Spontaneous pneumothorax due to bronchopleural fistula following reirradiation for locoregionally recurrent squamous cell lung cancer.

Spontaneous pneumothorax following radiotherapy for pulmonary malignancy is an unusual clinical condition. Here, we report a case of a 78-year-old male suffering from dyspnea during radiotherapy for squamous cell lung cancer of the right main bronchus. Imaging studies and fiberoptic bronchoscopy revealed that pneumothorax was due to a bronchopleural fistula.

Erlotinib is a well-tolerated alternate treatment for non-small cell lung cancer in cases of gefitinib-induced hepatotoxicity.

AIM: To evaluate the tolerability and efficacy of erlotinib treatment in advanced non-small cell lung cancer (NSCLC) patients who had previously experienced severe hepatotoxicity after gefitinib treatment. PATIENTS AND METHODS: Twenty-five NSCLC patients with epidermal growth factor receptor (EGFR) mutation were initially treated with gefitinib (250 mg/day). However, 7 of these experienced severe hepatotoxicity. After recovery from hepatotoxicity, treatment was switched to erlotinib (150 mg/day) in all 7 patients. Toxicity and efficacy of erlotinib were analyzed. RESULTS: None of the 7 patients reported severe hepatotoxicity with erlotinib despite gefitinib-induced severe hepatotoxicity. All patients achieved response with gefitinib or following erlotinib treatment. The response achieved with gefitinib was maintained after switching to erlotinib. Therefore, an excellent median progression-free survival of 372 days was achieved although gefitinib induced severe hepatotoxicity. CONCLUSION: Erlotinib treatment was efficient and well-tolerated in NSCLC patients with EGFR mutation, despite their severe hepatotoxicity with prior gefitinib treatment.

Phase II trial of amrubicin for second-line treatment of advanced non-small cell lung cancer: results of the West Japan Thoracic Oncology Group trial (WJTOG0401).

BACKGROUND: Amrubicin is a synthetic anthracycline drug that is a potent inhibitor of topoisomerase II. We have performed a multicenter phase II trial to evaluate the efficacy and safety of amrubicin for patients with previously treated non-small cell lung cancer (NSCLC). METHODS: Patients with advanced NSCLC who experienced disease recurrence after one platinum-based chemotherapy regimen were eligible for enrollment in the study. Amrubicin was administered by intravenous injection at a dose of 40 mg/m2 on 3 consecutive days every 3 weeks. RESULTS: Sixty-one enrolled patients received a total of 192 treatment cycles (median, 2; range, 1-15). Response was as follows: complete response, 0; partial response, seven (11.5%); stable disease, 20 (32.8%); and progressive disease, 34 (55.7%). Median progression-free survival was 1.8 months, whereas median overall survival was 8.5 months, and the 1-year survival rate was 32%. Hematologic toxicities of grade 3 or 4 included neutropenia (82.0%), leukopenia (73.8%), thrombocytopenia (24.6%), and anemia (27.9%). Febrile neutropenia occurred in 18 patients (29.5%). One treatment-related death due to infection was observed. Nonhematologic toxicities were mild. CONCLUSIONS: Amrubicin is a possible alternative for second-line treatment of advanced NSCLC, although a relevant hematological toxicity is significant, especially with a febrile neutropenia.