Third-line chemotherapy in advanced non-small cell lung cancer: identifying the candidates for routine practice.

BACKGROUND: The interest of first- and second-line treatments in non-small cell lung cancer (NSCLC) has been demonstrated by successive randomized trials. Improvements in lung cancer care have routinely allowed a significant proportion of patients to be considered for third-line treatment. METHODS: A retrospective analysis was performed, including all consecutive patients with advanced NSCLC, who received at least three lines of systemic antineoplastic treatment at our institution. RESULTS: From a population of 613 patients treated with first-line treatment, a total of 173 patients received third-line treatment (cytotoxic chemotherapy in 131 patients; epidermal growth factor (EGFR) tyrosine kinase inhibitors in 42 patients). Only 13 patients (8%) received less than 75% of the theoretical dose intensity; 22 patients (13%) presented with severe toxicities. Symptom relief and performance status (PS) improvement were observed in 121 (92% of the 131 patients with symptoms) and 90 patients (52%), respectively. Using multivariate analysis, survival after third-line treatment was significantly increased in patients younger than 70 years-old (hazard ratio [HR] = 0.73, 95% confidence interval [CI]: 0.53-0.99, p = 0.047), who smoked less than 10 pack-years (HR = 0.82, 95% CI: 0.57-0.93, p = 0.036), with no cancer-related symptoms (HR = 0.75, 95% CI: 0.61-0.92, p = 0.007), a weight loss inferior to 5 kg since the beginning of second-line (HR = 0.63, 95% CI: 0.52-0.75, p = 0.013), a PS 0 to 1 (HR = 0.81, 95% CI: 0.76-0.86, p = 0.008), and no extrathoracic tumor spread at initiation of third-line treatment (HR = 0.67, 95% CI: 0.47-0.94, p = 0.042). Disease control after both first- and second-line treatments was the strongest predictor of prolonged survival after third-line treatment (HR = 0.47, 95% CI: 0.33-0.67, p = 0.001). CONCLUSIONS: Patients with advanced NSCLC may benefit from third-line treatment. The best candidates can be identified using standard prognostic factors, such as PS, and disease control after first- and second-line treatments.

Bronchoscopic cryotherapy treatment of isolated endoluminal typical carcinoid tumor.

BACKGROUND: Bronchial typical carcinoid tumors are rare. The "gold standard" treatment is surgery, but there is literature to support bronchoscopic therapy with curative intent. Based on the efficacy of cryotherapy for in situ lung cancer, we studied the safety and efficacy of rigid bronchoscopic treatment with cryotherapy on isolated endoluminal typical carcinoid tumors. METHODS: All the patients from the Department of Pulmonary Diseases and Thoracic Oncology of St. Etienne University Hospital (France), and of Hôpital Notre Dame, University Hospital of Montreal referred with typical carcinoid were screened. Inclusion criteria included the following: proven typical carcinoid, strictly endoluminal disease amenable to bronchoscopic therapy, and no evidence of lymph node invasion. All patients had a complete removal of the tumor, and all patients received cryotherapy to the implantation base. RESULTS: Twenty-nine patients were screened, and 18 were included. Mean age was 47 years, and study population included 11 women. Median follow-up was 55 months. There was a single recurrence 7 years after the initial bronchoscopic treatment. CONCLUSIONS: Cryotherapy is a safe and effective adjunct to endobronchial mechanical resection of typical carcinoids. Unlike other adjuncts that have been proposed, cryotherapy is not associated with long-term complications including bronchial stenosis.