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<p><b>BACKGROUND</b>Chemotherapy is the main treatment measure of advanced non-small cell lung cancer(NSCLC).The aim of this study is to explore the efficacy,toxicity,time to disease progression(TTP) and overall survival under the combined chemotherapy with gemcitabine(GEM) plus cisplatin(DDP) in the treatment of advanced NSCLC.</p><p><b>METHODS</b>Retrospective review was conducted on 79 chemotherapy-naive cases of advanced NSCLC treated with GEM and DDP from October 1999 to November 2005.Among 79 patients,51 were male and 28 female;the median age was 53 years old(ranged from 21 to 74);there were 17 cases of squamous cell carcinoma,53 cases of adenocarcinoma,3 cases of large cell carcinoma,1 case of adeno-sqamous cell carcinoma,5 unidentified cases;there were 26 cases in IIIB stage and 53 cases in IV stage according to AJCC 1997 standard.All patients received GEM 800-1250 mg/m² on days 1 and 8 and DDP 75-80 mg/m² on day 1 or 30 mg/m² for three days by intravenous administration,with 21 days as one cycle.Each patient received 2-4 cycles chemotherapy.</p><p><b>RESULTS</b>The total clinical reponse rate(complete and partial response) was 31.6%,and clinical benefit rate(complete and partial response and stable disease) was 73.4%.1-year survival rate was 64.9%,2-year survival rate was 32%.After median follow-up of 2.33 years,median TTP was 5.06 months.The main toxicities were nausea,vomitting and hematological toxicities.The rates of grade III to IV leukopenia and thrombocytopenia were 25.4% and 31.6% respectively.Other toxicities were slight and tolerable.</p><p><b>CONCLUSIONS</b>Combined chemotherapy with GEM plus DDP as first-line treatment to advanced NSCLC is an effective and feasible regimen,which is one of the standard regimens.For old patients,this regimen is a good choice.The fit dosage of GEM for Chinese is 1000 mg/m².</p>
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<p><b>BACKGROUND</b>Gensing Rg3 is an active component from ginseng. The aim of this study is to observe the clinical anticancer effect of Rg3 in combination with chemotherapy regimen NP (vinorelbine+cisplatin) in advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Stage III-IV NSCLC patients confirmed by pathology or cytology all received vinorelbine plus cisplatin for at least two cycles, and were randomized into two groups: patients in arm A also received placebo twice a day, while patients in arm B received two tablets of Rg3 twice a day for at least two months. The endpoints of the study were the efficacy, survival and tolerance of patients.</p><p><b>RESULTS</b>From July 2000 to May 2002, 115 patients were enrolled into the trial. The patients' characteristics were well balanced in the two groups. Sex of patients: male, 79; female 36. Types of pathology: adenocarcinoma, 71; squamous cell carcinoma, 29; adenosquamous carcinoma, 8; others, 7. TNM stage: stage III, 45; stage IV, 70. Prior chemotherapy: with, 17; without, 98. Prior radiotherapy: with, 15; without, 100. Prior surgical treatment: with, 23; without, 92. Nine patients discontinued from the trial due to severe adverse effects (5) and other reasons (4), so there were 106 patients evaluable for clinical efficacy. The response rate was 14.5% (8/55) in arm A, and 33.3% (17/51) in arm B (P=0.011). The survival time in arm A was 9.7 months (mean) and 8.0 months (median), and 15.3 months (mean) and 10.0 months (median) in arm B (P=0.0088).</p><p><b>CONCLUSIONS</b>Preliminary results show improvements in response rate and survival time (median and mean) in Rg3 arm compared with placebo arm. It is worthy to confirm the results in further clinical trials.</p>
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<p><b>BACKGROUND</b>Iressa is the inhibitor of epidemic growth factor receptor and mainly used to treat non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the antitumor efficacy and toxicity of Iressa in the treatment of advanced NSCLC patients who had failed to previous chemotherapy.</p><p><b>METHODS</b>Twenty-four patiets with advanced NSCLC who were previously treated with chemotherapy received 250mg of Iressa orally once daily until disease progressing or intolerable toxicity developing. Tumor evaluation was performed before treatment. Then for every four weeks after administration they recevied the examination; after administration for sixteen weeks, examination was repeated once every eight weeks.</p><p><b>RESULTS</b>All twenty-four patients could be evaluated. One case got complete response, eight cases got partial response, three had no change and twelve had disease progression. So the response rate was 37.5%, the stable disease rate was 12.5%, and the clinical benifit rate was 50.0%. Median time to disease progressing was 87 days. All patients were followed up for two years and 1- and 2-year survival rate was 33.3% and 12.5% respectively. The common adverse effects were skin reaction and diarrhea and no grade III or IV toxicity was observed. Two cases were suspected of pulmonary interstitial changes and the treatment ended.</p><p><b>CONCLUSIONS</b>Iressa is effective in treatment of advanced NSCLC patients who had failed to previous chemotherapy and the adverse effects are tolerable. So Iressa is one of the best choice for NSCLC patients who need two or more line therapy.</p>
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<p><b>BACKGROUND</b>Gefitinib, an orally active epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), has shown targeted antitumor activity in patients with advanced non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the efficacy and tolerance of gefitinib on brain metastasis in patients with NSCLC.</p><p><b>METHODS</b>The clinical characteristics, response to treatment and outcome of survival were retrospectively reviewed in eighteen NSCLC patients with brain metastasis. All these patients received gefitinib of 250mg/d after brain metastasis was diagnosed. They would discontinued the targeted treatment because of disease progression or other reasons. Twelve of them received intracranial irradiation (group A), while the other six patients didn't (group B).</p><p><b>RESULTS</b>The overall response rate and disease controlled rate of gefitinib for brain lesions were 27.8% and 88.9% respectively (one complete remission, 4 partial remission, 11 stable disease, 2 progressive disease). No correlation among gender, smoking status, intracranial irradiation and the response of gefitinib was observed. There was no survival difference between the two groups (P=0.192), with the median follow-up time of 6 months (range 1-24 months). Rash and diarrhea were the most common adverse events.</p><p><b>CONCLUSIONS</b>Gefitinib is active in patients with brain metastasis from NSCLC. It is feasible to conduct randomized clinical trials to demonstrate the role of targeted treatment for NSCLC patients with metastatic brain lesions.</p>
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<p><b>BACKGROUND</b>Multimodality treatment is the milestone of improving the prognosis of patients with small cell lung cancer (SCLC). The aim of this study is to retrospectively review the prognostic factors for SCLC.</p><p><b>METHODS</b>From January 1999 to June 2005, clinical data were collected from 253 patients who had a good performance status (PS=0-1) and underwent multimodality therapy (chemotherapy+radiotherapy±surgery), and the prognostic factors were analyzed by Kaplan-Meier and COX multivariate proportional hazards model.</p><p><b>RESULTS</b>With a median follow-up of 23.2 months (3-85 months), 1-, 3-, and 5-year survival rate was 77.9%, 33.8% and 23.3% respectively, and 88.3%, 40.2%, 31.2% in LD patients, 62.9%, 22.0% and 8.8% in ED patients, respectively. Median survival time (MST) of all the patients was 23 months (95% CI: 19-27 months). Univariate analysis indicated that gender (P=0.0395), stage (P= 0.0000 ), LDH (P=0.0000), operation (P=0.0029), weight loss (P=0.0000) and the efficacy of first-line chemotherapy (P=0.0000) significantly influenced survival in SCLC. Multivariate analysis suggested that gender (P=0.019), LDH (P=0.000), operation (P=0.024) and weight loss (P=0.006) were the independent prognostic factors of survival.</p><p><b>CONCLUSIONS</b>Gender, LDH, operation, and weight loss are the important prognostic factors for patients with SCLC who have a good PS and undergo multimodality treatment.</p>
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Objective To evaluate the treatment effects of chemotherapy comparing with chemotherapy and radiotherapy in the limited-stage small cell lung cancer (SCLC). Methods 234 patients were cyto-pathologically diagnosed and staged as limited small cell lung cancer. The patients were treated with combined chemotherapy and radiotherapy,in which 22 cases were treated by alone chemotherapy (C),39 patients by chemotherapy plus radiotherapy(C+R),and 173 cases by combined chemotherapy and radiotherapy + chemotherapy (C+R+C). The chemotherapy regimen included CE (or PE),CAP or CAV for 4~6 cycles. Irradiation treatment covering the primary tumor,the ipsilateral hilar nodes and mediastinum was delivered once daily with 6 megavoltage X-ray beam to a median irradiation does of 56 Gy being given in 5~6 weeks. Results The 1-,2-,3-,and 5-year overall survival rates were 76.5%,38.2%,25.3%,15.6% respectively,and the median survival time (MST) was 19 months. There was a significantly difference on the survival rate between C+R+C group and C+R group or C group (P
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<p><b>BACKGROUND</b>To evaluate the efficacy and side effects of weekly administration of gemcitabine combined with docetaxel in the treatment of advanced non-small cell lung cancer.</p><p><b>METHODS</b>Twenty-six patients with advanced non-small cell lung cancer, with or without prior chemotherapy, were entered into this study. Gemcitabine and docetaxel were administrated weekly for 3 consecutive weeks, followed by 1 week rest. Gemcitabine was given as 800-1 200 mg/m² by intravenous infusion on days 1, 8, 15; while docetaxel was 35 mg/m² intravenously on the same days as gemcitabine. The efficacy including response rate and median survival duration and toxicity were observed.</p><p><b>RESULTS</b>Of the 26 patients, one achieved complete response (CR), and 6 achieved partial response (PR), with an overall response rate of 27%. The median survival duration was 9.5 months and 1-year survival rate was 38% (10/26). The main toxicities were neutropenia and thrombocytopenia. One patient died from allergic shock.</p><p><b>CONCLUSIONS</b>The combination of docetaxel and gemcitabine is effective and well-tolerated in the treatment of advanced NSCLC.</p>
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<p><b>OBJECTIVE</b>To evaluate the expression of fatty acid synthase (FAS) in non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>FAS was examined by immunohistochemical S-P technique in 175 specimens of NSCLC patients. Multiple clinical factors were analyzed according to their relation with expression of FAS.</p><p><b>RESULTS</b>The overall FAS expression rate was 31.4% (55/175). The expression of FAS in the non-adenocarcinoma patients was significantly higher than that of adenocarcinoma patients (38.4% vs 22.4%, P = 0.036). Higher FAS expression was also detected in patients who had vascular invasion or bone metastasis than those without (75.0% vs 29.3%, P = 0.02 and 46.9% vs 28.0%, P = 0.037). But, there was no significant difference between FAS and other clinical factors such as age, sex, smoking index, tumor size, stage, degree of differentiation, lymphatic metastasis, local recurrence or distant metastasis. Although there was no significant difference in the survival rates of FAS positive and negative patients (P = 0.066), the survival rate of FAS positive stage I patients was lower than that of negative ones (P = 0.005).</p><p><b>CONCLUSION</b>Fatty acid synthase in the specimens of non-small cell lung cancer patients has no correlation with most clinical factors, except that, in early lesions, it may signify poor prognosis.</p>
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas , Diagnóstico , Metabolismo , Mortalidade , Ácido Graxo Sintases , Expressão Gênica , Neoplasias Pulmonares , Diagnóstico , Metabolismo , Mortalidade , Prognóstico , Taxa de SobrevidaRESUMO
<p><b>OBJECTIVE</b>To evaluate the efficacy of combined modality treatment and determine the prognostic factors for small cell lung cancer (SCLC).</p><p><b>METHODS</b>From January 1974 to December 1995, 1260 patients with SCLC treated were retrospectively evaluated, with limited lesions in 732 patients, extensive lesions in 500 and stage unrecorded in 28. 553 patients were alloted into chemotherapy + radiotherapy (C + R) group, 355 into C + R + C group, 97 into R + C group, 126 into C group, 64 into R group and 65 into surgery (S + C + R) group. Patients with limited lesions received 2 - 4 cycles of chemotherapy including COMC, COMP, COMVP and CE-CAP. Radiotherapy was given to a dose of 40 - 70 Gy/4 - 7 w. Radiation portals for patients with limited lesions encompassed the primary tumor, hilar lymphatic drainage areas, partial mediastinum and bilateral supraclavicular regions. Patients with extensive lesions mainly received chemotherapy with or without palliative irradiation.</p><p><b>RESULTS</b>The overall CR and PR rates were 26.7% and 52.3%. Local recurrence and distant metastasis rates were 58.8% and 61.5%. The 1-, 3- and 5-year survival rates were 50.2%, 14.7% and 11.7%, with median survival time of 12 months. The era, sex, age, tumor stage and treatment modality were all significant prognostic factors by both uni-variate and multi-variate analyses (P < 0.05). The result of S + C + R rated the best among these modalities and the result of C + R + C was superior to C + R, though the difference of which was not significant.</p><p><b>CONCLUSION</b>Surgical resection should be considered as one part of comprehensive therapy for small cell lung cancer patients with limited lesions whenever possible. On top of routine chemotherapy early administration of radiotherapy is advisable.</p>
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma de Células Pequenas , Mortalidade , Terapêutica , Terapia Combinada , Neoplasias Pulmonares , Mortalidade , Terapêutica , Radioterapia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Purpose:The phase I study was conducted to evaluate the maximum tolerated dose (MTD) and toxicity of weekly administered docetaxel combined with cisplatin in patients with non-small cell lung cancer ( NSCLC ). The other objective was to measure the pharmacokinetic/dynamics (PK/PD).Methods:In the dose escalation study, 15 patients with unresectable and metastatic untreated NSCLC with performance status(0-1) were enrolled. Escalating doses of D 25 mg/m 2 (30 mg/m 2, 35 mg/m 2, 40 mg/m 2) on day 1, 8, 15 were given as a 30 min iv infusions and C 75 mg/m 2 30 min iv infusion after D on day 1 and the cycle was repeated every 4 weeks. Blood samples were drawn on day 1 and 15 in the first cycle to measure the PK. Dose limiting toxicity(DLT) was based on Cycle 1 and defined as any Grade 3 non-hematologic toxicity not declining to Grade 2 or less within 4 days or any Grade 4 toxicity. Results:Chemotherapy was repeated for at least two cyc1es every 28 days. All patients were assessable for toxicities. Although grade 3/4 neutropenia occurred, there were no significant modifications of chemotherapy schedule. One patient developed an infection (DLT). Non-hematological toxicities, including nausea/vomiting, a1opecia, fluid intension and asthenia were tolerable. Based on these data, the MTD has not yet reached up to dose level of docetaxel of 40mg/m 2 weekly given in combination with cisplatin 75mg/m 2 every 4 weeks at the fixed dose. The exposure to docetaxel after Ⅳ administration on day 1 in combination with cisplatin and on day 15 without cisplatin , increased proportional to the dose for the range 25 to 40 mg/m 2, as measured by Cmax and AUC. No statistically significant difference between clearance values was shown for the 4 dose levels. The pharmacokinetics of docetaxel was not influenced by the coadministration of cisplatin on day 1 as compared to day 15, as the CmaxN, AUCN and CL were not statistically significantly different on both days. Fourteen patients were eva1uab1e for response, five cases achieved partial response, and thus the overall response was 35.7%. 1, 2, and 3 year survivals were 73%, 27%, and 20%, respectively. Weekly administration of docetaxel at 35mg/m 2 (days 1, 8, l5) combined with cisplatin 75mg/m 2 (day 1) is recommended for phase Ⅱ studies. Conclusions:Using the weekly schedule, toxicity was mainly manifested by non-hematologic profile and was well tolerated. A phase Ⅱ study is currently ongoing with docetaxel 35mg/m 2 as the suggested dosage.
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Purpose:To study the efficacy and safety of docetaxel administrated weekly plus cisplatin in the treatment for patients with advanced non-small-cell lung cancer (NSCLC). Methods:Thirty-six patients with stage ⅢB,stage Ⅳ not treated previously by chemotherapy,or recurrenct after operation NSCLC received intravenous infusions of docetaxel at 35mg/m 2 three consecutive weeks,followed by a week of rest;and intravenous infusions of cisplatin at 75 mg/m 2 every four weeks. Results:There were 12 partial responses for an objective response rate of 33 %. The median survival was 11.5 months (range 4-27 months),and the 1-year survival was 50%. Hematologic toxicities,which were mild,included grade Ⅲ/Ⅳ neutropenia in 22%. The common nonhematologic toxicities included grade 2-3 nausea and vomiting (39%) and grade 2-3 asthenia (36%). Conclusions:Consecutive weekly administrations of docetaxel for 3 weeks plus cisplatin produce minimal myelosuppression and shows activity in the treatment of patients without previous chemtherapy with advanced NSCLC.
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Purpose:To study the clinical features of meningeal metastasis (MM) and investigate its diagnosis and treatments and prognosis. Methods:The clinical materials of 22 patients with MM were retrospectively analyzed. Results:Of all the 22 patients,MM was diagnosed by CT/MRI scan in 20 patients and by cytological analysis of CSF in 6 patients,the patients received therapies including systemic chemotherapy,intrathecal chemotherapy and radiotherapy,and also 1 patient without therapy.Median survival was 3 months (range 1 week-15 months). Conclusions:MM,with a poor prognosis,is one of the most serious complication of cancer. At present,all the therapies are palliative.
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Gemcitabine is a new active drug in the treatment of advanced non small cell lung cancer (NSCLC). It is validated that the response rate of the single agent gemcitabine was consistently above 20%, median survival was 34 weeks and it could improve the disease related symptoms with well toleranced toxicities by many clinical studies. This report reviews the clinical studies of gemcitabine in the patients with advanced NSCLC.
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Objective: To evaluate the efficacy and side effects of rhG-CSF(recombinant human granulocyte colony stimulating factor) in chemotherapy induced neuteropenia.Methods: 63 cases with malignacies confirmed by pathology or cytology were enrolled. All patients were divided into group AN or BA at randomly self-control cross-over test.At the time of 48 hours after chemotherapy,rhG-CSF was given at a dose of 5 g.kg-1 .d-1 for 7 to 14 days in group A. In group B, the patients received chemotherapy alone without rhG-CSF as control.Bolld routine examination was taken every other day from the start of chemother- apy.The change of absolute neutrophil and neukocyte counts were observed.Results:In the trial group,neutrophil count in- creased rapidly with the first peak after 48 born of rhG-CSF injection. The second peak occurred on the tenth day. In the control group,the absolute neuterophil and leukocyte counts decreased gradually,lower than that of the trial group all the time.There is a significant difference between the trial and control groups (P