Randomized Phase III Trial of Pemetrexed Versus Docetaxel in Patients With Non-Small-Cell Lung Cancer Previously Treated With Chemotherapy.

PURPOSE: To compare the efficacy and toxicity of pemetrexed versus docetaxel in patients with advanced non-small-cell lung cancer (NSCLC) previously treated with chemotherapy. PATIENTS AND METHODS: Eligible patients had a performance status 0 to 2, previous treatment with one prior chemotherapy regimen for advanced NSCLC, and adequate organ function. Patients received pemetrexed 500 mg/m2 intravenously (IV) day 1 with vitamin B12, folic acid, and dexamethasone or docetaxel 75 mg/m2 IV day 1 with dexamethasone every 21 days. The primary end point was overall survival. RESULTS: Five hundred seventy-one patients were randomly assigned. Overall response rates were 9.1% and 8.8% (analysis of variance P = .105) for pemetrexed and docetaxel, respectively. Median progression-free survival was 2.9 months for each arm, and median survival time was 8.3 versus 7.9 months (P = not significant) for pemetrexed and docetaxel, respectively. The 1-year survival rate for each arm was 29.7%. Patients receiving docetaxel were more likely to have grade 3 or 4 neutropenia (40.2% v 5.3%; P < .001), febrile neutropenia (12.7% v 1.9%; P < .001), neutropenia with infections (3.3% v 0.0%; P = .004), hospitalizations for neutropenic fever (13.4% v 1.5%; P < .001), hospitalizations due to other drug related adverse events (10.5% v 6.4%; P = .092), use of granulocyte colony-stimulating factor support (19.2% v 2.6%, P < .001) and all grade alopecia (37.7% v 6.4%; P < .001) compared with patients receiving pemetrexed. CONCLUSION: Treatment with pemetrexed resulted in clinically equivalent efficacy outcomes, but with significantly fewer side effects compared with docetaxel in the second-line treatment of patients with advanced NSCLC and should be considered a standard treatment option for second-line NSCLC when available.

Large-Scale Plasma Proteome Epitome Profiling is an Efficient Tool for the Discovery of Cancer Biomarkers.

Current proteomic technologies focus on the quantification of protein levels, while little effort is dedicated to the development of system approaches to simultaneously monitor proteome variability and abundance. Protein variants may display different immunogenic epitopes detectable by monoclonal antibodies. Epitope variability results from alternative splicing, posttranslational modifications, processing, degradation, and complex formation and possesses dynamically changing availability of interacting surface structures that frequently serve as reachable epitopes and often carry different functions. Thus, it is highly likely that the presence of some of the accessible epitopes correlates with function under physiological and pathological conditions. To enable the exploration of the impact of protein variation on the immunogenic epitome first, here, we present a robust and analytically validated PEP technology for characterizing immunogenic epitopes of the plasma. To this end, we prepared mAb libraries directed against the normalized human plasma proteome as a complex natural immunogen. Antibody producing hybridomas were selected and cloned. Monoclonal antibodies react with single epitopes, thus profiling with the libraries is expected to profile many epitopes which we define by the mimotopes, as we present here. Screening blood plasma samples from control subjects (n = 558) and cancer patients (n = 598) for merely 69 native epitopes displayed by 20 abundant plasma proteins resulted in distinct cancer-specific epitope panels that showed high accuracy (AUC 0.826-0.966) and specificity for lung, breast, and colon cancer. Deeper profiling (≈290 epitopes of approximately 100 proteins) showed unexpected granularity of the epitope-level expression data and detected neutral and lung cancer-associated epitopes of individual proteins. Biomarker epitope panels selected from a pool of 21 epitopes of 12 proteins were validated in independent clinical cohorts. The results demonstrate the value of PEP as a rich and thus far unexplored source of protein biomarkers with diagnostic potential.

OVERVIEW OF A DIGITAL TOMOSYNTHESIS DEVELOPMENT: NEW APPROACHES FOR LOW-DOSE CHEST IMAGING.

Lung cancer has the highest mortality rate among all cancer types, and it has especially high occurrence in Hungary. Low-dose computed tomography (LDCT) has been proved to be a beneficial screening method for lung cancer, decreasing the mortality rate by 20 %. Because of the intensifying fears from X-ray radiation, there is a need to develop other modalities that might work with less radiation and have similar sensitivity in lung nodule finding. Digital tomosynthesis (DTS) may be such a modality that can be a real alternative to LDCT. The goal of this article is to summarise the first results of a Hungarian project for developing a DTS system extended with a computer-aided detection system. It describes the main approaches applied and the main benefits of using DTS based on the first clinical examinations.

Tumor cell expression of heat shock protein (HSP) 72 is influenced by HSP72 [HSPA1B A(1267)G] polymorphism and predicts survival in small Cell lung cancer (SCLC) patients.

The inducible heat shock protein (HSP)72 plays a central role in antitumor immunomodulation. HSP72 expression was assessed on tumor samples of 43 patients with advanced and metastatic small cell lung cancer (SCLC) by immunohistochemistry and HSP72 [HSPA1B A(1267)G] polymorphism was determined. HSP72 expression of SCLC cells was significantly decreased in GG as compared to cells of AA or AG genotype patients, and was associated with significantly shorter survival in GG patients as compared to carriers of the A allele. Decreased HSP72 expression of SCLC cells associated with HSP72 GG genotype is a negative prognostic factor for survival in SCLC patients.

[Incidence, risk factors and prevention of cisplatin-induced nephrotoxicity in patients with lung cancer]. / A cisplatin okozta nefrotoxicitás elofordulása, kockázati tényezoi és megelozése tüdokarcinómás betegekben.

High-dose (75 mg/m2) cisplatin is baseline chemotherapy in lung cancer. To prevent nephrotoxicity, patients generally receive saline infusion on the day of chemotherapy prior to and following cisplatin (total of 3.5-4.0 liters during 3-4 hours). Despite these measures nephrotoxicity has remained frequent, especially among patients also suffering from cardiovascular disease or diabetes mellitus. Since 2005 several international recommendations have been formed about prevention of cisplatin nephrotoxicity. According to these recommendations: 1) renal function should not be evaluated by serum creatinine concentration; 2) evaluation of renal function should be based on calculated creatinine clearance (e.g. by the Cockcroft-Gault equation); 3) patients to be treated by high-dose cisplatin should be euvolemic and should have saline diuresis (urine NaCl concentration ~1%) of at least 100 ml/hour prior to, during and several days following the administration of cisplatin. Keeping these recommendations ensures prolonged cisplatin treatability of lung cancer patients. Moreover, decreased renal function will not limit the full dose administration of several other cytotoxic agents. Losonczy G, Máthé C, Müller V, Szondy K, Moldvay J. Incidence, risk factors and prevention of cisplatin-induced nephrotoxicity in patients with lung cancer.

Epidermal growth factor receptor (EGFR) high gene copy number and activating mutations in lung adenocarcinomas are not consistently accompanied by positivity for EGFR protein by standard immunohistochemistry.

The purpose of this study was to investigate whether detectable protein biomarker overexpression is a prerequisite for the presence of increased gene copy number or activating mutations and responsiveness to the epidermal growth factor receptor (EGFR) inhibitors gefitinib and erlotinib in patients with lung adenocarcinomas. EGFR status was prospectively analyzed in tumor biopsy samples by three methods: protein expression (n = 117) by standardized immunohistochemistry (IHC), gene copy number (n = 97) by fluorescent in situ hybridization (FISH), and mutation analysis by sequencing (n = 126). Fifty-nine percent of the samples were positive by IHC, 40% were positive by FISH, and 13.5% contained activating kinase domain mutations. Thirty-four percent of the FISH-positive and 27% of the mutant samples were also IHC-negative. All EGFR mutant patients had major clinical responses (five complete response and five partial response) to gefitinib or erlotinib treatment, although three of these tumors were IHC-negative and four were FISH-negative. In a retrospective analysis of samples from nine patients with excellent therapeutic responses (three complete response, five partial response, one stable disease) to erlotinib or gefitinib, mutations were identified in eight cases, but IHC was negative in four of these tumors. These results indicate that molecular diagnostic methods appear to be most important for the identification of lung adenocarcinoma patients who may benefit from EGFR inhibitor treatments.

[The role of adjuvant chemotherapy in the treatment of non-small cell lung cancer]. / Az adjuváns kemoterápia helye a nem kissejtes tüdorák kezelésében.

UNLABELLED: Postoperative treatments for lung cancer have been evaluated for more than two decades, but in the majority of the studies (especially until 1990) no significant effect on survival has been shown. In 1995, a meta-analysis of eight cisplatin-based adjuvant chemotherapy trials with NSCLC showed a 13% reduction in the risk of death (P=0.08) and 5% benefit in 5-year survival. Among four positive trials (IALT, JBR10, ANITA and CALGB study) the absolute increase in the 5-year survival rates by adjuvant chemotherapy ranged from 4% to 15%, and the hazard ratios for death ranged from 0.6 to 0.86. The author analyzes the most important studies. CONCLUSION: adjuvant chemotherapy after complete resection of NSCLC can be considered as a new standard of care in patients with good performance status. Patients should receive 4 cycles of platina-based chemotherapy beginning 4-8 weeks after surgery. FUTURE PERSPECTIVES: optimization of chemotherapy regimens including targeted therapy (such as EGFR inhibitors, angiogenesis inhibitors, anti-EGFR monoclonal antibodies). Further progress is anticipated through the integration of chemopreventive agents into the adjuvant treatment.

Inhibition of EGFR tyrosine-kinase in NSCLC treatment: the Hungarian experience with gefitinib in the context of an expanded access programme.

The ZD1839 (Iressa, gefitinib) treatment in phase I trials for patients with advanced non-small cell lung cancer (NSCLC) was associated with disease stabilization and tumor regression. The aim of this study was to analyze the efficacy of gefitinib monotherapy as a second- or third-line treatment for locally-advanced and advanced NSCLC. Data for 50 patients were analyzed. Patients were treated at 5 centers in Hungary as part of the gefitinib Expanded Access Programme (EAP). The response rate was 10% (all partial responses), with disease stabilization in 46% of patients. Disease progression was observed in 44% of patients. The median survival according to the Kaplan-Meier method was 8 months. Median survival of patients with adenocarcinoma was significantly increased compared with squamous cell carcinoma and, of the patients responding to therapy, 80% had adenocarcinoma. The 1-year survival rate was 34%. All patients were evaluable for safety; the adverse events seen with gefitinib were generally mild and only two patients had to be withdrawn from the study due to adverse events. The Hungarian experience suggests gefitinib therapy is effective and well tolerated.

[New therapies for non-small cell lung cancer]. / Uj terápiás lehetoségek a nem kissejtes tüdorák kezelésében.

Lung cancer is one of the most frequent causes of death from cancer. Non-small cell lung cancer represents approximately 80% of the total pulmonary malignancies. Unfortunately, most non-small cell lung cancer patients present advanced disease at diagnosis and a very poor prognosis. Despite advances in our understanding of the molecular and genetic basis of non-small cell lung cancer, and improvement in therapy with surgery, conventional chemotherapy, and radiation, 5-year survival for patients with this diagnosis remains poor and the disease remains a clinical challenge. However, strategies of molecular based therapies are in development and it is hoped that these new approaches will continue to improve survival for patients with advanced lung cancer. Any categorization of these drugs is hard, with overlap in several features. The main investigated agents are epidermal growth factor receptor (EGFR) family inhibitors, angiogenesis inhibitors and antivascular drugs, signal transduction inhibitors, apoptosis inducers, eicosanoid pathway inhibitors and immunotherapeutic drugs. To date, few of these new drugs can offer trust of a substantial influence on the natural history of non-small cell lung cancer, and disappointing results are more commonly reported than encouraging ones. Nevertheless, tailored treatment for non-small cell lung cancer patients may represent a further chance of tumor control and symptom palliation. This review presents an overview of molecular targeted therapy in non-small cell lung cancer.

Efficacy of gemcitabine--cisplatin treatment in stage IIIA ("bulky"N2), IIIB and IV non-small cell lung cancer.

UNLABELLED: The objective of the study was to assess the efficacy of a gemcitabine and cisplatin combination for patients with stage IIIA"bulky"N2, IIIB or IV non-small cell lung cancer(NSCLC). PATIENTS AND METHODS: Patients with histological and/or cytological diagnosis of NSCLC were administered gemcitabine 1250 mg/m2 on days 1 and 8, and cisplatin 70 mg/m2 on day 1, every 3 weeks. RESULTS: One hundred and twenty patients with NSCLC, with median age of 53 years, and a WHO performance status of 0 (26%) or 1 (74%), were evaluated. The overall response rate was 40.0% with 37.5% partial response (PR) and 2.5% complete response (CR). Also, 38% of the patients had either minimal response (MR) or stable disease (SD). The median survival was 54.9 weeks. The time to progression was 28.1 weeks. There was no treatment-related death in this series. CTC grade 3/4 neutropenia occurred in 4.4% of the patients, while febrile neutropenia developed in 0,9% of the patients. CTC grade 4 thrombocytopenia occurred in 2.2%, and CTC grade 3/4 anemia developed in 3.3%. CONCLUSION: Our results support that gemcitabine and cisplatin administered as a 3-week cycle is an effective and safe regimen for the treatment of locally advanced or metastatic NSCLC.

Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy.

PURPOSE: To compare the efficacy and toxicity of pemetrexed versus docetaxel in patients with advanced non-small-cell lung cancer (NSCLC) previously treated with chemotherapy. PATIENTS AND METHODS: Eligible patients had a performance status 0 to 2, previous treatment with one prior chemotherapy regimen for advanced NSCLC, and adequate organ function. Patients received pemetrexed 500 mg/m(2) intravenously (i.v.) day 1 with vitamin B(12), folic acid, and dexamethasone or docetaxel 75 mg/m(2) i.v. day 1 with dexamethasone every 21 days. The primary end point was overall survival. RESULTS: Five hundred seventy-one patients were randomly assigned. Overall response rates were 9.1% and 8.8% (analysis of variance P =.105) for pemetrexed and docetaxel, respectively. Median progression-free survival was 2.9 months for each arm, and median survival time was 8.3 versus 7.9 months (P = not significant) for pemetrexed and docetaxel, respectively. The 1-year survival rate for each arm was 29.7%. Patients receiving docetaxel were more likely to have grade 3 or 4 neutropenia (40.2% v 5.3%; P <.001), febrile neutropenia (12.7% v 1.9%; P <.001), neutropenia with infections (3.3% v 0.0%; P =.004), hospitalizations for neutropenic fever (13.4% v 1.5%; P <.001), hospitalizations due to other drug related adverse events (10.5% v 6.4%; P =.092), use of granulocyte colony-stimulating factor support (19.2% v 2.6%, P <.001) and all grade alopecia (37.7% v 6.4%; P <.001) compared with patients receiving pemetrexed. CONCLUSION: Treatment with pemetrexed resulted in clinically equivalent efficacy outcomes, but with significantly fewer side effects compared with docetaxel in the second-line treatment of patients with advanced NSCLC and should be considered a standard treatment option for second-line NSCLC when available.

[Effectiveness of Gemzar-Cisplatin therapy in stage IIIA-N2, IIIB and IV non-small cell lung cancer]. / A Gemzar+Cisplatin kezelés hatékonysága a nem kissejtes tüdôrák IIIA-N2, IIIB és IV-es stádiumában.

UNLABELLED: 120 chemotherapy naive patients were treated with gemcitabine 1250 mg/m2 iv. days 1 and 8 and cisplatin 70 mg/m2 iv. on day 1 between May 1999 and June 2001. The treatments were administered in 21 cycles. The median age of the patients was 53.1 years, the male/female ratio 65%-35%. Performance status was: WHO 0: 26%, WHO 1: 74%. The staging of patients were: IIIA-N2 23%, IIIB 37%, IV 40%. By histology the tumors were: 53.3% adenocarcinoma, 40% squamous cell carcinoma, 2.5% adenosquamous carcinoma, 0.8% macrocellular carcinoma and 3% non-small cell carcinoma (not categorised). We evaluated 413 cycles of chemotherapy. The median number of cycles was 3.44. The primary endpoint of the study was the median survival and time to progression, and the response rate. The results are the following: RR 40% (PR 37.5%, CR 2.5%), MR 13.3%, SD 25%, PD 22%. The time to progression (TTP) in the SD+MR group: 29.8 weeks, in the RR group: 34.1 weeks, mean of all patients: 28.1 weeks. The survival time was estimated by Kaplan-Meier curves. The median survival (MS) of all treated patients was: 54.9 weeks, in the PD group: 34.4 weeks, in the SD+MR group: 59.1 weeks, in the PR+CR group: 62.1 weeks. CONCLUSION: gemcitabine and cisplatin combination is a very well tolerated therapeutic regimen in the 1st line treatment of NSCLC. Furthermore, this treatment improves the RR and the survival of the patients as well.

[Chemotherapy of small cell lung cancer] / A kissejtes tüdôrák kemoterápiája.

The author summarizes the most recent information on small cell lung cancer. Reviews the epidemiology, prognostic markers and stages of small cell lung cancer Details the more frequently used combined therapeutic modalities, the criteria of the optimal therapeutic approaches and the achieved remission rates. Based on the most recent data, summarizes the new chemotherapeutic agents and their most effective combinations, the second line treatment and immunotherapy. Finally tries to answer the most frequently asked questions.