- Email: [email protected]
54 Targeted Iressa therapy in patients with brain metastases fromnon-small cell lung cancer
Abstracts not presented at the Conference/Smafl ceil lung cancer in 9 (38%) patients, and large call and undifferentiated carolnoma in 5 (20%) palJents No grade 4 hematologic toxicity occurred The oily grade 3 tmdcifies were esephagitis and fatigue in 2 (8%) patients each PaPal response (PR) was observed in 13 (,52%) patients and stable cisease (SD) in 10 (40%) pal~ents, while 2 (8%) pafients had progressive disease (PD) The median overall survival I~me was g mos (95%C1:7 25-11 7,5 mos) The 2 pafients who had PD and 5 of the 10 pal~ents who had SD had negafive prognosl~c factors of weight loss at baseline, whereas all patients with a PS of 0 had PR: however. we could not identify a relationship between response and clinical disease stage or ilstolog~cal subtype. Conclusions: Weekly GEM grven concurrently vath chest RT for the treatment of stage III NSCLC is tolerable. The actrvity seen in patients with good prognostic factors merits further study.
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Targeted Irassa therapy In patients wlth brain metastases from non-small cell lung cancer
W. SJ-yu. O Wei. L Yong4~in Thoracic Surgery, China
Ba(~ground: To evaluate the efficacy and tosiclty of Iressa in the t]'eatment of patients vath brain metastases from non small lung cancer. Methods: Eight patients with brain metastases from non small cell lung cancer postoperat?vely were received Iressa. at the dally dose of 250 mg. and concurrent combinated with whole brain radiotherapy. Results: Five patients had complete response on the brain cisease and survived for more than 1 years, tow patients had papal response, oily one patient failed to tTeatment Five patients had severe skin rash Conduslons: Iressa concurrent with whole brain radiotherapy may be effec~ve in patients with brain metastases from non-small cell lung cancer
]
A phase II Wlal of Induction therapy with gemcltablne and cerboplatln followsd by concurrent gemcttablne end radiotherapy In locally advanced non-small cell lung cancer (NSCLC)
V Sukthomya 2. C Charoentum I . S Pojchsmarnwiputh 2. P. Saengsaweng ~. ~Meaical Once/ogy UnIt, Department ot Medicine, Faculty
or Medicine, Chiang Mal University, Chiang Mai, Thailand, 2Department of Radiology, Faculty of Mecicine, Chiang Mai University, Chiang Mai, Thailand Background: Several clinical thals have demonstrated that the combination of chemotherapy and radiation therapy (RT) increases survrval t]me in locally advanced NSCLC compared to radiation alone Gemcitabine/platmum is the standard regimen in metastatic NSCLC Preclinieal data have also shown that gemcitabine is a potent radiosenail~er with interesfing activity in pancreatic, lung, and cervical cancer CALGB 9431 reported the efficacy and safety of induction chemotherapy with gemcitabineJearboplatin ~llowed by cor'K::urrent gemcitabine and radiation This study assessed the feasibility and efficacy o f i n d u ~ o n gemcitabineJearboplatin ~llowed by concurrent gemcitabine/RT in locally advanced NSCLC. Methods: Patients with pathologically confirmed stage Ilia or IIIB NSCLC received two cycles of chemotherapy with gemcitabine 1250 mgim 2 (days 1. 8,) and earboplafin AUC b (day 1) avery 21 days In,el assessment of turner response was done after two cycles of induction chemotherapy Pafients with stable cisease or papal response confinued to receive weekly gemcitabine. 2-4 weeks after completion of induction chemotherapy, at a dose of 200 mglm 2 concurrently with RT for a total dose of 6000~3400 cGy The concurrent chemeradiation (CT/RT) course was civided into two phases In the first phase. pnmary tumor along with all involved hilar and mediastJeal nodes with a 1 b 2ore margin were radiated to 40Gy/20 fraction by AP and PA fields In the second phase, only gross tumors shown on computed tomography were radiated by 3~3 confermal radiafion therapy to a total dose of 6(~66 Gy Results: From October 2003 to December 2004. 2b patients were enrolled Four of the 25 patients are still undergoing treatment, and one patient refused radiation therapy. Of the 20 patients evaluated, the median age was 59 yrs (range 45-72). with stages IIWIIIB in 5/15 patients. Two patients achieved partial response (10%). and fourteen had stable clsease (70%). Of these 16 patients. 13 completed concurrent CTiRT as planned. 6 of whom acllaved partial response (46.15%). and 2 had stable disease (15.38%). One patient had brain metastases and died during concurrent CT/RT. and two patients had pneumonia and died during raciotherapy One-year survival rate was 28% Hematologic tosicities dunng induction chemotherapy were moderate with neutropenia (grade 3: 7" b%: grade 4 : 7 5%) and anemia (grade 2: 3b%: grade 3: b%): during the concurrent phase, hematologic toxicity was moderate with neutropenia (grade 2:31 25%: grade 4 : 6 25%). thrombocytoperta (grade 1: 12 5%: grade 2:6 25%). and anemia (grade 2:31 25%: grade 3:18 7,5%: grade 4 : 6 2b%) Non-hematologic toxicity was mild with grade 2 nausea/vomiting (3.75%) dunng the induction phase. But osoghaglt]s was the main toxicity dunng the concurrent phase (grade 2: 68.75%; grade 3: 12.5%). Pneumonitis (grade 2: 25%; grade 3: 18.75%; grade 4: 12.5%) was observed. Conclusions: Induction chemotherapy with gem~abine and carboplat]n at this dosage is feasible; however, gemcltabine conct,rrent with raclation may not be
S393
the optimal regimen. Infectious pneumonia dunng the concurrent part needs to be observed closely
Pathology ]
Lymphoaplthelloma-Ilke cerclnoma of the lung: Two ceucaslan pstlents with good prognosis
M. Gulhan. E. (~)zaydyn. N. Oapan. A. ErtiJrk. S. Caobakan. E. Ak'~n@. E. (~zy~lmaz. E. GLilhan. Atat~rk Chest Diseases and ThoracJc Surgery
Training Hospital Ankara, Turkey Lymphoepithelioma4ike carcinoma (LELC) is a lymphocyte4"ich poorly cifferenfiated, nonkeratinizing squamous cell carcinoma of nasopharynx with cistinctive dinical, epidemiologieal and etiological features Primary LELC of the lung is very rare especially in eauossions: to date only 16 eases have been reported in the literature It preferentially affects the Assian populafion and is stTongly associated with Ebstain-Barr virus (EBV) infection We aimed to discuss two now caucasion patients with primary LELC of the lung responsed to the Izeatment and good prognosis in spite of advanced diseases (stage IV and stage IIIB). Case 1: A 49 year~31d male was referred to our hospital with right hilar mass and multiple pulmonary nodules. Brochoscopy was normal except mucosal hypersmia in the interroeclate bronchus. Computed thomography guided needle biopsy was not clagnostic. The patient underwent open lung biopsy. Case 2: A 68. year old male was presented with mass in the dght upper zone Brenchoscopy and transthoraclc needle biopsywere not diagnosfic Right upper Iohectomy was perbrmed Histologic evaluation of the materials demonstrated lymphoepitheliomalike carcinoma with no associated EBV ac~vity The e~aminalJon of the nasopharyns by an otorhinolaryngologist revealed no abnormality and the computed tomography of nasopharynx were normal Because there is no standart chemotherapy t]'eatment, we administered vlnorolblno and clsplat]n combined chemotherapy. They were good response and good prognosis. They have been followed for fourty and fifteen months with stable disease, respectTvoly
Small cell lung cancer ]
ClsplaUn and etoposlde followed by concurrent chemo-radlaUon therapy for limited small cell lung cancer (SCLC-LD). The experience of two Italian InsUtutlons
G. Benedett] 1, S. Tamderl ~, M. Fedele~ , F. Rastelli ~, F. saivi 2, G. Frezza 2, L. Crlnb ~. 1Medical Oncology "Bellana" Hospital, Bologna, Italy, 2Radiation
Therapy "Bella#a* Hospital, Bologna, Italy, 3Medical Oncology Faenza Hospital (Fodl) Italy, Bologna, Italy Background: Small cell lung cancer (SOLO) is a chemorosponslve tumor but overall survlval remains poor even in limited clsease (LD). Cisplatin and etoposide (PE) is now considered the standard regimen to be administered concurrently with thoracic raclafion therapy With the aim of deLxJIking the initial tumor volume and thus reducing toxicity of raclalJon therapy, we investigated a sequenlJal approach of induction chemotherapy based on PE regimen followed by the same chemotherapy (PE) and concurrent thoracic irraclation (TI) in SCLC-LD patients Patients and methods: From July 2000 to September 2004 twenty4hree consecutive SCLC-LD palJents were enrolled and tTeated in our Ins~ution Treatment consisted of two cycles of c~splat]n 80 mg/mq day 1 plus etopos~de 120 mg/mq days 1 to 3. repeated every three weeks. After tumor response assessment, the TI was concurrently administered to the third course of PE at the dose of 45 Gy by 25 fractions. Six cycles of PE were totally administered. The prophylactic cranial irradiation (PCl) was provided for patients with complete remission of the disease. Results: Twenty three patients completed the cherno raclat]on therapy program The response at the neoadjuvant PE chemotherapy was obtained in 16 out of 23 valuable palJents with 1 complete remission (CR). while ,5 palJents had a stable disease (SD) The evaluation of the cJsease at the end of chemoraclalJon therapy show that 17" out of 21 palJents (81%) responded at the tTeatroent with lb CR. 3 partial remission (PR) One pafients has SD and two patients have progression of the disease (PD) Median progression free survival (PFS) and overall survival (OS) refer to eighteen valuable pafients with 9.5 months and 17.5 months respectively. 1y e a r or 2 year overall survival were 67% and 28% respectively. Five patients are in continuous complete remission at 15+ to 49+ months. Texiclty were mild consisting mainly in grade II esophag~]s and grade 2 myelosppression. In no case the concomitant Izeatment was interrupted
]
Targeted Irassa therapy In patients wlth brain metastases from non-small cell lung cancer
W. SJ-yu. O Wei. L Yong4~in Thoracic Surgery, China
Ba(~ground: To evaluate the efficacy and tosiclty of Iressa in the t]'eatment of patients vath brain metastases from non small lung cancer. Methods: Eight patients with brain metastases from non small cell lung cancer postoperat?vely were received Iressa. at the dally dose of 250 mg. and concurrent combinated with whole brain radiotherapy. Results: Five patients had complete response on the brain cisease and survived for more than 1 years, tow patients had papal response, oily one patient failed to tTeatment Five patients had severe skin rash Conduslons: Iressa concurrent with whole brain radiotherapy may be effec~ve in patients with brain metastases from non-small cell lung cancer
]
A phase II Wlal of Induction therapy with gemcltablne and cerboplatln followsd by concurrent gemcttablne end radiotherapy In locally advanced non-small cell lung cancer (NSCLC)
V Sukthomya 2. C Charoentum I . S Pojchsmarnwiputh 2. P. Saengsaweng ~. ~Meaical Once/ogy UnIt, Department ot Medicine, Faculty
or Medicine, Chiang Mal University, Chiang Mai, Thailand, 2Department of Radiology, Faculty of Mecicine, Chiang Mai University, Chiang Mai, Thailand Background: Several clinical thals have demonstrated that the combination of chemotherapy and radiation therapy (RT) increases survrval t]me in locally advanced NSCLC compared to radiation alone Gemcitabine/platmum is the standard regimen in metastatic NSCLC Preclinieal data have also shown that gemcitabine is a potent radiosenail~er with interesfing activity in pancreatic, lung, and cervical cancer CALGB 9431 reported the efficacy and safety of induction chemotherapy with gemcitabineJearboplatin ~llowed by cor'K::urrent gemcitabine and radiation This study assessed the feasibility and efficacy o f i n d u ~ o n gemcitabineJearboplatin ~llowed by concurrent gemcitabine/RT in locally advanced NSCLC. Methods: Patients with pathologically confirmed stage Ilia or IIIB NSCLC received two cycles of chemotherapy with gemcitabine 1250 mgim 2 (days 1. 8,) and earboplafin AUC b (day 1) avery 21 days In,el assessment of turner response was done after two cycles of induction chemotherapy Pafients with stable cisease or papal response confinued to receive weekly gemcitabine. 2-4 weeks after completion of induction chemotherapy, at a dose of 200 mglm 2 concurrently with RT for a total dose of 6000~3400 cGy The concurrent chemeradiation (CT/RT) course was civided into two phases In the first phase. pnmary tumor along with all involved hilar and mediastJeal nodes with a 1 b 2ore margin were radiated to 40Gy/20 fraction by AP and PA fields In the second phase, only gross tumors shown on computed tomography were radiated by 3~3 confermal radiafion therapy to a total dose of 6(~66 Gy Results: From October 2003 to December 2004. 2b patients were enrolled Four of the 25 patients are still undergoing treatment, and one patient refused radiation therapy. Of the 20 patients evaluated, the median age was 59 yrs (range 45-72). with stages IIWIIIB in 5/15 patients. Two patients achieved partial response (10%). and fourteen had stable clsease (70%). Of these 16 patients. 13 completed concurrent CTiRT as planned. 6 of whom acllaved partial response (46.15%). and 2 had stable disease (15.38%). One patient had brain metastases and died during concurrent CT/RT. and two patients had pneumonia and died during raciotherapy One-year survival rate was 28% Hematologic tosicities dunng induction chemotherapy were moderate with neutropenia (grade 3: 7" b%: grade 4 : 7 5%) and anemia (grade 2: 3b%: grade 3: b%): during the concurrent phase, hematologic toxicity was moderate with neutropenia (grade 2:31 25%: grade 4 : 6 25%). thrombocytoperta (grade 1: 12 5%: grade 2:6 25%). and anemia (grade 2:31 25%: grade 3:18 7,5%: grade 4 : 6 2b%) Non-hematologic toxicity was mild with grade 2 nausea/vomiting (3.75%) dunng the induction phase. But osoghaglt]s was the main toxicity dunng the concurrent phase (grade 2: 68.75%; grade 3: 12.5%). Pneumonitis (grade 2: 25%; grade 3: 18.75%; grade 4: 12.5%) was observed. Conclusions: Induction chemotherapy with gem~abine and carboplat]n at this dosage is feasible; however, gemcltabine conct,rrent with raclation may not be
S393
the optimal regimen. Infectious pneumonia dunng the concurrent part needs to be observed closely
Pathology ]
Lymphoaplthelloma-Ilke cerclnoma of the lung: Two ceucaslan pstlents with good prognosis
M. Gulhan. E. (~)zaydyn. N. Oapan. A. ErtiJrk. S. Caobakan. E. Ak'~n@. E. (~zy~lmaz. E. GLilhan. Atat~rk Chest Diseases and ThoracJc Surgery
Training Hospital Ankara, Turkey Lymphoepithelioma4ike carcinoma (LELC) is a lymphocyte4"ich poorly cifferenfiated, nonkeratinizing squamous cell carcinoma of nasopharynx with cistinctive dinical, epidemiologieal and etiological features Primary LELC of the lung is very rare especially in eauossions: to date only 16 eases have been reported in the literature It preferentially affects the Assian populafion and is stTongly associated with Ebstain-Barr virus (EBV) infection We aimed to discuss two now caucasion patients with primary LELC of the lung responsed to the Izeatment and good prognosis in spite of advanced diseases (stage IV and stage IIIB). Case 1: A 49 year~31d male was referred to our hospital with right hilar mass and multiple pulmonary nodules. Brochoscopy was normal except mucosal hypersmia in the interroeclate bronchus. Computed thomography guided needle biopsy was not clagnostic. The patient underwent open lung biopsy. Case 2: A 68. year old male was presented with mass in the dght upper zone Brenchoscopy and transthoraclc needle biopsywere not diagnosfic Right upper Iohectomy was perbrmed Histologic evaluation of the materials demonstrated lymphoepitheliomalike carcinoma with no associated EBV ac~vity The e~aminalJon of the nasopharyns by an otorhinolaryngologist revealed no abnormality and the computed tomography of nasopharynx were normal Because there is no standart chemotherapy t]'eatment, we administered vlnorolblno and clsplat]n combined chemotherapy. They were good response and good prognosis. They have been followed for fourty and fifteen months with stable disease, respectTvoly
Small cell lung cancer ]
ClsplaUn and etoposlde followed by concurrent chemo-radlaUon therapy for limited small cell lung cancer (SCLC-LD). The experience of two Italian InsUtutlons
G. Benedett] 1, S. Tamderl ~, M. Fedele~ , F. Rastelli ~, F. saivi 2, G. Frezza 2, L. Crlnb ~. 1Medical Oncology "Bellana" Hospital, Bologna, Italy, 2Radiation
Therapy "Bella#a* Hospital, Bologna, Italy, 3Medical Oncology Faenza Hospital (Fodl) Italy, Bologna, Italy Background: Small cell lung cancer (SOLO) is a chemorosponslve tumor but overall survlval remains poor even in limited clsease (LD). Cisplatin and etoposide (PE) is now considered the standard regimen to be administered concurrently with thoracic raclafion therapy With the aim of deLxJIking the initial tumor volume and thus reducing toxicity of raclalJon therapy, we investigated a sequenlJal approach of induction chemotherapy based on PE regimen followed by the same chemotherapy (PE) and concurrent thoracic irraclation (TI) in SCLC-LD patients Patients and methods: From July 2000 to September 2004 twenty4hree consecutive SCLC-LD palJents were enrolled and tTeated in our Ins~ution Treatment consisted of two cycles of c~splat]n 80 mg/mq day 1 plus etopos~de 120 mg/mq days 1 to 3. repeated every three weeks. After tumor response assessment, the TI was concurrently administered to the third course of PE at the dose of 45 Gy by 25 fractions. Six cycles of PE were totally administered. The prophylactic cranial irradiation (PCl) was provided for patients with complete remission of the disease. Results: Twenty three patients completed the cherno raclat]on therapy program The response at the neoadjuvant PE chemotherapy was obtained in 16 out of 23 valuable palJents with 1 complete remission (CR). while ,5 palJents had a stable disease (SD) The evaluation of the cJsease at the end of chemoraclalJon therapy show that 17" out of 21 palJents (81%) responded at the tTeatroent with lb CR. 3 partial remission (PR) One pafients has SD and two patients have progression of the disease (PD) Median progression free survival (PFS) and overall survival (OS) refer to eighteen valuable pafients with 9.5 months and 17.5 months respectively. 1y e a r or 2 year overall survival were 67% and 28% respectively. Five patients are in continuous complete remission at 15+ to 49+ months. Texiclty were mild consisting mainly in grade II esophag~]s and grade 2 myelosppression. In no case the concomitant Izeatment was interrupted