Evaluation of the efficacy and safety of chemotherapy for patients with wet stage IIIB/IV non-small-cell lung cancer aged 80 years old or more.

BACKGROUND: Because of the number of elderly patients with NSCLC is increasing, it is becoming a public health problem world wide. In elderly patients with advanced NSCLC, mono-chemotherapy is the standard treatments. But little information is available for patients aged ≥80 regarding the management of advanced NSCLC. PURPOSE: The purpose of the present study is to evaluate the efficacy and safety of chemotherapy for patients aged ≥80. METHODS: 110 patients aged ≥75 with advanced NSCLC were retrospectively reviewed. Data was collected from the electronic medical records of our hospital from January 2005 to August 2008. The patient population was divided into three age groups: patients aged ≥80 who received chemotherapy (group A), patients aged 75-79 who received chemotherapy (group B), and patients aged ≥75 who received only best supportive care (group C). Date cut-off of this study was on 20th June, 2009. We evaluated and compared the survival and the toxicity between three groups. RESULTS: Among 110 patients, there were 21 patients in group A, 55 patients in group B, 34 patients in group C. Among group C, there were 8 patients aged 75-79 and the main reasons for BSC were poor PS in 7 patients, and there were 26 patients aged ≥80 and the main reason for BSC were age itself in 17 patients. Response rate and disease control rate were similar in group A and group B (16.4% vs. 23.8%, and 57.1% vs. 49.1%). MST was 237 days in group A with PS 0-2 and was 232 days in group C with PS 0-2. Median PFS and MST were 86 and 237 days in group A with PS 0-2 and was 107 and 263 days in group B. Toxicity profile of group A seems to be acceptable: over grade 3 leucopenia was observed 33%; over grade 3 neutropenia was 52%; but no febrile neutropenia; over grade 3 non-hemotological toxicity was observed 14%. CONCLUSION: There was no obvious difference between patients aged ≥80 and 75-79 in terms of safety and efficacy of chemotherapy. Patients aged ≥80 with advanced NSCLC who have good PS might be good candidates for the chemotherapy.

Pulmonary pleomorphic carcinoma: a clinicopathological study including EGFR mutation analysis.

BACKGROUND: Pulmonary pleomorphic carcinoma is a rare epithelial tumor and has an aggressive clinical course. As few studies of pulmonary pleomorphic carcinoma have been described, the clinicopathological characteristics of the disease remain unclear. Especially, the information on the epidermal growth factor receptor (EGFR) mutation status of pulmonary pleomorphic carcinoma is sparse. METHODS: We retrospectively examined 17 patients with pulmonary pleomorphic carcinoma. EGFR mutation and Ki-67 labeling index were investigated in these patients. RESULTS: The median age of the patients was 72 years (range, 47-84 years). Thirteen patients were men and four were women. EGFR mutation was observed in 3 (18%) of 17 patients. The median value of Ki-67 labeling index was 62% (range, 20-87%). Positron emission tomography with 18-fluorodeoxy-glucose was performed in 16 patients, and the standardized uptake value tended to be high (median 19.3). The survival of patients without surgery demonstrated a significantly poor prognosis compared with those with surgery (P = 0.0096). Palliative chemotherapy was almost poor response in advanced pulmonary pleomorphic carcinoma. The response to gefitinib in a patient with EGFR mutation was small and transient. CONCLUSION: EGFR mutation was recognized in approximately 20% of patients with pulmonary pleomorphic carcinoma. It is necessary to investigate whether the use of a molecular targeting drug improves outcome for pulmonary pleomorphic carcinoma.

Pooled analysis of the reports of erlotinib after failure of gefitinib for non-small cell lung cancer.

PURPOSE: The use of erlotinib after gefitinib failure in patients with non-small cell lung cancer (NSCLC) is not clearly clarified in clinical practice. We sought to compile the available clinical reports to better understand the effectiveness of erlotinib after failure of gefitinib. METHODS: We searched published reports including erlotinib and gefitinib. Eleven reports were identified (published between November 2004 and December 2008). Advanced NSCLC who documented progressive disease (PD) for gefitinib 250 mg/day, received erlotinib 150 mg once daily. RESULTS: A total of 106 patients were pooled from these studies. Asian was observed in 70.8%, women in 72.6%, adenocarcinoma in 85.1%, never smoker in 75.3%. In erlotinib therapy, there was observed in 9.9% in partial response (PR), 18.9% in stable disease (SD) and 70.8% in PD. Disease control (DC) rate for gefitinib and erlotinib was 71.7% and 29.2%, respectively. No significant difference of disease control rate (37.5% vs 21.7%, p=0.1503) and response rate (6.3% vs 8.7%, p=1.000) was observed between patients with EGFR mutations and those with wild type EGFR. The significantly different response on erlotinib therapy was observed in patients who had shown SD for gefitinib therapy (p=0.0095) and those who had a PFS of more than 6 months during gefitinib treatment (p=0.0261). The common toxicities were skin rash and diarrhea. CONCLUSION: Erlotinib may produce clinical benefits in patients who had shown long SD on prior gefitinib therapy. Moreover, EGFR mutations were not positive predictors for erlotinib response after gefitinib failure.

Thymic squamous cell carcinoma producing granulocyte colony-stimulating factor associated with a high serum level of interleukin 6.

Granulocyte colony-stimulating factor (G-CSF)-producing thymic carcinoma is extremely rare. A-66-year-old man presented with an anterior mediastinal mass, and underwent surgical biopsy. He had marked leukocytosis, and his serum levels of G-CSF and interleukin-6 were elevated. Histologically, the tumor consisted of squamous cell carcinoma, which showed positive immunoreactivity for G-CSF. He was treated with thoracic radiotherapy, and chest imaging revealed a marked reduction of tumor size. He was doing well at 8 months after tumor diagnosis.

[Lung cancer].

Biomarkers for lung cancer may be used for early detection, diagnosis, treatment selection and prognostication. They are also expected to contribute to the realization of tailored therapy. To identify the optimal therapy candidates, EGFR (epidermal growth factor receptor)mutations are biomarkers available as predictive factors for EGFR tyrosine kinase inhibitors and UGT(uridine diphosphate glucuronosyltransferase)1A1 as a risk predictor of irinotecan in the present practice. Novel potential biomarkers for prognostication have been developed by genomic methods. Biomarker development for early detection is much awaited for the future.

[The efficacy of influenza vaccine for acute exacerbation of chronic obstructive lung disease in elderly patients].

OBJECTIVE: Acute exacerbations adversely affect the quality of life and prognosis of patients with chronic obstructive lung disease (COPD). Prevention of future exacerbations is extremely important, especially for elderly patients. In this study, we evaluated the efficacy of influenza vaccine for acute exacerbation of COPD in elderly patients. METHODS: A prospective cohort study was conducted among 289 patients over 65 years of age with COPD (FEV1/FCV<0.70) during the 2001-2002 influenza season. Background data, outpatient visits for wheezing and hospitalizations were compared between the vaccinated group (n = 189) and the unvaccinated group (n = 100). RESULTS: The number of patients who visited hospital for wheezing was 11 of 189 (5.8%) in the vaccinated group and 23 of 100 (23%) in the unvaccinated group (RRR: relative risk reduction 74.7%, 95% CI: confidence interval 0.51-0.87). The number of hospitalizations for pneumonia was 8 of 189 (4.2%) in the vaccinated group and 14 of 100 (14%) in the unvaccinated group (RRR 69.8%, 95% CI: 0.32-0.87). The costs of hospitalization were lower in the vaccinated group with direct savings of 91,525 yen per patient. CONCLUSIONS: For elderly COPD patients, influenza vaccine decreases acute exacerbation due to pneumonia and bronchoconstriction, and also may minimize the costs of hospitalization.

[Effectiveness of inhaled corticosteroids (ics) combination therapy; the addition of qvar to flutide].

PURPOSE: We recently reported treatment of asthmatic patients with a combination of FP-DPI 800 microg/day and BDP-HFA 400 microg/day. This regimen induced significant improvement in subjective symptoms and pulmonary function tests. This led us to study the additive effect of BDP-HFA 400 microg/day for seven unstable severe persistent bronchial asthma patients. RESULTS: PEF improved, daily (circadian) variation was minimized and FVC and FEV1.0 testing showed slight improvement. V25/height also revealed significant improvement. The more peripheral the airways are, the greater improvement was observed. The annual emergency admission rate of 4.6 times per patient decreased to 2.1 times after the addition of BDP-HFA 400 microg/day. All the three cases dependent on oral steroid medication could be removed from the drug and 6 out of 7 cases were able to lower the dose of anti-asthmatic drugs. CONCLUSIONS: The effectiveness of inhaled corticosteroids (ICS) differs based on the site reached in the bronchi and depending on the inhalation devices used. Addition of a second ICS has the potential to further alleviate symptoms of unstable asthmatics on conventional therapy with ICS and other drugs.