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Sep 18, Further improvements in the treatment of NSCLC can only be achieved with continued development of novel targeted approaches and correlative science studies that will help select proper patients for various treatment strategies.
Efficacy of various doublet chemotherapy combinations. In recent years, several randomized trials comparing various doublet chemotherapy combinations have determined that efficacy is similar between most of the regimens Table 1.
Results indicate that chemotherapy doublets should not be withheld in elderly patients solely on the basis of age. Age-specific analyses demonstrate that older patients do demonstrate modest increases in toxicity, but efficacy benefit was independent of age.
Patients on the DC arm who were 65 years or older had a median survival of Survival results for the DCb group were similar to those observed with VC median survival, 9. There was a moderately higher incidence of grade asthenia, infection and pulmonary toxicities across all three treatment arms in the elderly subgroup. Doublet versus Single-agent Chemotherapy. Data on patients was presented at the meeting. Doublet Versus Triplet Combinations.
Although three-drug combinations have been evaluated for NSCLC therapy with the intention of improving upon the benefits seen with doublet combinations, results continue to indicate that the therapeutic index of doublet chemotherapy combinations is superior to triplet combinations. Non-platin Combinations. In order to reduce the toxicity associated with the platinum compounds, non-platinum doublets have been evaluated for the treatment of advanced NSCLC. When the study matures, it will be interesting to see whether there is a difference in efficacy amongst various sub-histologies of NSCLC.
Optimization of chemotherapy schedules. Efficacy was also comparable between the treatment arms. Similar observations were made by Dr. Masters in their prospective randomized phase II study that utilized the same schedules as in Dr. Three weekly day regimens are more commonly used in practice. A long-held pursuit of researchers has been the identification of molecular targets that are unique to cancer cells.
Such targets provide the framework for development of therapies that are specific to cancer cells and nontoxic to the normal cell. Several molecularly targeted therapies are currently in various phases of development. There were 6 partial responses and 5 patients had stable disease. One patient had a complete response in the brain. Miller and colleagues. Two other clinical trials that have combined chemotherapy with erlotinib have been completed and the results are awaited.
Erlotinib has also been compared to best supportive care in patients who failed prior chemotherapy regimens and the study is currently being analyzed. From these studies, it is evident that there are sub-groups of patients that benefit from therapy with EGFR inhibitors more than others and it will be important to identify these patients prior to treatment. Cetuximab : Cetuximab Erbitux, C is a chimeric monoclonal antibody that inhibits the ligand-induced tyrosine kinase-dependent phosphorylation and downstream signaling of the EGFR.
Robert reported that median survival was days and median time to progression was days. The salient toxicities included skin rash, leucopenia, and infection. The data from Dr. It will be interesting to see whether there are differences in efficacy between the small molecule EGFR tyrosine kinase inhibitors and monoclonal antibodies directed against the EFGR ligand. Antisense Agents : Antisense technology is based on sequence-specific binding of antisense oligonucleotide single stranded DNA molecules to target mRNA, leading to modulation of splicing and prevention of gene translation.
The effect is highly selective, allowing for complete sparing of normal cells, thus avoiding adverse effects. Unfortunately, results from a randomized study presented by Dr. The median survival was 9. While the development of newer cytotoxic agents has widened treatment options, it appears that we have reached a chemotherapy efficacy plateau in the treatment of advanced NSCLC.
Platinum-based doublet chemotherapy will continue to be the standard of care in the treatment of advanced NSCLC. While comparable efficacy was reported between platinum and non-platin doublets, platinum-based doublets are more effective than single agent or triplet combinations. Determining the efficacy of targeted approaches and identifying the appropriate methods of incorporating them into existing treatment paradigms remains a challenge for future research.
We should probably look carefully at patient selection when we use these targeted agents. Correlative science studies will be of immense importance in guiding treatment with these selective agents and in making sense from antisense strategies. Understand the role of precision cancer medicine, surgery, chemotherapy and radiation in the management of NSCLC. Jul 18, Lung Cancer; Risk factors, diagnostic evaluation, staging and treatment planning. Jan 27, Apr 7, Keep up with the growing number of precision medicines targeting specific mutations in lung cancer.
Dec 15, Jun 3, May 31, Alcensa, Xalkori, and several other precision cancer medicines target ALK positive lung cancer and improve treatment. May 22, May 19, May 21, Tagrisso resistance mutation recently identified. Mar 2, Apr 16, May 24, Top Stories. Cancer Connect Sep 18, Lung Cancer. Cancer Connect Jul 18, Overview of Lung Cancer.
Cancer Connect Jan 27, Ask Dr. TraceyS Apr 7, MedMaven Dec 15, Cancer Connect Jun 3, MedMaven May 31, Cancer Connect May 22, Cancer Connect May 19, Cancer Connect Mar 2, Cancer Connect Apr 16,
Advanced (NSCLC): Implications from Recent Trials
Elderly-Specific Trials. Patients With PS 2. Please enter valid email address. Login Register. December November
Study record managers: refer to the Data Element Definitions if submitting registration or results information. This is a Phase III, open label, randomized study to enroll patients with advanced in a ratio at the time of registration. For the purpose of the study, treatment Arm A or Arm B will consist of up to four cycles of therapy repeated every 21 days. Primary endpoint of the study is overall survival; secondary endpoints include toxicity, response rate, and progression-free survival.