A Case Report on Successful Third Challenge to the Pemetrexed-based Regimen for Advanced Non-small Cell Lung Cancer / 中国肺癌杂志

Non-small cell lung cancer (NSCLC) accounts for about 85% of lung cancer, with a 5-year survival rate of less than 15%-19%, and more than 80% of the patients with lung cancer have progressed to advanced stage (Stage IIIb-IV) when they are clearly diagnosed. The comprehensive treatment mainly based on chemotherapy as the primary form is now considered as the major therapy method for advanced NSCLC without actionable driver gene mutations. Pemetrexed plus platinum doublet as well as single-agent pemetrexed are respectively the first-line major regimens recommended by guidelines and the second-line optional regimens. Yet the third-line treatment or beyond in advanced NSCLC is not evidence-based but conducted based on patients' previous medications, which is one of the most commonly used clinical methods. As pemetrexed is a multi-target chemotherapy drug with high efficiency but low toxicity, pemetrexed re-challenge strategy in advanced NSCLC is also a reasonable choice. We report one effective individual case that adopted pemetrexed re-challenge strategy in advanced NSCLC for three times, and at the same time conduct the relevant literature review.

Diagnostic value of nuclide bone imaging for bone metastasis from lung cancer and clinic analysis / 中国肺癌杂志

<p><b>BACKGROUND</b>Bone metastasis is very common in lung cancer patients. Metastasis to spine can lead to paralysis and fracture, deteriorate the quality of patient's life. The objective of this study is to investigate the diagnostic values of bone scanning (NBS), MRI, CT and X-ray examination to discover bone meastasis of lung cancer, and the therapy of bone metastasis and the prognostic factors.</p><p><b>METHODS</b>About 561 consecutive NSCLC cases were analyzed with NBS and compared with other radiological examinations (MRI, CT and X-ray).</p><p><b>RESULTS</b>Out of the 455 positive patients by NBS, 300 cases were confirmed to be with bone metastases by dynamic follow-up, MRI, CT and X-ray, and 5 cases were false negative.The sensitivity and specificity of NBS was 98.36% and 39.45% respectively. The accuracy of NBS was 71.48%. Among the 305 patients with bone metastases, 23 patients had no records, 138 patients had bone pain, the incidence of asymptomatic bone metastasis was 47.21%. Multivariables analysis showed that asymptomatic bone metastasis, flat bone metastases, therapy with disodium pamidronate were significantly good prognostic factors, respectively (P < 0.05).</p><p><b>CONCLUSIONS</b>A whole body NBS examination is preferred for the staging of NSCLC. NBS is necessary for patients with NSCLC. In order to exclude the possible false positive or false negative diagnosis by NBS, CT or MRI could be selected according to the sites of lesions.</p>

Prognostic analysis of intrapulmonary metastasis for patients with non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>It is well known that more than 40% patients were initially diagnosed with advanced non-small cell lung cancer (NSCLC) with intrapulmonary or/and distant metastasis. However, up to now, the reports about effects of different metastatic sites on survival were limited. The aim of this study is to investigate the clinicopathologic and survival difference by retrospective analysis among sole intrapulmonary metastasis, sole extrathoracic distant metastasis and simultaneous metastasis of lung and other extrathoracic organs for the patients with advanced NSCLC, and to analyze the prognosis-related factors of NSCLC with intrapulmonary metastasis.</p><p><b>METHODS</b>Of the 425 patients with stage IV NSCLC diagnosed by pathology and through staging evaluation and treated at Beijing Cancer Hospital with long follow-up during Oct. 1995 to Dec. 2003, 81 cases had sole intrapulmonary metastasis, 98 cases had sole extrathoracic distant metastasis and 68 cases presented simultaneous lung metastasis and extrathoracic spread. Kaplan-Meier survival curve was performed to estimate the survival of patients with different metastasis, Log-Rank test was used to compare their survival difference, and univariate analysis was used to find prognostic related factors.</p><p><b>RESULTS</b>Median survival time (MST) and 1-, 2-, 3-year survival rate (SR) for patients with sole intrapulmonary metastasis were 13 months (95% CI: 11-15), 57%, 21%, 7%, respectively; MST was 22 months (95% CI: 18-26) for patients with N1 and/or N2 and 10 months (95%CI: 7-13) for patients with N3 (P=0.001). Among the patients with ipsilateral, contralateral and bilateral intrapulmonary metastasis, difference of MST and 1-, 2-, 3-year SR had no statistical significance (P > 0.05); Survival of patients with sole intrapulmonary metastasis was not significantly different from that of patients with sole brain or bone metastasis (P > 0.05), but was longer than that of patients with simultaneous lung and extrathoracic spread (P=0.021). One way analysis of variance showed that no significant association were found among age, pathologic subtype, differentiation degree or response of first-line chemotherapy and survival of the patients with sole intrapulmonary metastasis (P > 0.05), but sex and invasive status of lymph node (N1/N2 vs N3) were found to influence the survival of the patients (P= 0.018, P=0.001). Further stratified analysis by age showed that invasion of lymph node was independent prognostic factor (P=0.002); whereas for the patients with simultaneous metastasis of lung and distant organs, metastatic numbers (2 vs ≥3) of organ were independent prognostic factor (P=0.013).</p><p><b>CONCLUSIONS</b>No statistical difference is found among survival of NSCLC patients with sole intrapulmonary metastasis and with sole brain, bone metastasis. Invasive status of lymph node and metastatic number of organ are important prognostic factors for patients with sole intrapulmonary metastasis and simultaneous metastasis of lung and extrathoracic organs, respectively.</p>

Treatment and prognosis of brain metastases from non-small cell lung cancer: A retrospective study / 中国肺癌杂志

<p><b>BACKGROUND</b>Now the treatment of non-small cell lung cancer (NSCLC) patients with brain metastasis is not a standard program. The aim of this study is to summarize the factors related to survival of patients with brain metastases from NSCLC.</p><p><b>METHODS</b>A total of 111 NSCLC patients with brain metastases (from September 1995-May 2004) were defined as symptomatic group (37 patients) and asymptomatic group (74 patients) according to central nervous system (CNS) symptoms. The patients in the symptomatic group were given whole brain radiation therapy (WBRT, DT 30-40Gy/20f) first, and then received cisplatin-based chemotherapy. The patients in the asymptomatic group were given cisplatin-based chemotherapy first, and then received WBRT. During the treatment, 49 patients received chemotherapy of BCNU or VM-26 irregularly.</p><p><b>RESULTS</b>The median survival time was 11 months. The 1-and 2-year survival rate was 40.79% and 13.26% respectively. The survival time was not significantly different between the symptomatic group and asymptomatic group. Median chemotherapy of asymptomatic group was 3 cycles (1-6 cycles) before WBRT. Those patients who received 3 or 4 cycles of chemotherapy before WBRT had better survival (P= 0.0188 , P=0.0035). The treatment of BCNU or VM-26 was a benefit factor for survival (P=0.0219) in asymptomatic group. The hematologic toxicity of grade III or IV was not significantly different between the two groups (P > 0.05). The number of brain metastasis (P=0.000), extracranial metastasis (P=0.022) and WHO performance status (P=0.001) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>The patients with asymptomatic brain metastases receive 3-4 cycles of chemotherapy before WBRT may be reasonable. During the therapy, the patients with administration of BCNU or VM-26 may have survival benefit.</p>

Analysis of prognostic factors of sequential treatment in 355 patients with advanced non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the prognostic factors of 355 patients with advanced non-small cell lung cancer for researching an individual treatment module.</p><p><b>METHODS</b>From March 1988 to October 2000, after diagnosed by histology or cytology and staged by staging examinations, 355 novel advanced NSCLC patients (stage III, 134; stage IV, 221) were enrolled, who were given at least 2-cycle chemotherapy. Response rate and survival were observed and prognostic factors were analysed.</p><p><b>RESULTS</b>Out of 355 patients, 101 got partial response and 147 had stable disease. Response rate was 28.45%, and tumor control rate was 69.86%. Median survival duration was 16 months. The 1-, 2-, 3- and 5-year survival rates were 58.41%, 29.35%, 14.60% and 8.60%, respectively. In the patients with stage IV, median survival duration was 14 months, and 1-, 2-, 3- and 5-year survival rates were 54.62%, 25.59%, 12.70% and 6.73%, respectively. COX multiple variable analysis showed that improved/stable ECOG score (P=0.044 0) and chemotherapy (after second line failure) combined with γ-IFN (P=0.039 0) had prognostic significance.</p><p><b>CONCLUSIONS</b>Improvement of quality of life is quite important in the treatment of advanced NSCLC. Combination with γ-IFN or TAM and radiotherapy of primary tumor may be helpful to improve the survival of patients with stage IV.</p>