Chemotherapy vs supportive care in advanced non-small-cell lung cancer. Results of a meta-analysis of the literature.

STUDY OBJECTIVE: To contribute to the current debate about the relative merits of meta-analysis of the literature (MAL) and of individual patients data (MAP). DESIGN: Identification of published randomized trials and extraction of essential results directly from the published reports. SETTING: Chemotherapy vs supportive care in advanced non-small-cell lung cancer. MEASUREMENTS AND RESULTS: Survival probability at 6 months after randomization, as estimated from the published survival curves, has been considered as the end-point of interest. Quality scoring of the studies has also been performed. Specific methodologic issues concerning the estimation of relevant quantities necessary for the MAL have been addressed. The estimated pooled odds ratio of death was 0.44, with 95 percent confidence interval of 0.32 to 0.59, thus significantly favoring chemotherapy, and it corresponds to an estimated increase in median survival from 3.9 months for best supportive care to 6.7 for chemotherapy. CONCLUSIONS: The results of our MAL, favoring chemotherapy, are in line with those of a MAP recently published. However, they have to be considered in the light of their actual clinical relevance and of the balance between quality of life, toxicity, and costs of chemotherapy and best supportive care.

Soluble interleukin 2 receptor in lung cancer. An indirect marker of tumor activity?

Circulating levels of the soluble interleukin 2 receptor (sIL-2R) could provide an in vivo measure of the immunologic response to human tumors. We performed a total of 326 sIL-2R serum assays in 126 patients with lung cancer (67 at diagnosis, 59 during and after treatment), 112 patients with pulmonary benign diseases, and 63 voluntary healthy subjects. Patients with lung cancer had a median value of sIL-2R of 791 U/ml, which was superior to that of both controls (398 U/ml, p less than 0.001) and patients with noninflammatory benign diseases (583 U/ml, p less than 0.02). However, infectious pulmonary disorders, such as tuberculosis and pneumonia, were associated with the highest values of the substance (median, 1150 U/ml; p less than 0.001). At the diagnosis of lung cancer, sIL-2R correlated neither with the stage of disease nor with the cell type. On the contrary, posttreatment levels of the receptor were significantly related to disease status (RO = .41, p less than 0.002), particularly in the subgroup of nonsurgical patients (RO = .48, p less than 0.001). Patients with abnormal sIL-2R levels had a nearly significant reduction in survival as compared with patients with normal values (p less than 0.1). Measurements of sIL-2R could be useful in monitoring patients under treatment for bronchogenic carcinoma, as well as in prognostication. In this setting, sIL-2R might open a new class of biologic markers, providing information that is complementary to those of the more classic tumor-derived markers.

Single-agent chemotherapy versus combination chemotherapy in advanced non-small cell lung cancer: a quality and meta-analysis study.

STUDY OBJECTIVE: To estimate the quality of the studies and to compare single-agent with combination chemotherapy in advanced non-small cell lung cancer. DESIGN: Identification of published randomized trials and extraction of essential results directly from the published reports. MEASUREMENTS AND RESULTS: Survival probability at 1 year, as estimated from the published survival curves, has been considered as the end-point of interest. Quality scoring of the studies has also been performed. Arithmetical calculation, concerning the estimation of quantities necessary for the meta-analysis of the literature, has been addressed. The estimated pooled Odds Ratio of death was 0.8, with 95% confidence interval of 0.6-1.0, thus favoring combination chemotherapy. CONCLUSIONS: The results of our meta-analysis favor combination chemotherapy. They must, however, be considered in the light of their clinical relevance and of the balance between quality of life, toxicity and costs of chemotherapy.

[The interleukin-2 receptor]. / Il recettore dell'interleukina-2.

The interleukins comprise a class of hormones that have a definite known secondary and tertiary structure under physiologic conditions. The interleukin-2 is the leader in T cell differentiation. The interleukin-2 acts via interaction with high affinity, cell bound receptors (IL-2R). High affinity IL-2 receptors are constructed by cooperative binding of IL-2 to both the low affinity (55-Kd chain) and intermediate affinity (75-Kd chain) binding sites. The light (55-Kd) chain of these heterodimeric receptors is identified by monoclonal antibodies as TAC antigen. A soluble form of these receptors is released in the serum and it can be assayed by ELISA. Extraordinarily high levels of IL-2R are characteristic of hairy cell leukaemia. Smaller increases of IL-2R have been reported in other haematological conditions as well as in other disorders including AIDS, organ transplantation etc. Moreover, we have recently demonstrated that IL-2R is elevated in lung cancer.

Biomarkers and IL-2R in lung cancer.

A study of TPA, CEA and IL-2R serum levels was conducted in patients untreated with various histological types of bronchial carcinoma. A total of 43 subjects were evaluated. We have observed a significant correlation between serum levels and stage of the disease for both CEA and TPA markers, whereas for IL-2R an increase was shown for the all patients not correlated with stage.

Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages IIIa and IIIb nonsmall cell lung cancer. A meta-analysis.

BACKGROUND: For patients with Stage III nonsmall cell lung cancer (NSCLC), radiation is the standard treatment, but survival remains poor. The authors performed a meta-analysis study using clinical trials that evaluated combined radiotherapy plus chemotherapy versus radiotherapy alone in patients with Stages IIIa and IIIb NSCLC: METHODS: For the meta-analysis study and the point estimates, essential data were extracted directly from published reports. RESULTS: Survival probabilities at 1, 2, 3, and 5 years, as estimated from published survival curves, were considered as the endpoints of interest. For survival at 3 and 5 years, the point estimates and the confidence intervals were used. Quality scoring of the studies also was performed. Fourteen trials were selected, comprising 1887 patients in the meta-analysis. For the cisplatin-based group, the estimated pooled odds ratio of death at 1 and 2 years was 0.76 (0.6-0.9 CI) and 0.70 (0.5-0.9 CI), with a reduction in mortality of 24% and 30%, respectively. For the noncisplatin-based group, the estimated pooled odds ratio at 1 and 2 years was 1.05 (0.7-1.5 CI) and 0.82 (0.5-1.3 CI), with a reduction in mortality of 5% and 18%, respectively. However, no significant differences were found between the percentage of survival and the CI at 3 and 5 years using the point estimates. CONCLUSIONS: These results favor combined cisplatin-based chemotherapy and radiotherapy, although it was not so at 3 and 5 years of survival. These data must, however, be considered in the light of their clinical relevance and of the balance between quality of life, toxicity, and costs of chemotherapy.

Liver abscesses due to Listeria monocytogenes.

Involvement of the liver in cases of Listeria monocytogenes is uncommon. We report a case of hepatitis due to L. monocytogenes, with a pathological finding of multiple abscesses. Blood cultures yielded L. monocytogenes. The patient died a few days after admission.