Salvage chemotherapy with high-dose carboplatin and etoposide with peripheral blood stem cell transplant in patients with relapsed pure seminoma.

PURPOSE: To evaluate rates of complete remission and overall survival for patients with relapsed pure seminoma treated with high-dose carboplatin and etoposide followed by peripheral blood stem cell transplant. PATIENTS AND METHODS: Forty-eight consecutive patients with relapsed pure seminoma who were treated with high-dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplant between May 1996 and June 2006 were retrospectively reviewed. Upon relapse (first, second, or third relapse) patients were given HDCT with carboplatin 700 mg/m(2) and etoposide 750 mg/m(2) for 3 consecutive days followed by infusion of peripheral blood stem cells. Here, we review both response and survival. RESULTS: Thirty-eight (79%) of 48 patients obtained a complete response (CR) with overall survival of 75%. Median follow-up of all patients was 45.6 months. Twenty-two (92%) of 24 patients in first relapse achieved CR and are still alive and continuously disease-free. Sixteen (67%) of 24 patients had HDCT as third- or fourth-line therapy with 67% CR and overall survival of 64%. There were 3 treatment-related deaths, all of which occurred as third- or fourth-line therapy. CONCLUSION: HDCT results in high rates of both CR and overall survival in patients with first or later relapsed pure seminoma germ cell tumors.

Advanced non-small cell lung cancer: the role of maintenance therapy.

Platinum-based chemotherapy has been shown to provide survival benefits in advanced non-small cell lung cancer (NSCLC). Maintenance/consolidation chemotherapy in NSCLC has gained renewed interest with improved tolerability of chemotherapy and the addition of biologic agents. Various studies have evaluated the role of prolonged duration of chemotherapy as well as maintenance/consolidation strategies with both chemotherapy and biologic agents. The available data at this time demonstrates that maintenance or consolidation therapy can improve progression free survival; however this does not result consistently in an improved overall survival. We review the literature with regard to duration of therapy and use of maintenance/consolidation therapy in advanced NSCLC.

Gefitinib plus celecoxib in chemotherapy-naïve patients with stage IIIB/IV non-small cell lung cancer: a phase II study from the Hoosier Oncology Group.

BACKGROUND: Gefitinib, an inhibitor of the epidermal growth factor receptor (EGFR) pathway, has single agent activity in non-small cell lung cancer (NSCLC). Preclinical studies demonstrate significant interactions between the EGFR and cyclooxygenase 2 (COX-2) pathways and that simultaneous inhibition may have benefits over EGFR inhibitors alone. ELIGIBILITY CRITERIA: chemotherapy-naive, stage IIIb (with pleural effusion) or IV NSCLC, Eastern Cooperative Oncology Group Performance Status (PS) 0-1. Patients were treated with gefitinib 250 mg po daily plus celecoxib 400 mg po every 12 hours. Cycles consisted of 21-day treatment and continued until unacceptable toxicity or progression of disease. The primary objective was to evaluate the overall response rate; secondary objectives included estimation of progression free survival, overall survival, and to assess the toxicity of this regimen. RESULTS: From January 2004 to November 2004, 31 patients were enrolled: male/female 13/18; median age 70 years (range, 19-93); 68% had adenocarcinoma; Eastern Cooperative Oncology Group PS 0/1 13/18; stage IIIb/IV 2/29. Two patients died of interstitial lung disease due to treatment. There were three additional deaths during treatment that were not considered treatment related. Two additional patients discontinued treatment due to adverse events (elevated liver enzymes). Select grade 3/4 toxicities included: pneumonitis (3%), hepatic (7%), diarrhea (7%), and skin (3%). Response rate was 16% (95% CI, 5-34%), median progression free survival and overall survival were 3.2 (95% CI, 2.7-5.7 months) and 7.0 months (95% CI, 3.7-14.2 months), respectively. All responders were females with adenocarcinoma, two were remote or never smokers and three were former smokers. CONCLUSION: Gefitinib plus celecoxib in an unselected population of chemotherapy naive patients with advanced NSCLC and a PS of 0-1 has a lower response rate and overall efficacy compared with historical controls of combination chemotherapy.

Long-term survival in a patient with stage IV non-small-cell lung carcinoma after bone metastasectomy.

Patients with bone metastases related to non-small-cell lung cancer (NSCLC) have a poor prognosis. In the rare situation in which a patient has a solitary bone metastasis, aggressive treatment may be warranted, as illustrated by the case reported here.