Abstracts/Lung Cancer 12 (1995) 265-329

Currcnt management of unrescctable non-small cell lung cancer Livingston RB, Gralla R, Coltman CA Jr, Crawford J, ‘+bkes EE. Division o/ Oncology Unit! oJ Washington Medical Cenfn: 1959 NE PaQic SI. Seartie, WA 98195. Scmin Oncol 1994;21:Suppl. l&4-13.

Historically, the standard treatment for Unmsectabk non-small cell lung cancer was radiation therapy. Data are now accumulating, however, to indicate that combined chemotherapy and radiation therapy is superior to radiation therapy alone, although it remains uncertain whether concumnt chemotherapy with radiation lherapy yields better results than a sequential approach. It is clear that surgical resection is feasible in most patients following ncoadjuvant chemotherapy with or without radiation therapy, hut whether surgery contributes to survival has not been established, a raodomized intergroup study in stage Ills f.N2) disease addresses this question. The Southwest Oncology Group reports comparable resectability rates and survival in patients with stage IIla and IIIb disease who received concurrent chemotherapy and radiation therapy followed by resection. Stage IV disease has traditionally been managed by supportive care alone and chemotherapy. In selected patients, statistically significant cff~ts on survival have been seen in five randomized trials of platinum-based chemotherapy, one of which had a control arm of supportive care alone. As single agents, only carboplatin and vinorelbinc (Nsvclbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabn Medicament, Paris, France) have demonstrated a survival advantage over other regimens in randomized trials, although cisplatin appears to producz similar results. Data from French stodies indicate that cisplatin plus vinorelbine is superior to vindesine plus cisplatin and to vinorclhinc alone. Several agents appear interesting on the basis of reported response rates in phase II trials: these include paclitaxel (Taxol; Bristol- Myers Squibb Co, Princeton, NJ), docetaxel (Taxotcn; Rbone- Poulmc Rarer, Collcgeville, PA), irinotecan (CPT-II), cdatrexate, and gcmcitabine. Response rates are notoriously variable in this disease, however, and correlate poorly with survival effects. Randomized trials are needed to determine the value of these new agents.

Small cell lung cancer Analysis of factors influencing the response to trcatnjwt and survival De Wet M, Falkson G, Rapoport BL. Deportmenf oJMedica/ Oncology, University of Pretoria. Pretoria 5501. Oncology (Switzerland) 1994;51:523- 34.

The aims of this study were to identify prognostic factors in patients (pts) with small cell lung cancer and to identify dominant prognostic factors independent of disease stage, to define prognostic subsets through recursive partitioning and amalgamation (RPA) and to analyze the clinical characteristics of long-term survivors. The prognostic significance of 27 pre-treatment variables was evaluated in I44 pts seen at a single institution. The current study confirmed the superior outcome for pts with limited disease (L.D) in terms of response, response duration, time to treatment failure and survival when compared to those with extensive disease (ED). None of the variables independently predicted for response in patients with LD. Rcsponsc correlated significantly with a good pcriormsnce status (I’S) for pts with ED and for the whole group. A good PS was the most significant predictor for prolonged survival in pts with LD. In ED a longer survival was associated wdh a normal pre-treatment albumin value, absence of weight loss and female gender. When the whole group was considered, PS and number of metastatic sites were identified as the most influential factors for survival independent of disease stage. RPA analysis defined 3 prognostic subsets based on stage of disease, PS and number of metastatic sites. The best survival rates were seen in pts with LD with a good PS and pts with ED, only one metastatic site and a good PS. I I% of pts survived > 2 years (18% LD, 6% ED) A complete response to chemotherapy was the most important predictor for long-term survival. Comparison of the data from this study with published results of protocol stodics showed similar outcomes.

Treatment of advanced non-small cell lung cancer Shepherd FA. FRCPC, Tomnto Hospital, 200 Elizabeth SI, Toronto, Onl. MSG 2C4. Semin Cncol 1994;2I:Suppl 7:7-l&

Lung cancer is now the leading CILUSC of cancer-related mortality for men and women in North America. Non-small cell lung cancer (NSCLC) accounts for more than three quarters of all primary lung tumors. Chemotherapy, however, has had little impact on the survival of patients with NSCLC. Agents like cisplatin, ifosfamide, and mitomycin, used singly and as part of combination

regimens, have shown some activity in NSCLC, but have had only a modest effect on the long-term survival of patients with locally advanced sod disseminated disease. Combination chemotherapy and promising new agents like gemcitabinc, vinorelbine, paclitaxel, and docetaxel warrant forther study, as does the use of chemotherapy in novel combined-modality regimens. For patients with locally advanced disease (stages IIIA and IIIB), the goal of chemotherapy must be to increase cure rates, whereas for patients with advan.& disease (stage IV), palliation of symptoms and prolongation of S U N ~ V S I with an improvement in the quality of life represent reasonable treatment goals.

Practical nppmacbcs to the treatment of patients with extensive stage small cell lung cancer Greco FA, Ha&worth JD. S. Cannon (Minnie Pearl) Cancer Ctr, 250 25th Aw N, Nashville, TN 37203. Semin Oncol 1994;2I:Suppl. 7:3-6.

Although initially extremely sensitive to many chemotherapeutic drugs and radiotherapy, ultimately small cell lung cancer (SCLC) is a progressive and fatal disease. Stage of disease is a major prognostic factor in the treatment of SCLC patients. Patients with limited stage disease have approximately a 10% chance of long-term (>5 years) disease-free survival, whereas those with extensive stage disease are incurable with currently available therapy. In extensive stage disease, patients with a good performance status and younger than 65 years of age are ideal candidates for trials using intensive standard chemotherapy or experimental modalitie& most patients, however, including those who are elderly and medically unfit, are best treated conservatively with single-agent etoposide. Various types of therapy, including intensive induction chemotherapy and consolidation regimens, have been unable to improve survival rates in extensive stage SCLC. Thus, until better treatments are developed, the goal of therapy for extensive stage SCLC should be adequate palliation and prolongation of quality survival.

Miscellaneous

Quality of life in patients with lung cancer Pavlovic N, Pavlovic M. INA-Najhpfin. Grupo zo Socijolni Rod, Zagreb. Acta

Clin Cmst 1994;33:171-80. A large number of papers published in the medical literature advocate a

comprehensive approach to the problems of somatic patients, which would include both prevention of adverse psychological responses to the underlying disease and treatment of these responses and of their complications, in order to ensure a better quality of life. In this study, analyzed were the effects of the patients’ mental elaboration of somatic occurrences on their social functions and quality of life. The patients stodied had caneor of the lungs. An attempt was made to determine the degree of their adjustment to the discasc, i.e. in what way is their behaviour determined by the pathologic process itself, in view of their capacity to recognize and interpret their symptoms and their severity. Another goal of the study was to determine the natare and, extent of the patient’s mental problems, the family’s acceptance of the patient’s illness and the patient’s response to this acceptance Analyzed was also the extent to which the patient’s beheviour was determined by the attitude of the society to the patient and the type of disease he is suffering from. The crucial problem is in what way will the patients experience psychosocial support, i.e. how will they relate themselves to others and others to themselves. Lung cancer patients have beco found to experience their somatic condition realistically and their anxiety corresponded to their condition. Their high level of depression and significantly lower level of anxiety and need for close relationship with others indicated good acceptance of the disease and need for psychosocial support. The patients’ attitude to the disease and the accompanying psychologic difficulties point to the need of better education of the medical personnel, family members and general society to ensure adequate psychosocial support and better quality of life to lung cancer patients.

Should we reestablish the lung cancer study group? Rusch VW. Memorial Sloan-Keuering Cancer Cw, 1275 York Ave. New York, NY 10021. Chest 1994;106:Suppl:408S-10s.

The hallmark of the Lung Cancer Study Group (LCSG) was its multidisciplinary approach to cancer management, based on close collaboration among thomcie surgeons, medical oncologists, radiation oncologists, pathologists,