 patients in 1999–2003 with carbon-beam radiotherapy by use of a respiratory-gated irradiation system. Most tumours were irradiated obliquely from four directions. Cumulative local control for all tumours was 94·7% at 58 months after treatment. Overall 5-year survival was 68·7% for patients with stage IA disease and 46·4% for those with stage IB disease. No toxic dermal effects and no toxic effects more severe than grade III were noted.
Pneumothorax risk Silvia Novello and colleagues (Orbassano, Italy) have identified risk factors for pneumothorax after CT-guided transthoracic needle biopsy. The predominant risk factor for this complication was the length of lung parenchyma crossed during biopsy. Other risk factors were: tumour size 1 cm or less; chest-wall invasion; and high number of cutting specimens. Risk factors in 708 biopsy procedures were assessed in 691 patients with a central or peripheral pulmonary tumour. Pneumothorax occurred in 181 procedures. The most significant risk factor was mean depth of tumour from the pleural surface (27·4 mm in patients with pneumothorax vs 17·2 mm in patients without [p=0·002]). Number of pleural punctures, angle of needle with pleura, time between pleural puncture and needle removal, tumour location, presence of emphysema in needle path, and patient sex did not affect risk of pneumothorax.
Lidia Siemaszkiewicz http://oncology.thelancet.com Vol 8 October 2007
12th World Conference on Lung Cancer; Sept 2-6, 2007; Seoul, South Korea Pemetrexed plus cisplatin Pemetrexed plus cisplatin (PC) has similar efficacy to gemcitabine plus cisplatin (GC) in previously untreated patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) and has fewer toxic effects according to findings from a non-inferiority phase III study. Giorgio Scagliotti (Turin, Italy) and colleagues randomly assigned 1725 patients to one of the two treatment combinations. Overall survival for patients assigned PC was non-inferior to GC (10·3 vs 10·3 months [hazard ratio (HR) 0·94; 95% CI 0·84– 1·05]). Febrile neutropenia, alopecia, and grade 3 to 4 haematological toxic effects were significantly less frequent in the PC group, whereas grade 3 to 4 nausea and anorexia were significantly less frequent in the GC group.
Neoadjuvant chemotherapy? Addition of neoadjuvant platinumbased chemotherapy does not improve overall survival compared with surgery alone in patients with resectable NSCLC, according to findings from a multicentre trial. Marianne Nicolson (Aberdeen, UK) and colleagues randomly assigned 519 patients to surgery alone or to three cycles of platinumbased chemotherapy before surgery. Although neoadjuvant chemotherapy resulted in a good response (4% complete response and 45% partial response), and led to about 13% of patients being down-staged, more patients in the chemotherapy group developed brain metastases. No difference in overall survival was noted between the two groups (HR 1·02; 95% CI 0·80–1·31). Median 5-year survival in the surgeryalone group was 45% compared with 44% in the neoadjuvant chemotherapy group.
No benefit with docetaxel Docetaxel added to cisplatin plus etoposide does not improve survival 876
compared with cisplatin plus etoposide alone in patients with inoperable, stage III NSCLC. Furthermore, the addition of docetaxel leads to an increased risk of hospitalisation and premature death, according to a phase III study by Nasser Hanna (Indianapolis, IN, USA) and co-workers. 243 patients were treated with cisplatin plus etoposide concurrently with chest radiotherapy. Patients who did not progress were randomly assigned to docetaxel or to observation. However, the trial was stopped early after an analysis of 203 patients, due to evidence of futility. After a median follow-up of 25·6 months, 28·8% of patients assigned docetaxel were hospitalised compared with 8·1% of those in the observation group. 5·5% of those assigned docetaxel died. Progressionfree survival was 12·3 vs 12·9 months (p=0·9412) and median survival was 21·6 months vs 24·2 months (p=0·9402) for the docetaxel group and observation group, respectively.
Doublet for SCLC Andreas Hermes and colleagues from Germany, Norway, and Sweden noted that irinotecan plus carboplatin leads to improved overall survival compared with oral etoposide plus carboplatin and does not compromise quality of life (QoL) in patients with extensive-stage small-cell lung cancer (SCLC). 220 patients were randomly assigned to one of the two treatment groups. Median overall survival was 214 days in the etoposide group compared with 255 days in the irinotecan group (p=0·04; HR 1·34, 95% CI 1·01–1·79) and 1-year survival was 28% vs 35%, respectively. Seven patients in the etoposide group and 18 in the irinotecan group had a complete response (p=0·02). Grade 3 to 4 haematological toxic effects and QoL scores over time did not differ significantly between the groups.
Carbon-ion radiotherapy Japanese researchers have shown that carbon-beam radiotherapy has efficacy in patients with stage I NSCLC and might be a useful treatment modality for those who are poor candidates for surgery. In a phase II trial, Masayuki Baba and colleagues from Chiba, Japan, treated 129 patients in 1999–2003 with carbon-beam radiotherapy by use of a respiratory-gated irradiation system. Most tumours were irradiated obliquely from four directions. Cumulative local control for all tumours was 94·7% at 58 months after treatment. Overall 5-year survival was 68·7% for patients with stage IA disease and 46·4% for those with stage IB disease. No toxic dermal effects and no toxic effects more severe than grade III were noted.
Pneumothorax risk Silvia Novello and colleagues (Orbassano, Italy) have identified risk factors for pneumothorax after CT-guided transthoracic needle biopsy. The predominant risk factor for this complication was the length of lung parenchyma crossed during biopsy. Other risk factors were: tumour size 1 cm or less; chest-wall invasion; and high number of cutting specimens. Risk factors in 708 biopsy procedures were assessed in 691 patients with a central or peripheral pulmonary tumour. Pneumothorax occurred in 181 procedures. The most significant risk factor was mean depth of tumour from the pleural surface (27·4 mm in patients with pneumothorax vs 17·2 mm in patients without [p=0·002]). Number of pleural punctures, angle of needle with pleura, time between pleural puncture and needle removal, tumour location, presence of emphysema in needle path, and patient sex did not affect risk of pneumothorax.
Lidia Siemaszkiewicz http://oncology.thelancet.com Vol 8 October 2007