Sequential two-line strategy for stage IV non-small-cell lung cancer: docetaxel-cisplatin versus vinorelbine-cisplatin followed by cross-over to single-agent docetaxel or vinorelbine at progression: final results of a randomised phase II study.

BACKGROUND: This phase II trial compared docetaxel-cisplatin (DC) with vinorelbine-cisplatin (VC), both as first-line therapy followed by cross-over at progression to single-agent vinorelbine or docetaxel in advanced non-small-cell lung cancer (NSCLC). METHODS: Overall, 115 patients received DC (docetaxel 75 mg/m(2) and cisplatin 100 mg/m(2) both on day 1, every 3 weeks, arm A1) and 118 VC (vinorelbine 30 mg/m(2)/week on days 1 and 8 and cisplatin 100 mg/m(2) on day 1, every 3 weeks, arm B1) for six cycles, and subsequently maintained by monotherapy with docetaxel (A1) or vinorelbine (B1) with cross-over on disease progression to vinorelbine 30 mg/m(2) days 1 and 8 (A2), or docetaxel 100 mg/m(2), day 1, both every 3 weeks (B2). The primary end point was overall response rate (ORR). RESULTS: Patient characteristics were balanced; median follow-up was 8.8 months. First-line response rate was 33.9% with DC and 26.3% with VC (P=0.20). In arms A1 and B1, respectively: duration of response was similar (8.2 versus 8.4 months); median time to progression was 5 months in both; median survival was 8 versus 9 months (P=0.38); 1-, 2- and 3-year survival was 36% versus 35%, 17% versus 10% and 13% versus 6% (P not significant). However, with a low number of long-term survivors, statistical significance was not reached. Overall, almost half of the patients crossed over to second-line therapy; there were no response with vinorelbine and 6 (11.2%) partial responses with docetaxel. Considering the safety profile, the occurrence of febrile neutropenia was 9.6% with DC and 26.3% with VC. Treatment-related mortality was 2.5% with DC and 8.5% with VC. CONCLUSIONS: The trend in favour of the DC arm in ORR, even though statistical significance was not reached, is consistent with previous reports. This study suggests an activity of first-line DC in advanced NSCLC, and that second-line vinorelbine does not provide additional clinical benefit. As already shown in other studies, the use of DC in first-line should provide a better percentage of long-term survivors, despite the absence of efficacy of the second-line in our study.

[Pneumonitis caused by hydrocarbon inhalation]. / Pneumopathies par inhalation d'hydrocarbures volatiles.

INTRODUCTION: Kerosene pneumonitis is rare. It most commonly occurs in children who have ingested a hydrocarbon by accident. In adults, pneumonitis caused by aspiration of incompletely vaporized kerosene may be seen in fire-eaters can cause pneumonitis. CASE REPORTS: We report six cases of fire-eater's pneumonitis, from our region, due to hydrocarbon inhalation. CONCLUSIONS: This inhalational pulmonary insult has classical clinical manifestations. The frequency of cases, particularly in tourist areas that host street festivals, is probably underestimated. Its tendency to spontaneously resolve questions the need for antibiotics and corticosteroids.

[Meningococcal pneumonia]. / La pneumonie à méningocoque.

Meningococci can cause primary bacterial pneumonia. The clinical picture is non-specific and the clinical course leads to meningeal infection. Diagnosis is based on isolation of Neisseria meningitidis in lung samples. Outcome is usually favourable.

[Pulmonary metastasis of a uterine epithelioid leiomyosarcoma]. / Métastase pulmonaire d'un léiomyosarcome épithélioïde utérin.

We report a case of patient presenting with a very large pulmonary metastasis which revealed a previously unrecognised uterine epithelioid leiomyosarcoma. This is a rare tumour with a poor prognosis. The treatment of both the primary tumour and the metastasis was surgical.

[Pleural manifestations of secondary monoclonal dysproteinemia (apropos of 4 cases)]. / Manifestations pleurales au cours de dysprotéinémies monoclonales secondaires (à propos de 4 observations).

A pleural effusion with monoclonal macroglobulinemia is not unusual outside Kahler and Waldenström diseases which are the two commonest. It can occur in lymphoid leucosis with plasma concentration peaks, where surface immunoglobulins play an important part, and in some epithelial cancers. As in primitive macroglobulinemia the plasma concentration peak corresponds to pleural globulin modifications. But it seems that, whatever the variations of pathological immunoglobulins, the pleural lymphocytes, predominant in the effusion, play an active part due to various etiological stimulations.