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Experimental treatments for lung cancer reviewed at meeting
Role of neoadjuvant treatment being investigated in the NSCLC setting.
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Potential lung cancer treatments continue to be researched including the roles of neoadjuvant treatment and consolidation treatment, according to a presentation at the European Society of Medical Oncology Conference 2007 in Lugano, Switzerland.
At a “Highlights in Lung Cancer,” presentation, Giuseppe Giaccone, MD, PhD, chief of the medical oncology branch for the Center for Cancer Research at the National Cancer Institute, discussed the current paths of research for non–small cell lung cancer and small cell lung cancer.
Results from several trials have shown benefits of neoadjuvant chemotherapy, though few reached statistical significance, according to Giaccone. Most recently, results of the MRC LU22/NVALT 2/EORTC 08012 randomized trial were presented at the 2007 ASCO Annual Meeting.
In this trial, neoadjuvant chemotherapy demonstrated good response rates, caused down-staging in about 20% of the patients and did not adversely affect quality of life or complete resection rates. However, there was no evidence of a benefit in progression-free survival or overall survival.
For locally-advanced NSCLC, concomitant chemotherapy and radiotherapy is standard in the United States. Researchers recently began to study the role of consolidation treatment with docetaxel (Taxotere, Sanofi Aventis) in these patients.
In 2005, final data from the SWOG 9504 phase-2 trial and interim data from the HOG LUN 01-21/USO 02-33 trials were presented at the ASCO Annual Meeting. The SWOG trial demonstrated a median survival time of 26 months. At the 2007 ASCO Annual Meeting, however, updated data from the HOG LUN 01-21 trial showed no benefit on either progression-free survival or overall survival.
Advanced NSCLC
Platinum-based chemotherapy is standard for advanced disease that has a good performance status, and single-agent treatment the gold standard for patients with worse performance status.
“Chemotherapy has reached a plateau,” Giaccone said. “Several doublets have shown similar efficacy in first-line treatment.”
Bevacizumab (Avastin, Genentech) was recently approved by the FDA to treat advanced NSCLC in combination with carboplatin and paclitaxel. Data from the Eastern Cooperative Oncology Group 4599 trial showed that patients treated with bevacizumab in addition to carboplatin and paclitaxel had a better response rate, overall survival and progression-free survival. However, there were more treatment-related deaths and toxicities associated with bevacizumab.
“Addition of bevacizumab clearly increases the risk of hemorrhage such as hemoptysis and gastrointestinal bleeding,” Giaccone said. “Other adverse events, including cerebovascular events and pulmonary embolus, were common with bevacizumab.”
At the 2007 ASCO Annual Meeting, data from the AVAiL study were presented. Researchers studied the effect of bevacizumab when added to cisplatin and gemcitabine (Gemzar, Lilly). Two doses of bevacizumab were studied: 7.5 mg/kg and 15 mg/kg. The primary endpoint, progression-free survival, was superior to placebo in both bevacizumab arms.
Epidermal growth factor receptor mutations may play a role in determining the patients who would respond better to treatment with EGFR tyrosine kinase inhibitors. Though mutation frequency is low in whites, mutations are more frequent in never smokers, women, patients with adenocarcinoma and Asians.
SCLC
For limited SCLC, surgery is rarely used for treatment. The standard treatment is concomitant radiotherapy and chemotherapy. The best tested chemotherapy treatment for this disease is a combination of cisplatin and etoposide, Giaccone said. Prophylactic cranial irradiation is used for complete responders.
Platinum-based chemotherapy is the standard treatment for extensive disease. Data from the IRIS trial showed that carboplatin with irinotecan (Camptosar, Pharmacia & Upjohn) is superior to carboplatin with etoposide, with a longer median survival that does not compromise quality of life. Topotecan (Hycamtin, GlaxoSmithKline) can be used for second-line therapy. – by Emily Shafer
For more information:
- Giaccone G. Highlights in Lung Cancer. Presented at: European Society of Medical Oncology Conference 2007; July 5-8, 2007; Lugano, Switzerland.