Hyponatremia as prognostic factor in small cell lung cancer--a retrospective single institution analysis.

PURPOSE: The aim of this retrospective study is to present data on clinical significance of hyponatremia in an unselected contemporary patient population with small cell lung cancer (SCLC) with limited disease (LD) and extensive disease (ED). PATIENTS AND METHODS: Our electronic database was searched for patients with newly diagnosed SCLC from June 2004 to December 2008. 395 cases were identified. We collected data on patient characteristics including clinical performance status, serum sodium values, serum LDH values, metastatic sites, chemotherapy regimens and response, radiotherapy and survival. RESULTS: Hyponatremia (sodium <135 mmol/l) was present in 18.9% of all cases. Severe hyponatremia (sodium <129 mmol/l) was detected in 8.8%. Hyponatremia was present in 58 out of 241 (24%) patients with ED SCLC and 17 of 154 (11%) patients with LD SCLC. Hyponatremia was associated with significantly shorter median survival (SCLC all patients: 9.0 vs. 13.0 months, p < 0.001, LD SCLC: 9.0 vs. 17.0, p = 0.050, ED SCLC 9.0 vs. 10.0, p = 0.135). After adjustment for age, gender, LDH and performance status hyponatremia was an independent predictor of mortality in patients with ED and LD SCLC. CONCLUSION: According to the extensive statistical analyses in our comprehensive unselected patient population, hyponatremia seems to constitute an independent prognostic factor in patients with SCLC.

Efficacy and safety of bronchoscopic laser therapy in patients with tracheal and bronchial obstruction: a retrospective single institution report.

PURPOSE: The aim of this retrospective study is to present data efficacy and safety of bronchoscopic laser therapy in patients with tracheal and bronchial obstruction. PATIENTS AND METHODS: From February 2004 to April 2010, our electronic database was searched for all patients who had undergone bronchoscopic laser therapy. We collected data on age, gender, performance status, diagnosis leading to bronchoscopic laser treatment, number of procedures per patient, efficacy by means of extend of recanalisation and symptom improvement, additional interventions and procedure-related complications. RESULTS: Two hundred fifty-six procedures were performed in 121 patients. 17% of obstructions were localised in the trachea, 57% in main bronchi and 26% in lobar bronchi including right intermedius bronchus. The sum of complete and partial recanalisation reached 95%, 80% and 68%, respectively. 26% of interventions in lobar bronchi were undertaken to treat haemoptysis which could be controlled in all cases. Moderate bleeding occurred in 6%; severe bleeding in 1%. Cardiac arrhythmias were seen in 2%. We observed one treatment-related death (overall mortality 0.4%). CONCLUSION: Bronchoscopic laser therapy is a generally safe and effective method to regain airway patency in cases with tracheal or bronchial obstruction and to treat haemoptysis. We observed clinical improvement in terms of reduced dyspnea or controlled haemoptysis in 93% of our patients.

Characteristics, treatment patterns and outcomes of patients with small cell lung cancer--a retrospective single institution analysis.

PURPOSE: The aim of this retrospective study is to present data on patient characteristics, treatment patterns, and treatment results in an unselected contemporary patient population with small cell lung cancer (SCLC) in limited disease (LD) and extensive disease stage (ED). PATIENTS AND METHODS: From June 2004 to December 2008, our electronic database including all in-patient and out-patient contacts was searched for patients with newly diagnosed lung cancer. 397 patients were found having SCLC. We collected data on patient characteristics, chemotherapy, side effects, response on treatment and survival. RESULTS: 39% of all patients had LD SCLC. Median age was 63 years. The response rate (RR) reached 76%. Stable disease was the result of first line therapy in 16%. Consecutive thoracic radiotherapy was given in 72%. Additional prophylactic cranial irradiation (PCI) was administered to 33%. 43% received second line therapy. Median survival was 18.8 months. In 61% of cases, ED SCLC was diagnosed. Median age was 61 years. Main metastatic sites were liver, bone, brain and adrenal glands. RR was 69%. Stable disease and progressive disease were the result of first line chemotherapy both in 12%. 15% received palliative cranial irradiation, 3% PCI. 51% were treated with second line therapy. Median survival reached 10.6 months. CONCLUSION: We provide a comprehensive analysis of a contemporary patient population. Treatment patterns and survival data fit well in the context of current international trials on more selected patients. Multivariate analyses confirmed extend of disease, performance status and LDH serum levels as independent prognostic factors for survival. Age and gender reached no statistical significance.

Tissue sampling in lung cancer: a review in light of the MERIT experience.

Lung cancer continues to present an enormous global burden of morbidity and mortality, despite an increasing therapeutic armamentarium of chemotherapy and targeted agents. Recent research efforts have been directed towards identifying predictors of response to treatment, in order to facilitate the selection of patients likely to obtain the greatest benefit from specific therapeutic interventions, with the ultimate goal of providing customized therapy. A strong scientific basis exists for the use of markers to identify patients who are most likely to respond to biological and targeted therapies, based on characteristics such as tumour genotype and histology. Biomarkers have the potential to aid in patient stratification (risk assessment), treatment-response identification (surrogate markers), or differential diagnosis (identifying individuals who are likely to respond well to specific therapies). Numerous trials have demonstrated correlations between molecular biomarkers and the outcome of treatment with targeted therapies such as epidermal growth factor inhibitor tyrosine-kinase inhibitors in patients with non-small-cell lung cancer (NSCLC). The recently completed MarkER Identification Trial (MERIT) found some evidence of a link between the molecular profile of a tumour and the clinical response to erlotinib in patients with relapsed NSCLC. However, MERIT also highlighted the difficulties in obtaining adequate samples for the various procedures involved in genetic analyses in clinical trials. Routine clinical practice brings its own challenges relating to biopsy techniques and tissue availability and this has implications for the application of molecular analyses in treatment decision-making. Applying the lessons learned from tissue sampling and molecular testing in MERIT and other major NSCLC trials will be essential in paving the way for the routine use of biomarker analyses in clinical practice.

Lactate dehydrogenase as prognostic factor in limited and extensive disease stage small cell lung cancer - a retrospective single institution analysis.

PURPOSE: The aim of this retrospective study is to present data on clinical significance of lactate dehydrogenase (LDH) serum levels in an unselected contemporary patient population with small cell lung cancer (SCLC) in limited disease (LD) and extensive disease stage (ED). PATIENTS AND METHODS: From June 2004 to June 2008, our electronic database including all in-patient and out-patient contacts was searched for patients with newly diagnosed LD and ED SCLC. 397 cases were identified. We collected data on patient characteristics including clinical performance status and LDH serum levels, metastatic sites, efficacy of first line chemotherapy and survival. RESULTS: In both limited and extensive disease SCLC, elevated LDH serum levels resulted in significantly shorter median survival. The effect was most pronounced if levels were 300 U/l or higher. In patients with limited disease and normal LDH levels, median survival was 18.0 months. If LDH was higher than 300 U/l, overall survival was reduced to 12 months. In cases with extensive disease, overall survival was significantly lower in patients with elevated LDH serum levels with an additional reduction in overall survival in patients with LDH levels above 300 U/l. (7.0 vs. 12.0 months, p = <0.001). Multivariate Cox regression analyses revealed LDH levels to be an independent predictor of mortality after adjustment for age and Performance Status in LD and ED SCLC (HR 1.003, p = 0.017; HR 1.001, p = 0.002 respectively). However, categorizing LDH levels revealed no significant difference in LD SCLC. CONCLUSION: In our contemporary comprehensive patient population, LDH is proved to be a strong, independent predictive factor of median survival in patients with LD and ED SCLC.

Irinotecan plus carboplatin versus oral etoposide plus carboplatin in extensive small-cell lung cancer: a randomized phase III trial.

PURPOSE: A Japanese randomized trial showed superior survival for patients with extensive-disease (ED) small-cell lung cancer (SCLC) receiving irinotecan plus cisplatin compared with etoposide plus cisplatin. The present trial evaluated the efficacy of irinotecan plus carboplatin (IC) compared with oral etoposide plus carboplatin (EC). PATIENTS AND METHODS: Patients with ED SCLC were randomly assigned to receive either IC, which consisted of carboplatin (area under the curve = 4; Chatelut formula) and irinotecan (175 mg/m2) intravenously both on day 1, or EC, which consisted of carboplatin as in IC and etoposide (120 mg/m(2)/d) orally on days 1 through 5. Courses were repeated every 3 weeks with four cycles planned. Doses were reduced by one third in patients with a WHO performance status (PS) of 3 to 4 and/or age older than 70 years. Primary end point was overall survival (OS). Secondary end points were quality of life (QOL) and complete response (CR) rate. RESULTS: Of 220 randomly assigned patients, 209 were eligible for analysis (IC, n = 105; EC, n = 104). Thirty-five percent were older than 70 years, and 47% had a PS of 2 to 4. The groups were well balanced with respect to prognostic factors. OS was inferior in the EC group (hazard ratio = 1.41; 95% CI, 1.06 to 1.87; P = .02). Median survival time was 8.5 months for IC compared with 7.1 months for EC. One-year survival rate was 34% for IC and 24% for EC. CR was seen in 18 IC patients compared with seven EC patients (P = .02). There were no statistically significant differences in hematologic grade 3 or 4 toxicity. Grade 3 or 4 diarrhea was more common in the IC group. QOL differences were small, with a trend toward prolonged palliation with the IC regimen. CONCLUSION: IC prolongs survival in ED SCLC with slightly better scores for QOL.