[Anemia and lung cancer]. / Anémie et cancer bronchique.

Erythopoietin (EPO) treatment of anemia during cancer has dramatically improved the tolerance of chemotherapy and quality of life of patients at all stages of the disease. Several surveys have demonstrated a high prevalence and a high incidence of anemia in lung cancer patients. The guidelines updates concerning EPO treatment for these patients are described. They take into account the debate concerning the potential harm of these molecules on the neoplastic disease and the possible role of EPO receptors expressed by several tumors, including non small cell lung cancer.

[Pulmonary metastases from endometrial stromal sarcoma may benefit from hormone therapy]. / Les métastases pulmonaires de sarcomes utérins peuvent bénéficier d'une hormonothérapie!

INTRODUCTION: Low grade endometrial stromal sarcoma (ESS) often expresses oestrogen (ER) and progesterone (PR) receptors, even in metastatic disease. These receptors may also be hormone dependent. CASE REPORT: Two years after the institution of oestrogen replacement therapy (HRT) a woman of 56 presented with haemoptysis which led to the discovery of multiple pulmonary nodules. Twelve years previously the patient had had a hysterectomy for a low grade endometrial stromal sarcoma, ER and PR positive. Surgical resection of the nodules on the right side confirmed the diagnosis of metastatic endometrial stromal sarcoma. The metastases expressed oestrogen and progesterone receptors. Three months after the withdrawal of HRT and treatment with an aromatase inhibitor (letrozole) the contralateral metastases had disappeared and this complete response was maintained for more than 2 years of follow-up. CONCLUSION: Care should be taken in the institution of HRT in a woman with a history of low grade ESS. Hormonal treatment with aromatase inhibitors may be considered in cases where ER and PR are expressed by the primary tumour and metastases, with possible benefits even in metastatic disease.

[What treatment for a patient of PS 2-3 with stage IV non-small cell lung cancer?]. / Quel traitement pour un patient de PS-2/3 ayant un cancer bronchique non à petites cellules (CBNPC) de stade IV?

Patients with poor performance status (PS) and advanced lung cancer have been underrepresented in clinical trials. As a consequence, the management of these patients in clinical practice is often empirical. Recent data indicate that patients with advanced non-small cell lung cancer (NSCLC) and a PS of 2 tend to benefit from first line chemotherapy with respect to symptom improvement and perhaps overall survival. Whether single-agent or combination chemotherapy is preferable remains debatable. In previously treated patients with NSCLC, EGFR tyrosine kinase inhibitors produced a substantial rate of clinical benefit and led to an improvement in survival compared with placebo in studies that included a significant percentage of patients with poor PS.

[Which truth for patients and their family]. / Quelle vérité au patient et à sa famille?

Must the truth always be told to a cancer patient and/or his relatives? Taking a personal experience as the basis for discussion, the author examines this question in the context of Western cultural norms where death is taboo. The legal obligations to inform patients and the representation of cancer are discussed. Two key situations are considered: the delivery of a diagnosis of cancer and the announcement of a bad prognosis. What does it really mean "to tell the truth"? A best strategy for giving information to relatives is developed. The author's conclusion is that it seems more important to establish a "true" relationship with the cancer patient and his relatives than telling or not telling the whole truth.

[Gefitinib treatment for carcinomatous meningitis in non-small cell lung cancer]. / Géfitinib et méningite carcinomateuse d'un carcinome bronchique non à petites cellules (CBNPC).

BACKGROUND: Carcinomatous meningitis is a major complication in Non Small Cell Lung Cancer (NSCLC). Despite treatment with radiotherapy alone or in combination with intrathecal and systemic chemotherapy, its prognosis remains poor. OBSERVATION: We report a case of a female non-smoker with adenocarcinoma with bronchoalveolar features presenting with carcinomatous meningitis three years after the diagnosis of her primary tumour. Gefitinib treatment was proposed because of the persistence of meningitic symptoms despite cranial irradiation. Clinical response was observed within 3 weeks and lasted for 9 months. CONCLUSION: Gefitinib may be effective in treating carcinomatous meningitis complicating NSCLC and should be considered in this situation given the absence of effective alternatives.

[Complementary therapy in NSCLC. Supportive treatment in thoracic oncology. Management of chemotherapy induced anaemia and neutropenia, nausea and vomiting and bone metastases]. / CBNPC et soins complémentaires. Quels traitements de support en cancérologie thoracique? Prise en charge de l'anémie et des neutropénies chimio-induites, des nausées et vomissements et des métastases osseuses.

The aim of supportive treatment is to minimise the toxic effects of antineoplastic therapy. More useful new drugs are now available for the management of chemotherapy induced anaemia, neutropenia, and nausea and vomiting. One can include the treatment of bone metastases with biphosphonates. Recommendations on the use of these treatments have been made by various specialist organisations. This article reviews the recent data concerning these developments in thoracic oncology.

[Thrombosis and lung cancer]. / Coagulation et cancers bronchiques.

Venous thromboembolism (TE) is a frequent occurrence in lung cancer patients and can be precipitated by venous stasis, the activation of clotting cascades by pro-coagulant tumour factors and by vascular injury due to chemotherapy and central venous catheters. Subcutaneous low molecular weight heparin (LMWH) has replaced intravenous unfractionated heparin in the treatment of acute TE. The use of long-term LMWH is recommended to prevent the recurrence of TE. Prophylactic treatment is indicated in patients undergoing surgery or hospitalised. Heparin appears to have distinct anti-neoplastic as well as anticoagulant effects, which benefit overall survival.

[Treatment of anemia and bone metastasis in metastatic non-small-cell lung cancer. A French survey]. / Prise en charge de l'anémie et des métastases osseuses dans les cancers bronchiques non à petites cellules (CBNPC) métastasés. Une enquête française.

Use of erythropoietin (EPO) for chemotherapy-induced anemia and biphosphonates (BP) for bone metastasis has increased steadily. However, there are no guidelines on their use in many situations such as non small cell lung carcinoma (NSCLC), which frequently alters quality of life markedly. Therefore, a multicentric survey was designed to assess the treatment of anemia and bone metastasis in chemotherapy-treated patients with non-small-cell lung carcinoma. Nine representative centers of the oncology working party of the French respiratory society (Groupe d'Oncologie de la Société de Pneumologie de Langue Française) participated. Inclusion criteria were stage IV NSCLC and at least one course of chemotherapy in the last 3 months. A total of 148 and 50 patients (pts) were included in the anemia and bone metastasis surveys, respectively. Anemia was present in 60.8% of patients, and was not treated in 75%; 15 patients received EPO (10.1%). Independent predictors of EPO use were presence of anemia-related symptoms, hemoglobin level, age and center: the rate of prescription in patients with anemia varied from 13 to 73% between centers. BP were administered in 38% of patients with bone metastasis. Independent predictors of BP use were calcium serum level, pain, and center with a rate of prescription ranging from 0 to 80% between centers. This study reveals that, in France, most patients with anemia are not treated, EPO being seldom prescribed. The use of both EPO and BP is highly variable between centers. Guidelines on the use of these supportive treatments could help improve the care for lung cancer patients receiving chemotherapy.

[The place of targeted treatments: receptor tyrosine kinase inhibitors]. / Place des thérapeutiques ciblées: les inhibiteurs des récepteurs tyrosine kinases.

Targeted biological treatments are aimed at correcting one or several abnormalities inherent to cancer cells by specifically affecting one or several identified abnormal cell mechanisms. Many signalisation pathways involve membrane receptors of the tyrosine kinase receptor family, notably the HER receptors (with, first-line, EGFR or epidermal growth factor receptor) and the VEGF receptors. These receptors can be blocked either by a monoclonal antibody directed against the ligand (i.e., bevacizumab or anti-VEGF Avastin) or against the extra-cellular segment of the receptor (i.e., cetuximab or anti-EGFR Erbitux) or by tyrosine kinase inhibitors of the intracellular segment of the receptor (i.e., gefitinib or Iressa and erlotinib or Tarceva). The preliminary studies with these new treatments in pulmonary oncology are presented.

CYFRA 21-1 is a prognostic determinant in non-small-cell lung cancer: results of a meta-analysis in 2063 patients.

The purpose of this study was to determine the prognostic significance of a high pretreatment serum CYFRA 21-1 level (a cytokeratin 19 fragment) adjusted for the effects of well-known co-variables in non-small-cell lung cancer (NSCLC). This meta-analysis based on individual updated data gathered comprehensive databases from published or unpublished controlled studies dealing with the prognostic effect of serum CYFRA 21-1 level at presentation in NSCLC of any stage (nine institutions, 2063 patients). Multivariate regression was carried out with the Cox model. The proportional hazard assumption for each of the selected variables retained in the final model was originally checked by log minus log plots baseline hazard ratio. The follow-up ranged from 25 to 78 months. A total of 1616 events were recorded. In the multivariate analysis performed at the 1-year end point, a high pretreatment CYFRA 21-1 level was an unfavourable prognostic determinant in all centres except one (Hazard ratio (95% confidence interval): 1.88 (1.64-2.15), P<10(-4)). Other significant variables were stage of the disease, age and performance status. Within the first 18 months, the procedure disclosed a nearly similar hazard ratio for patients having a high pretreatment serum CYFRA 21-1 level (1.62 (1.42-1.86), P<10(-4)). For patients who did not undergo surgery, the hazard ratio during the first year of follow-up was 1.78 (1.54-2.07), P<10(-4). Finally, in the surgically treated population, at the 2-year end point, a high pretreatment CYFRA 21-1 and a locally advanced stage remained unfavourable prognostic determinants. In conclusion CYFRA 21-1 might be regarded as a putative co-variable in analysing NSCLC outcome inasmuch as a high serum level is a significant determinant of poor prognosis whatever the planned treatment.

Randomised, multicentre phase II study assessing two doses of docetaxel (75 or 100 mg/m2) as second-line monotherapy for non-small-cell lung cancer.

BACKGROUND: The survival benefit associated with first-line chemotherapy in advanced lung cancer led to the need for second-line chemotherapy. Docetaxel (Taxotere) has proven efficacy in both settings. This study evaluated the safety and efficacy of two doses of docetaxel in patients with non-small-cell lung cancer who had failed first-line platinum-based chemotherapy. PATIENTS AND METHODS: In total, 182 patients from 24 French centres were randomised and treated with either docetaxel 75 mg/m(2) (arm A) or 100 mg/m(2) (arm B) every 3 weeks. Baseline characteristics were well balanced, except more patients in arm A had metastatic disease (91.4% versus 78.7%) and therefore the median number of sites involved for arm A was three compared with two for arm B. RESULTS: Median time to treatment failure was 1.34 months [95% confidence interval (CI) 1.28-1.64] for arm A and 1.64 months (95% CI 1.34-2.62) for arm B. Median overall survival was 4.7 months (95% CI 3.8-5.9) for arm A versus 6.7 months (95% CI 4.8-7.1) for arm B. According to a blinded expert panel, disease control was achieved in 35 (43.8%) patients in arm A and 39 (49.4%) patients in arm B. More patients in arm B experienced grade 3-4 neutropenia (B: 72.7% versus A: 44.0%), asthenia (B: 20.2% versus A: 10.8%) and infection (B: 6.7% versus A: 2.2%). Three treatment-related deaths were reported in each arm. CONCLUSIONS: The optimal docetaxel dosage in this second-line setting is 75 mg/m(2), as it has a more favourable safety profile and on balance a similar efficacy to the 100 mg/m(2) dose.