Abstracts/Lung Cancer II (1994) 123-150 149

in persons 55 years or younger, while there has been almost a 20% increase in mortality in older patients. Although maay factors may account for the increased incidence as well es the higher mortality from cancer in elderly persons, it is clear that specifically designed therapeutic approaches must be developed for the elderly population. Among patients with small cell lung cancer (SCLC), 20-25% will be 65 years or older at diagnosis. For these patients the use of oral etoposide alone, administered over 5 days, gives treatment results comparable to more intensive schedules that frequently require hospitalization. The use of oral etoposide in this group permits successful treatment of SCLC with minimum morbidity and mortality. This in turn may lead to a marked improvement in quality of life and overall survival in elderly SCLC patients.

Treatment options for patients with relapsed small cell lung cancer Greco FA. S. Cannon (Minnie Pearl) Cancer Cw., 250 25th Avenue Norrh, Nashville, ZN 37203. Lung Cancer (Ireland) 1993;9 Suppl l:S85-9.

The majority of patients with small cell lung cancer eventually develop progressive metastatic tumor in spite of initial cytotoxic therapy. Many of these patients are candidates for other forms of therapy. Most of thebest drugs were found to be useful for these patients before subsequently beiig incorporated into primary therapy. Several clinical feature8 (e.g. time since last chemotherapy, performance status) give some indication as to the possibility of clinical benefit from secondary therapy. Gniy a few drugs are currently useful for sek?cted patientswho havepreviously receivedetoposidelcisplatin radiotherapy. This brief review discusses the issue of treatment options for patients with progressive tumor after primary therapy.

The role of colony-stimulating factors in small cell lung cancer Bishop JF. Dept. of H~ology/Medical Oncology, Peter MacCallum Cancer Inwinue, 481 Link Longsaide Sweet, Melbourne, Vie. 3ooO. Lung Cancer (Ireland) 1993;9 Suppl l:S75-3.

Colony stimulating factors (CSFs) stimulate proliferation anddifferen- tiation of hematopoietic progenitor cells. Possible uses for these ageots iu the treatment of patients with small cell lung cancer (SCLC) are to speed neutrophil recovery in patients with febrile neutropenia following chemotherapy, to protect patients prupbylactically from febrile neutropenia with standard dose chemotherapy, and to allow possible chemotherapy dose escalation. Dose intensification can occur with CSF alone or following autologous bone marrow transplantation. Peripheral stem cell harvests following in vivo stimulation with CSFs provide a further technique for chemotherapy dose escalation. These new techniques may allow repeated dosing with high-dose chemotherapy in SCLC patients and hold some promise for eventually improving outcome in this disease.

Extensive small cell lung cancer: Trials of Indiana University and the Hoosier Oncology Group Loebrer PJ Sr, An& R, Einhom LH. Indiana University Hospital, 926 Wart Michigan Street, Indianapolis, IN 46202. Lung Cancer (Ireland) 1993;9 Suppl l:S41-9.

Significant advances in the therapy of extensive SCLC have occurred during the past two decades. The first major step involved the incorporation of active single agents into combination chemotherapeutic regimens, suchas CAV. Duringthepastdecadetheplatticompounds (cisplntin, carboplatin) and the epipodophylotoxius (etoposide, teniposide) also have beea included in induction and salvage regimens for patients with SCLC. More recently, trials in previously untreated or

minimally treated patients have revealed activity of several compounds such as ifosfamide and teniposide, as well as P potentially emerging role for chronic oral administration of etoposide. Numerous trials are currently being conducted by the HOG and others, and it is hoped that their results will elucidate the optimum role of ifosfamide and daily oral etoposide therapy in SCLC. Clearly, carefully designed prospective, randomised trials are necessary to weigh accurately potential benefits against the cost, morbidity, and mortality of treatments.

Extensive small cell lung amcer CO& RL. Medical Science, Fox Chase Cancer Center, 7701 Burholme Aw, Phikuklphia, PA 19211. Lung Cancer (Ireland) 1993;9 Suppl l:S27-39.

Despite significant advances in the treatment of small cell lung CBncer (SCLC), complete response and survival rates have remained essentially stable, and a variety of strategies have been implemented in attempts to improve therapeutic impact. Increasing dose intensity, for example, has been evaluated in studies of dose d&ion, altemating combinations of drugs, and weekly dose-intensive regimns. Although there has been someindicPtioathrteid~ci~la~ may pmvideasmall, reproducible benefit in the treatment of limited SCLC, there is no evidence that such is the case in the extensive-disease setting. With currently available drugs, extensive SCLC remains a disease not curable by chemotherapy. In fact, studies combining agents with proven single-agent activity suggest theexistenceofaresistantcoreof SCLCcellsthatareiitive to current therapies. Thus, it is essential that new agents with tNly unique mechanisms of action be developed. It is also imperative that the role of biologic tools, such as the interfemns, interleukin-2, moaoclomd antibodies and anti-growth factor strategies, be aggressively studied if we are to improve the current climate of treatment for extensive SCLC.

Treatment of limited-stage small cell lung cancer: Recent progress and future directions Johnson DH. Division of Medical Onculogy, 1956 Vanderbilt Clinic, Narhdlle, 7’N37232-5536. Lung Cancer (Ireland) 1993;9 Suppl l:Sl- 19.

Small cell lung cancer (SCLC) is a common, largely preventable malignancy seen almost exclusively in smokers. Since the late l%Os, it has been recognized that SCLC is a systemic process that is not curable with surgery or thoracic radiotherapy alone. Accordingly, these patients are typically treated with combiion chemotherapy irrespective of stage at diagnosis. Unfortunately, patients with extensive stage disease are rarely cured, evea with aggressive treatment. On the other hand, patients with limited-stage disease sometimes experience long-term progression-free survival with chemotherapy with or without thoracic radiotherapy. Of the more than 40 Ooo cases of SCLC that will be diagnosed in the United States in 1992, approximately 25-50 96 will have limited-stagedisease.Thus, asmanyas20000patientshaveapotentially curable malignancy. Definite progress has been made in the treatment of limited-stage SCLC.

Future directions in the management of non-small cell lung cancer Bunn PA. University of Colorado Cancer Center, Box BlSS. 4200 East !%h Avenue, Denver, CO 80262. Lung Cancer (Ireland) 1993;9 Suppl 2:S91-107.

In the past decade we have witnessed major advances in both the treatment and biologic understanding of lung cancer. There is evidence for the first time that chemotherapy with cisplatin-based regimens has a small, but definite, effect on overall survival in Stages II-IV non-small cell lung cancer (NSCLC). The discovery of activation and mutations