Development of a Conceptual Model of the Patient Experience in Small Cell Lung Cancer: A Qualitative Interview Study.

INTRODUCTION: Small cell lung cancer (SCLC) is a subtype of lung cancer, the second most common cancer diagnosis worldwide. Currently, there is little published qualitative research that provides insight into the disease-related symptoms and impacts that are relevant to patients living with SCLC as directly reported by patients themselves. METHODS: This qualitative, cross-sectional, noninterventional, descriptive study included concept elicitation interviews with participants diagnosed with SCLC and the development of a conceptual model of clinical treatment benefit. RESULTS: Concept elicitation interview data from 26 participants with SCLC were used to develop a conceptual model of clinical treatment benefit that organized 28 patient-reported concepts into two domains: disease-related symptoms (organ-specific and systemic) and impacts. Organ-specific symptoms included cough, chest pain, and difficulty breathing. Systemic symptoms included pain, fatigue, appetite loss, and dizziness. Impacts included physical functioning, role functioning, reduced movement, impact on sleep, and weight loss. CONCLUSION: As evidenced by this study, people with SCLC experience considerable and significant symptoms and impacts, including physical and role functioning challenges, that affect their quality of life. This conceptual model will inform the design of a patient-reported outcome (PRO) questionnaire for a future SCLC clinical trial, helping to establish the content validity of the items and questionnaires used in the trial and ensuring that the questionnaires and items selected are appropriately targeted to the population. This conceptual model could also be used to inform future SCLC clinical trials.

Comparison of a gene expression profiling strategy to standard clinical work-up for determination of tumour origin in cancer of unknown primary (CUP).

CupPrint® is a genomic signature able to identify 47 different cancer types. The aim of our study was to compare the accuracy of this genomic signature to that of a full clinical work-up in diagnosing the primary tumour site. Patients with newly diagnosed, untreated metastatic tumours were eligible for this trial. The clinical work-up and gene expression profiling on a biopsy from a metastatic site were started at the same time. The study was planned using a one-stage Fleming design. Patients in whom no primary site was diagnosed by the clinical work-up were excluded. Out of the 67 patients registered, the primary site was identified by clinical work-up in 36 patients, and diagnosis with CupPrint was obtained in 53. There were 31 evaluable patients with both clinical and CupPrint diagnoses, and out of these a similar diagnosis was obtained in 11 patients, i.e. the concordance rate was 35% (95% confidence interval: 19-55%). The median time to diagnosis through the clinical work-up was 48 days, and 10 days with CupPrint (P<0·001). We concluded that in patients with newly diagnosed metastatic tumours, CupPrint has low accuracy in diagnosing the primary cancer site.

First-line systemic treatment of ovarian cancer: a critical review of available evidence and expectations for future directions.

PURPOSE OF REVIEW: Epithelial ovarian cancer (EOC) is a prevalent gynecologic malignancy whose prognosis in most cases remains poor despite advances in therapy. In this article, we critically review the available clinical evidence for the choice of first-line chemotherapy in EOC and discuss promising therapeutic strategies. RECENT FINDINGS: In the last 25 years, first-line chemotherapy regimens and the indication of systemic treatment for early-stage disease have been better established. Significant progress has been made in the treatment of advanced EOC with the optimization of the carboplatin plus paclitaxel regimen and the use of intraperitoneal chemotherapy for selected patients. Targeted therapies may be approved for EOC in the near future and this would bring more specific treatments and improve outcomes for patients. Validated biomolecular signatures to better define prognosis and to predict response to therapeutic agents are still lacking. SUMMARY: The standard first-line chemotherapy in EOC is based on the doublet carboplatin plus paclitaxel. It may be possible to improve the efficacy of treatment by means of a more intensive dose-dense regimen or by the intraperitoneal delivery of chemotherapy. Significant improvements in the treatment of EOC are expected from the development of antiangiogenic and other targeted agents and from better patient selection.

Molecular targeted therapy in prevalent tumors: learning from the past and future perspectives.

Important advances have been achieved with molecular targeted agents in clinical oncology. Breast, colon, and lung cancer, are now commonly treated with a combination of chemotherapy and targeted agents. In this article the authors discuss the limitations of targeted therapy development, failures of previous studies, and possible strategies for an intelligent drug development. Initial attempts to block mTOR in breast cancer, the magnitude of benefit obtained with anti-EGFR therapy in lung cancer, and the narrowing use of anti-EGFR therapy in colon cancer based on KRAS status are discussed.

Changing the clinical picture of challenging tumors: tales becoming reality?

The treatment of neoplastic diseases has become increasingly dependent on tumor biology and is focused on targeted therapy. Understanding complex networks of intracellular signaling pathways, blockades of specific targets and a myriad of other approaches has brought new fuel to the battle against many types of cancer. Unfortunately, the degree of benefit achieved in this new era of cancer treatment has not been distributed homogeneously among the different disease types. Neoplasms with lower incidence rates, but that are also highly challenging, are not consistently given due attention by research leaders. This article aims to evaluate new insights and potential gains obtained with new therapies in a particular group of tumors: those rarely debated in clinical practice, but which still pose a considerable challenge to clinical oncology.

Larotaxel: broadening the road with new taxanes.

Significant advances in cancer treatment have been achieved with novel targeted and state-of-the-art treatments. While the targeted treatments have received much attention in recent years, the more 'traditional' chemotherapeutic agents continue to play an important role in several malignancies. Former taxanes such as docetaxel and paclitaxel, with their broad anticancer activity, have contributed significantly to the improved treatment of a number of neoplastic diseases. Unfortunately, until now, the achievements obtained with these compounds have been mitigated by clinical limitations such as acquired or intrinsic resistance of tumors, poor CNS activity, allergic reactions and unfavorable toxicity profiles. Larotaxel (RPR 109881A) is a taxane analogue with a broad spectrum of activity and different toxicity profile and with the possible advantages of surpassing some mechanisms of resistance and penetrating into the CNS. The development path of this drug, its core clinical data and future treatment perspectives are discussed in this article.