Drug prolongs life expectancy for lung cancer patients (AFP-2/06/2008)

The cancer drug Erbitux prolonged the lives of patients with advanced lung cancer by five weeks, according to a new clinical study described as an important gain for such individuals. "Patients with advanced NSCLC (non-small cell lung cancer) have limited treatment options and life expectancy is short, so the survival increase shown in this study is an important step for these patients," said Robert Pirker of the Medical University of Vienna, a lead investigator in the study. Lung cancer patients typically have a 30 percent chance of living a year and a one to two percent chance of surviving five years, Pirker explained Sunday at the 44th annual conference of the American College of Clinical Oncology. "It's a very moderate gain, but it's a positive step in the world's number one cause of cancer death," said Roy Herbst of the M.D. Anderson Cancer Center at the University of Texas, who was not a participant in the study. Erbitux is currently approved for treating colorectal cancer and cancers of the neck and head. It was developed by US firm ImClone Systems and sold in partnership with Bristol-Myers Squibb in the United States, and by Germany's Merck elsewhere in the world. The clinical trial financed by Merck involved 1,125 patients in 30 countries with lung cancer that had already metastasized, or spread to other parts of the body. Patients treated with Erbitux combined with chemotherapy lived a median 11.3 months, compared to 10.1 months for a control group given just chemotherapy.

Pirker called the results statistically significant and said, "The results clearly establish cetuximab in combination with chemotherapy as a new standard in first-line treatment of NSCLC." The results varied depending on the ethnicity of the recipient. Asians had seen a net gain of two months, or double the increased life expectancy of Caucasians, Pirker said. Erbitux could potentially compete with Avastine of the US firm Genentech as a treatment option. An initial trial of the latter drug showed a median gain in life expectancy of two months in patients with advanced stage cancer. A second Avastine trial did not confirm those results, however, but showed the drug having no effect. Lung cancer is one of the most common and deadly forms of the disease. There will be 215,000 new cases in the United States in 2008 -- 15 percent of all US cancers -- and 161,849 will die from lung cancer, accounting for 28.6 percent of all cancer deaths, according to the American Cancer Society. Worldwide, 1.3 million people died of lung cancer in 2005, according to the World Health Organization. Health experts expect to see a sharp rise in the incidence of the disease due to smoking. Meanwhile, a different study presented by the Anderson Cancer Center in Houston, Texas, argued that the anti-inflammatory drug Celebrex, used in high doses, could slow down the development of lung cancer among smokers. Celebrex appeared to be able to block an enzyme known as COX-2, which in previous studies was linked to this type of cancer, viewed around the world as one of the most widespread and dangerous, according to the research.

"We cannot sit here and say that taking celecoxib is going to prevent lung cancer," said Doctor Edward Kim, the main author of the study. "What we do know was that Celebrex, when taken over a three- or six-month period, was safe to administer even at a higher dose of 800 milligrams daily." Tim Olivier, a professor emeritus of medical oncology at Saint Bartholomew's Hospital in London, argued in his study that a single dose of chemotherapy could be as effective as radiological therapy in treating early stages of testicular cancer. "This study establishes surgery followed by carboplatin chemotherapy as a safe new alternative for patients who have early stage seminoma and would prefer a treatment that lasts a shorter period of time," Olivier said.

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Personalized cancer therapy found valuable (Yahoo News-21/05/2008)

U.S. medical scientists said they've conducted a trial that supports first-line use of targeted therapy to treat lung cancer. The Massachusetts General Hospital Cancer Center researchers said the study -- the first such U.S. clinical genetic screening trial -- supports the use of targeted therapies as primary treatments, rather than only after standard chemotherapy has failed. Investigators found gefitinib (Iressa) treatment considerably improved the outcomes for non-small-cell-lung-cancer, although additional research is required before such a strategy can be used for routine treatment. "This is a pivotal clinical trial that demonstrates the power of personalized medicine in lung cancer treatment," said Dr. Lecia Sequist, who led the study. "It is an exciting glimpse into what we hope is the future of cancer care. Instead of a 'one size fits all' therapy, we are moving towards finding the best treatment for each patient." The report appears in the Journal of Clinical Oncology.

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Ventilator Relieves Lung Cancer Pain in Final Hours (HealthDay-20/05/2008)
 
New research suggests that a mechanical ventilator can ease suffering and help lung cancer patients avoid sedation at the end of life. A large percentage of these patients didn't want to have anything to do with a ventilator, which requires them to wear an oxygen mask. But those who were willing to try the treatment needed less morphine and had fewer symptoms in their final hours. The findings could change the way doctors treat lung cancer patients in the end stages of their disease, said study author Dr. Stefano Nava, chief of the respiratory critical care unit at Istituto Scientifico di Pavia in Italy.  According to Nava, the ventilator approach could "provide some relief to patients and a better quality of dying." At issue are lung cancer patients who typically only have a matter of hours or days to live. They often suffer from pain and difficulty breathing. One approach is to help the patients breathe with the use of oxygen that reaches their lungs through nasal tubes. This approach, known as standard oxygen therapy, is used by many patients with lung conditions. Another approach relies on mechanical ventilators, which use pressure to push oxygen into the lungs. The ventilators require the use of a face mask. According to Nava, no studies have compared the two approaches in end-stage lung cancer patients. Nava and his colleagues in Italy and Spain randomly assigned 92 patients to either of the two treatments. Eighteen other patients declined to accept the ventilator treatment after trying out the masks; another five declined after trying the standard oxygen treatment. The findings were scheduled to be released Tuesday at the American Thoracic Society's International Conference, in Toronto.

The researchers found the ventilator treatment reduced discomfort and difficulty breathing at one, three and 24 hours. It took three hours for those on the standard oxygen therapy to experience improvement. The patients on ventilators also needed much less morphine. Dr. Neil Schachter, a professor of pulmonary medicine, said the findings could help doctors make better decisions. "There now appears to be an alternative way of making what is really a very horrible situation more comfortable for the person who is dying," said Schachter, medical director of the respiratory care department at Mount Sinai Medical Center in New York City. The ventilator treatment appears to reduce the sensation of breathlessness in the patients. That, he said, could mean less need for sedation. "By doing it in this way, you're not sedating them, making them go to sleep," he said. "They can presumably have a better interaction with their family in these last moments." In another study to be released at the conference Tuesday, Veterans Administration-funded researchers report that so-called "pulmonary rehabilitation" -- which includes counseling and instruction in lung exercises -- provides less relief for patients with chronic obstructive pulmonary disease if given late in the course of their disease. The finding, "suggests that treatments for end-stage patients with COPD may still be effective and introducing exercise training sooner in the course of their disease results in more improvement," lead researcher Bonnie Steele, a respiratory clinical nurse specialist at the VA Puget Sound Health Care System in Seattle, said in a statement.

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Blood test could detect early lung cancer:(AFP-19/05/2008)

 A blood test for certain genes may be more effective at detecting early stage lung cancer than current methods such as CT scans and biopsies, researchers said Monday. The new test looks at gene expression in the patient's white blood cells, according to lead researcher Anil Vachani, assistant professor of medicine at the University of Pennsylvania. "We found that the types of genes present in these cells could tell us whether or not cancer was present," Vachani said. Researchers studied a group of 44 people known to have early stage lung cancer and a control group of 52 subjects of comparable age, sex, race and smoking status. By comparing various genetic arrays to determine the best combination for detecting cancer, researchers settled on a 15-gene array that showed 87 percent accuracy in detecting lung cancer. In comparison, CT screening "results in the detection of lung nodules in 20 to 60 percent of subjects," said Vachani. "This high false-positive rate requires patients to undergo extensive follow-up investigations, such as serial CT scans, PET scans or biopsies," she said. The study suggested that "lung cancers interact with circulating white blood cells and change the types of genes that are active in these cells," she said, adding that she hoped to expand the research and perhaps pursue a clinical trial of the larger population. "A diagnostic test that could more accurately determine the risk of cancer in patients would be extremely valuable and have very important economic implications by reducing unnecessary surgery, biopsies and repeated imaging tests," she said. The research is to be presented at American Thoracic Society's 2008 International Conference in Toronto on Tuesday.

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Post-Surgery Exercise Benefits Lung Cancer Patients (Yahoo News-8/05/2008)

Patients who have undergone surgical procedures for the removal of lung cancer can tolerate and benefit from exercise regimens started just a month after surgery, according to a new study led by researchers at the Duke Comprehensive Cancer Center. "Previous studies have demonstrated that exercise can benefit cancer survivors but lung cancer patients have been a particularly challenging group, because surgery on the lung was perceived to have a restrictive effect on the amount of exercise a person can do," said Lee Jones, Ph.D., a researcher at Duke and lead investigator on the study. "Our study showed that this population can not only tolerate exercise but that it can lead to improved tolerance for exercise, and better quality of life." This study lays the foundation for future studies looking at the effect of exercise on survival in lung cancer patients, Jones said. The researchers will share their findings in a poster presentation on Sunday, June 1, at this year's American Society of Clinical Oncology meeting on May 31, in Chicago. The study was funded by the Lance Armstrong Foundation. This study followed 20 newly diagnosed lung cancer patients, who had undergone surgery. Participants had been diagnosed with Stage I to Stage IIIb cancer. The patients were expected to participate in three hour-long exercise sessions per week, on stationary bikes. The study lasted 14 weeks. 

The attendance rate for the exercise sessions was nearly 85 percent, and patients were less fatigued and gained greater aerobic fitness over the course of the study, as measured by what is known as a "maximal exercise test," similar to the type Lance Armstrong performed prior to riding in the Tour De France. The test involves having a participant pedal until he can no longer tolerate it, and then measuring his oxygen levels by asking him to breathe into a device. "What we found is that patients can stick with the regimen, and that they are functioning a lot better as a result," Jones said. "Investigating the most effective type of exercise on changes in exercise tolerance, uncovering the mechanisms underlying these changes, and whether these changes can impact long-term survival will be the subject of subsequent studies." Study participant Danny Robbins said that being part of this study has helped him develop an exercise habit, which he hopes will help him continue to beat lung cancer, as well as combat his high blood pressure and diabetes. "Before I participated in this study, I struggled with walking in the neighborhood with my wife," Robbins said. "Now, I exercise five days a week and it's gotten to the point that I don't feel like I have to do it; rather, I feel like I don't want to miss it." 

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Lung cancer screenings may not save lives (Yahoo News-6/03/2007) 

A new study casts doubt on the potential of lung cancer screenings to save lives.
Patients screened with spiral CT scans are three times more likely to be diagnosed with lung cancer. But they're no less likely to die from the disease than if they were never tested, according to an analysis in today's Journal of the American Medical Association. Although smokers and ex-smokers may worry about their risk of lung cancer, Peter Bach of New York's Memorial Sloan-Kettering Cancer Center suggests that they wait for the results of the National Lung Screening Trial — a study of 50,000 patients — whose results are expected in 2009. Bach's results differ from those of an October study in The NewEngland Journal of Medicine, led by Claudia Henschke of Weill Medical College of Cornell University. Henschke estimates that screening could boost 10-year survival rates to 80% — much higher than the current rate of 11%. New research suggests that small lung tumors found by CT may be very different than those found through older methods, such as X-rays, says William Black, a professor at Dartmouth-Hitchcock Medical Center in New Hampshire, who was not involved in Bach's study. Tumors found through CT can take five times longer to double in size than other lung tumors, for example. A 1-centimeter tumor like this could take 14 years to prove deadly, he says. And Bach notes that even painless exams carry risks, especially if they lead to unnecessary and risky surgeries. On average, 1 in 20 people who have a lung removed die within 30 days of the operation, he says.

Bach acknowledges that his analysis, which involved 3,246 patients, is "small and preliminary." Because researchers have not yet completed large trials comparing screened and unscreened patients, Bach pooled the results of three studies and created a "synthetic" comparison group using a statistical model. Henschke questions Bach's methods and says his study has several major problems. Bach followed patients for 3.9 years, for example, which may not be long enough to notice a real difference in lung cancer death rates. The American Cancer Society's Robert Smith notes that — for now — there's no definitive answer about the value of lung screening. The society neither recommends nor discourages the tests. Black says that patients should think carefully about whether they really need screening. He notes that ex-smokers may face a much greater risk from heart disease than cancer and could gain more from exercise and a healthy diet than a lung test. "What a physician should tell people is, 'Don't smoke,' " Black says. "Not smoking would have a much bigger effect than getting a CT screening."

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New Method Helps Detect Lung Cancer, Smokers Turn Toward New Test ( Yahoo News- 6/05/2008) 

Too often lung cancer isn't caught until it's too late to successfully treat. But there is a new method to detect if smokers might get lung cancer. News Center 5's Liz Brunner reported Tuesday on the first of its kind test. "I'm a smoker," said Thomas Lundrigan, of Abington. 

New Method Helps Detect Lung Cancer 

After smoking for 35 years, Lundrigan is getting a new test to determine if he may have lung cancer. "We believe our test is predictive of future risk of the disease," said Dr. Avrum Spira, an assistant professor of medicine for Boston University School of Medicine. Spira has been a part of ongoing lung cancer research. He helped develop a new way to test for lung cancer on smokers who had abnormalities show up on their X-ray or CT-scan. "We put a fiber optic scope through the nose or mouth," he said. The scope brushes cells that line the bronchial area. The cell samples are tested for genes that could put patients at higher risk of developing lung cancer. "In smokers who develop lung cancer, there's a different genetic pattern that occurs," said Spira. During a clinical trial of the study, researchers found the results can determine the extent of lung cancer more efficiently to help save lives. "It will basically enable us to get people treated more quickly, and also will enable us to avoid unnecessary procedures in people who don't have lung cancer," Spira said. Lung cancer screening regimen provides opportunity for cure 27-Mar-2007. OAK BROOK, Ill. – Annual computed tomography (CT) screening identifies a high proportion of patients with early-stage lung cancer, according to the latest findings of the New York Early Lung Cancer Action Project (NY-ELCAP) published in the April issue of the journal Radiology. “The regimen of screening determines how early the cancer is diagnosed. This is critical, as it provides the opportunity for earlier treatment which can be curative,” said NY-ELCAP principal investigator Claudia I. Henschke, Ph.D., M.D., professor of radiology at Weill Cornell Medical College and chief of the divisions of chest imaging and health care policy and technology assessment at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. “Following the appropriate regimen also markedly decreases unnecessary work-up and biopsies,” she added.

Lung cancer remains the leading cause of cancer death in both men and women, killing more people than breast, prostate and colon cancers combined, according to the American Cancer Society (ACS). According to the study, the estimated cure rate for lung cancer in the absence of screening is approximately 5 percent, but increases significantly when the cancer is diagnosed and treated at its earliest stage. NY-ELCAP investigators at 12 medical institutions in New York State provided baseline (first-time) CT screenings to 6,295 people with no symptoms of cancer. The participants were age 60 or older with a history of smoking but no prior cancer and no chest CT in the past three years. A total of 6,014 annual repeat screenings were provided.  CT results prompted recommendations for further work-up on 14 percent of the 6,295 baseline screening participants and 6 percent of the 6,014 repeat screening participants. A total of 124 people were diagnosed with lung cancer, all but three directly based on screening results, rather than interim symptom-prompted diagnoses. A high proportion of the 124 patients (89 percent in the baseline and 85 percent in the repeat rounds of screening) had no evidence of metastases when recommended for biopsy, indicating that a regimen of annual repeat screenings allows for detection of lung cancer at its earliest, most treatable, stage. Long-term follow-up, as shown in an International ELCAP study recently published in the New England Journal of Medicine, demonstrated a 10-year survival rate of 92 percent among patients with Stage 1 lung cancer when diagnosed early and promptly treated.

“It is critical that physicians and the people being screened understand the importance of following an optimal screening regimen,” Dr. Henschke said. “Delay in the recommended diagnostic work-up detracted from the full benefit of CT screening, as it resulted in progression of the cancer in size, and sometimes resulted in a higher stage of the disease.” While a recent JAMA study has suggested that screening CT does not reduce mortality rates for lung cancer, Dr. Henschke disagrees. “The JAMA article was the first application of a newly developed computer model which predicted expected deaths from lung cancer, and there are numerous concerns about its validity,” she said. “The main problem with that study is that it focused on too short a time period to assess the decrease in lung cancer deaths, which starts to be evident after the first five years of screening.” Dr. Henschke recommends that smokers and former smokers considering CT screening should talk to their physicians and, if they decide to be screened, go to an imaging facility with a multidisciplinary team of physicians knowledgeable and experienced in CT lung screening.

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Cancer immuno therapy shows long-term promise in lung cancer (Yahoo News- 26/04/2008)

New, long-term results from a clinical trial presented at the 1st European Lung Cancer Conference jointly organized by the European Society for Medical Oncology (ESMO) and the International Association of the Study of Lung Cancer (IASLC) show that MAGE-A3 ASCI (Antigen-Specific Cancer Immunotherapeutic), an immune-boosting treatment for lung cancer patients, reduces the risk of relapse after surgery -- to the same extent as chemotherapy but without the side-effects of chemotherapy. Prof. Johan Vansteenkiste from University Hospital Gasthuisberg in Belgium described the results after 44-months follow-up from a double-blind, placebo-controlled trial in 182 patients with non-small-cell lung cancer -- the most common form of the disease. After complete surgical resection of the tumor, patients were randomly assigned to receive either placebo injections or injections of MAGE-A3 ASCI administered over 27 months (five given at three-week intervals followed by eight given once every three months). MAGE-A3 is a tumor-specific antigen, expressed in 35-50% of non-small-cell lung cancer, but not on normal cells. "The aim is to help the body immune system to recognize the MAGE-A3 antigen and therefore eliminate the cancer cells that express MAGE-A3," explains Prof. Vansteenkiste. "In other words, it is a kind of treatment method that makes the body immune system specifically attack the lung cancer cells." After 44 months, 69 of 182 patients had experienced a recurrence of their cancer, including 57 deaths. Those given the MAGE-A3 injections had longer on average before their cancer recurred, were less likely to have any recurrence, and were less likely to die.

"Surgical resection is the standard treatment for patients with early stage lung cancer, but after complete resection about 50% will relapse and die from their cancer," says Prof. Vansteenkiste. "Postoperative chemotherapy is able to improve cure rates, but is sometimes poorly tolerated by patients recovering from thoracic surgery. In addition, not all patients are fit to receive chemotherapy. This is why the signal from this phase II randomized study is important: the reduction in risk of postoperative cancer relapse is similar to the one obtained with postoperative chemotherapy, while the side-effects of this new strategy are minimal compared to chemotherapy." Most patients only experience mild reactions at the injection site and fever within 24 hours of the injection, he explained. "Therefore, it is suitable for long-term maintenance treatment and for most patients, including older patients or patients in weak physical condition after surgery, allowing them to live a normal life whilst on cancer treatment." A large Phase III trial of the therapy, named MAGRIT, is now underway.

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Biomarker May Predict Response to Cancer Therapy (HealthDay News -13/04/2008) 

A biomarker that may help doctors monitor the effectiveness of common treatments for kidney cancer and non-small cell lung cancer has been identified by researchers in the Netherlands. The researchers found that CD34bright/CD133neg candidate circulating Endothelial Progenitor Cells (ccEPCs) are a potential biomarker during treatment with sunitinib (Sutent) or bevacizumab (Avastin). "Our work provides novel data on a potential biomarker for the monitoring of anti-angiogenic drug activity in cancer patients, as well as identifies a cell type that is a potential target for these agents," Laura Vroling, a researcher in the department of medical oncology at VU University Medical Center in Amsterdam, said in a prepared statement. Vroling and her colleagues noted that bevacizumab and sunitinib, which target the vascular endothelial growth factor (VEGF), have proven effective against a number of cancers, but doctors aren't able to determine which patients might derive the most benefit from these drugs. "Therefore, it is of great importance to identify and validate biomarkers for early response or duration of response," Vroling said. She and her team studied 23 patients with renal cell cancer and 19 patients with non-small cell lung cancer. "In our study, for the first time, the behavior of two CD34bright cell populations, (CD45neg) candidate cEPcs and (CD45dim) HPCs (hematopoietic progenitor cells), were monitored and showed a different response of both cell populations during sunitinib or bevacizumab therapy. The role of ccEPCs in human tumor angiogenesis and their potential in prediction of treatment outcome of anti-VEGF therapy needs to be addressed in future, larger clinical cohorts," Vroling said.

The study findings were to be presented Sunday at the annual meeting of the American Association for Cancer Research, in San Diego. High-intensity chemotherapy does not improve survival in small cell lung cancer. Small cell lung cancer (SCLC) patients treated with high-dose chemotherapy did not have better survival rates than those treated with standard doses, according to a randomized controlled trial published online April 8 in the Journal of the National Cancer Institute. SCLC accounts for nearly 13 percent of lung cancer cases in the United States. Although many patients with SCLC initially respond to chemotherapy, most suffer disease recurrence relatively quickly. Laboratory data suggest that increasing the dose of chemotherapy agents kills SCLC cells that were resistant to standard doses, and thus might improve patient survival. To test this possibility, Serge Leyvraz, M.D., of the University Hospital in Lausanne, Switzerland, and colleagues enrolled 140 patients with SCLC in a randomized trial that compared high-dose and standard-dose chemotherapy. Both groups were treated with the same chemotherapy agents, ifosfamide, carboplatin, and etoposide (ICE). The 3-year survival rates in the two arms were similar, with 18 percent of patients in the high-dose arm and 19 percent of patients in the standard-dose arm still alive. Additionally, a similar fraction of patients in both arms showed tumor shrinkage in response to therapy—78 percent in the high-dose arm and 68 percent in the standard-dose arm, which was not a statistically significant difference. "The approach explored in the present trial succeeded in raising the peak dose, total dose, and dose intensity of ICE by threefold but has clearly been ineffective and highly toxic," the authors write. "As a result, this strategy should be abandoned." 
In an accompanying editorial, Paul A. Bunn Jr., M.D., agrees with that assessment and emphasizes that other avenues of therapy should now be explored. "The declining incidence of SCLC and the lack of progress seem to have dampened the enthusiasm of funding agencies and industry for exploring novel therapies. This is indeed unfortunate because SCLC remains a common cancer in both the developed and developing world," Bunn writes.

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Defective gene link to lung cancer- (Yahoo News- 08/08/2007) 

Scientists have identified a genetic mutation that makes lung cancer more aggressive and increases the likelihood of it spreading. The discovery could lead to the development of a test that would allow doctors to treat the disease more effectively. The LKB1 gene is a "master gene" which has been shown to play a role in preventing cells becoming cancerous. Prof Kwok-Kin Wong, of the Dana-Farber Cancer Institute, in Boston, Massachusetts, found that mice genetically engineered to have lung cancer and a defective form of LKB1 developed tumours which spread more quickly.  Prof Wong and colleagues, whose study was published online by the journal Nature yesterday, examined 140 samples of human lung tumours and discovered defective LKB1 genes were also more likely to develop more aggressive forms that spread more quickly.

Patients who undergo a test for defective LKB1 could be given varying doses of chemotherapy drugs depending on which form of the gene they had. The mutation occurs spontaneously in around 30 per cent of lung cancer cases. Prof Wong said: "As we make more and more discoveries about the relationships between different genetic variations and disease, we will be able to tailor more specific and effective therapies."

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First oral drug approved for small cell lung cancer -(Yahoo News- 15/10/2007)

GlaxoSmithKline announced today approval by the U.S. FDA for oral HYCAMTIN® (topotecan) capsules for the treatment of relapsed small cell lung cancer (SCLC). Specifically, HYCAMTIN capsules are indicated for patients who had a complete or partial response to first-line chemotherapy and who are at least 45 days from the end of that treatment. HYCAMTIN capsules are the only oral single-agent chemotherapy approved for the treatment of SCLC after failure of first-line therapy. The product will be available in 2008. "The approval of HYCAMTIN capsules is particularly important for patients with relapsed small cell lung cancer as they now have an effective treatment option that has been shown to provide a survival benefit and can be conveniently taken at home," said Dr. Debasish Roychowdhury, vice president, Global Clinical Development, Oncology at GSK. "Additionally, this milestone underscores GSK Oncology's commitment to helping improve cancer patients' quality of life." 

This approval was based on positive results from a large comparison study of HYCAMTIN capsules plus best supportive care (BSC) to BSC alone in patients with relapsed SCLC, in addition to earlier smaller supporting studies. Best supportive care refers to treatments intended to control, prevent and relieve disease complications to improve comfort and quality of life for the patient, but are not intended to have any anti-tumor effects. In the large multicenter trial, 70 patients with relapsed SCLC who were not considered candidates for standard intravenous therapy were randomly assigned to receive BSC alone and 71 were assigned to receive HYCAMTIN capsules plus BSC. 

The primary objective was to compare overall survival between the two treatment arms. Patients who received HYCAMTIN capsules plus BSC showed a statistically significant improvement in overall survival compared with the patients who received BSC alone. Median survival with HYCAMTIN capsules plus BSC was 25.9 weeks compared to 13.9 weeks for those given BSC alone. This represents a 36 percent reduction in the risk of death for patients who received HYCAMTIN capsules plus BSC compared with the patients who received BSC alone. The results were published in the Dec. 1, 2006 issue of the Journal of Clinical Oncology. 

"In clinical trials, HYCAMTIN capsules have shown the potential to benefit patients with small cell lung cancer, many of whom are prone to relapse," said Dr. John Eckardt, director of clinical research for the Center for Cancer Care and Research, St. Louis, MO. "The approval of HYCAMTIN capsules opens up new possibilities for patients battling this disease and provides a convenient alternative to IV therapy." The most common severe or life-threatening side effects involved the immune and blood systems with HYCAMTIN capsules linked to a severe or life-threatening loss of infection-fighting white cells (neutropenia) occurring in 61% of those treated, while 37 percent suffered severe loss of blood-clotting platelet cells and 25 percent experienced a severe or greater loss of red blood cells (anemia). The most common (>10%) non-hematologic adverse reactions (all grades) were nausea (27%), diarrhea (14%), vomiting (19%), fatigue (11%) and alopecia (10%).(2) 

SCLC is caused by an uncontrolled growth of cells beginning on the surface of the lung's breathing tubes (called bronchi) and tends to spread widely through the body. This is important because it means that surgery is rarely used as a treatment option. Chemotherapy is the most common treatment for SCLC. Although SCLC is often responsive to first-line treatments, patients may relapse. SCLC is most common in current or past smokers, but can also be caused by environmental risk factors such as exposure to radon and air pollution. About 15% of patients with lung cancer have SCLC, a fast-growing form of the disease.

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PET scans can help lung cancer diagnosis- (Reuters- 27/11/2007)

The use of positron emission tomography, known as PET scans, can improve the diagnosis of people with lung cancer and better guide treatment decisions, Canadian researchers said on Tuesday. Doctors often use imaging techniques like magnetic resonance imaging, MRI, or computed tomography imaging, called CT scans, along with other methods to see if a patient has lung cancer.

But researchers led by Dr. Yee Ung of the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto analyzed the results of several recent studies to see if PET scans might do the job better. PET scans detect biochemical processes in the body that may indicate disease before the appearance of anatomical changes that other methods like MRIs and CT scans may detect.

PET scans can also accurately differentiate between malignant and benign tumors in the lung as small as four-tenths of an inch, according to the study published in the Journal of the National Cancer Institute. These scans can correctly distinguish between extensive and limited disease in people with small cell lung cancer, a fast-growing type that spreads more quickly than the more commonplace non-small cell lung cancer, the researchers said.

PET scans seem to be superior to CT scans for guiding treatment decisions in non-small cell lung cancer, they said. The findings seem to support the idea of broader use of PET scans in lung cancer diagnosis and treatment, although more research is needed, Ung said in a telephone interview.

"Things that we cannot see with CT scans we are now able to pick up on the PET scans and, therefore, we're able to offer better and more appropriate treatment," Ung said. "We still need to do very good clinical trials to see where PET scans fit into the overall treatment strategy," Ung added. 

One key to treatment of lung cancer is how accurate doctors are in "staging" patients -- finding out how much cancer there is in the body and where it is located, to figure how advanced it is -- to give the most appropriate treatment, Ung said. "So if you have somebody who truly has lung cancer confined to the chest, without being spread outside the chest, you would treat that very aggressively with a combination of surgery and/or chemotherapy and radiation, if indicated," Ung said.

"If the lung cancer is too far advanced where it's already spread outside of the chest area, then we cannot cure it, and then we don't want to put people through unnecessary treatment like putting them through surgery or putting them through high-dose radiation," Ung added. PET scan equipment is less widely available than CT scan and MRI equipment, but generally is in use in larger medical institutions, according to Frederic Fahey, director of nuclear medicine physics and PET at Children's Hospital Boston.

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Lung cancer therapys' timing ups survival- (Yahoo News- 12/11/2007)


Taking radiation treatments together with chemotherapy rather than after extends lung cancer patients' lives, a U.S. researcher says. International Non-small Cell Lung Cancer Collaborative Group researchers looked at 1,200 patients from six trials and found the five-year survival rate was 10.8 percent with sequential therapy and 15.1 percent with concurrent therapy.

Research team leader Dr. Walter Curran Jr., of Philadelphia's Radiation Therapy Oncology Group, a cooperative clinical trials organization, said the only difference is in the timing of the two treatments. Giving the radiation treatment on day one instead of day 40 could increase the number of five-year-survivors in 50,000 patients from 5,000 to 7,500, Curran said. 

"That means a relative increase of nearly 50 percent," Curran said in a statement. "We've demonstrated that the magnitude of benefit is observable in many studies, regardless of the regimen. I think it will be as persuasive as any data that this will change not only the tumor control rate but the chance for a long-term cure." Curran presented the results in Los Angeles at the meeting of the American Society for Therapeutic Radiology and Oncology.

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Scientists map gene flaws linked to lung cancer- (Yahoo News- 4/11/2007) 


Scientists have mapped the genetic aberrations underlying lung cancer and discovered a gene that plays a critical role in spreading the deadly disease, according to a study published Sunday. The massive DNA study, involving dozens of research centres worldwide, sheds important light on the biological basis of lung cancer and will help shape new strategies for treatment, the authors said.

"This view of the lung cancer genome is unprecedented, both in its breadth and depth," said Mathew Meyerson of Harvard and MIT, who led the research. "It lays an essential foundation, and has already pinpointed an important gene that controls the growth of lung cells." Each year some 1.3 million people die from lung cancer, making it the most lethal form of the disease, according to the World Health Organisation.

The new study focuses on lung adenocarcinoma, which accounts for just under a third of all lung cancer cases. Part of the international Tumour Sequencing Project, the study looked for abnormalities in the DNA of more than 500 tumours from lung cancer patients. Most human cancers stem mainly from DNA changes that accumulate in cells through a person's life, but the nature of these changes -- and their consequences -- has remained largely unknown.

The scientists used cutting-edge technologies to scan the human genome for markers called single nucleotide polymorphisms (SNPs) that highlight missing or duplicate sections of genetic code. The study, published online by the British journal Nature, uncovered a total of 57 genomic changes that occur frequently in cancer patients. Of these, at least 40 are associated with genes not previously known to be involved in lung adenocarcinoma. The genetic anomaly that turned up the most frequently incriminates a gene called NKX2.1 as an accelerator of cancer cell growth.

NKX2.1 normally acts as a "master regulator" that controls the activity of other genes in cells lining tiny air sacs in lungs called alveoli. The discovery that a gene functioning in a particular group of cells can promote cancer growth could help scientists design drugs to fight not just lung cancer but a wide range of cancers, the researchers said.

In addition, the use of powerful tools and technologies to sequence the genomes of lung cancer patients "represents a general approach that can and should be used to analyse all types of cancer," said co-author Eric Lander, director of the Broad Institute of MIT and Harvard. The collaborative research behind the study has laid the groundwork for even more ambitious genome projects such as the Cancer Genome Atlas, which seeks to map the common genomic changes in a wide range of human cancers. In its pilot phase, the Atlas project is focusing on the most common form of brain cancer, glioblastoma multiforme, as well as ovarian and squamous cell long cancer

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Lung cancer research looks at women- (Yahoo News- 28/09/2007)


U.S. researchers and women's health advocates want more federal funding for research on women who get lung cancer. Meeting with lawmakers on Capitol Hill last week, Phyllis Greenberger, head of the Society for Women’s Health Research, said new research shows differences in susceptibility, progression and responsiveness to treatment in lung cancer between women and men.

The Lung Cancer Alliance said lung cancer research is severely underfunded. The disease kills more than 70,800 women a year, 30,000 more than breast cancer. The National Cancer Institute in 2006 spent approximately $13,519 for research on breast cancer per death compared to $1,638 on research per lung cancer death.  A study in the Journal of Clinical Oncology last February found that about 20 percent of lung cancer cases in women occur in nonsmokers, compared to 8 percent in men. Research is under way to examine whether the biological traits of being a woman or a man impacts lung cancer susceptibility, the Society for Women’s Health Research said Friday in a release.

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Merck KGaA's Erbitux Helps Survival in Lung Cancer (Yahoo News- 11/09/2007) 

 Merck KGaA, the German drugmaker that bought Serono SA in January, said its Erbitux cancer medicine helped lung cancer patients live longer, contradicting the results of an earlier trial by ImClone Systems Inc. The drug, combined with chemotherapy, met the main goal of an advanced test by faring better than chemotherapy alone, Darmstadt, Germany-based Merck said in a statement on DGAP- Adhoc wire today. Merck shares rose as much as 4.8 percent. 

Merck, which bought rights to the drug outside the U.S. from ImClone in 1998, proved a benefit where its partner didn't, the study suggests. It used more patients and combined the drug with a different chemotherapy to show that Erbitux can prolong the lives of patients whose cancer had spread. As part of their agreement, ImClone may use Merck trial data for regulatory submissions in the U.S. ``Non-small cell lung cancer that has spread from its primary site is extremely difficult to treat, so we are delighted with these results,'' said Wolfgang Wein, head of Merck's oncology business. The patients, who had advanced lung tumors, had not previously been treated for the disease. 

ImClone said in July that a study it conducted on lung cancer patients showed Erbitux failed to slow tumor growth. Merck said at the time that its trial may show a different outcome.   Merck and ImClone are expanding tests on Erbitux as they try to close the gap on Roche Holding AG and Genentech Inc.'s Avastin. The German drugmaker plans to publish full data from the latest trial at a medical meeting soon. Spokeswoman Phyllis Carter declined to say which meeting. 

The Merck trial also examines patients' response to the drug, how long it keeps lung cancer at bay, and the quality of life it offers as secondary goals, according to Carter. Once all the data are available it will decide when to submit an application to European drug regulators, she said. The European drug agency is currently reviewing Erbitux, which is approved to treat colon cancer, as a first-choice therapy for tumors of the bowel. A submission for lung cancer can only take place once the agency has ruled on the current application, Carter said. 

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Different Biology May Mean Differences in Lung Cancer- (Yahoo News)

As smoking rates among women increased over the years, so did their lung cancer rates. The death rates among women attributed to lung cancer jumped 600 percent since 1950. With these increases, researchers have been noticing a difference in the way lung cancer affects women and men — from diagnosis through treatment. Women are more likely to get a certain type of lung cancer — adenocarcinoma — than men. They are most likely to get the disease at an earlier age and are more likely to have had less tobacco exposure before its onset. Women also respond better to some targeted treatments and generally live longer with the disease.

Dr. Kathy Albain, a top lung cancer expert with the Loyola University Health System who is treating Corrine Lamb, is one of the leaders of a new national study looking at these gender differences in lung cancer. "It may be that as a gender, as a sex, women have overall different biology to their lung cancers than do men," Albain said. "So that's what we're working toward is understanding these biologies." Albain and other researchers in the Southwest Oncology Group — with funding from the National Cancer Institute — hope their work can solve some of the gender puzzle. They want to know why women metabolize carcinogens differently, why women's bodies are less able than men's to repair DNA damage that occurs with cancer, and why lung cancer may be helped along by certain hormones, particularly estrogen.

"It can stimulate cells in the lung that are perhaps destined to become lung cancer and haven't quite made that final commitment," Albain said. "The estrogen can come along and make those cells grow and develop into lung cancer." Another trend researchers are examining is gender differences among those lung cancer patients who have never smoked. Twenty percent of female lung cancer patients never smoked, while among men the number is only 10 percent. Exposure to substances like radon and other environmental toxins are believed to play a role, and researchers want to learn more about how gender factors into the equation.

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'None of My Doctors Know Why'- (Yahoo News)

Karen Parles would like to know the answer, too. A 46-year-old wife and mother of two, Parles never smoked tobacco and was diagnosed with advanced lung cancer in 1998. She had gone to the doctor with a persistent cough and was put on antibiotics when doctors thought it was pneumonia. Weeks later, a follow up x-ray and CT scan found cancer throughout one lung.

"I've never smoked and I've never been exposed to secondhand smoke," Parles said. "None of my doctors know why I have it. And I really don't spend much time thinking about it. I just got lung cancer." Parles was initially told she had only six to nine months to live. Trying to buy herself some time, she had experimental surgery to remove the lung and some of her chest wall. That, along with aggressive treatments and chemotherapy two out of every three weeks left Parles outliving her doctors' predictions.

After her surgery, Parles was "cancer-free" for a period of four and a half years. But late in 2002, doctors found the cancer had returned — and this time had also spread to her bones and her liver. Today, Parles maintains a positive attitude but acknowledges that the prognosis is not reassuring. "We know with my recurrence, I'm going to die of lung cancer," Parles says. "But right now, I can say there are treatments available. I am responding to treatment. I'm not going to die tomorrow. I've got lots of things to do, reasons to live and so you take each day as it comes."

Parles launched a website, www.lungcanceronline.org, to help other people with the disease access information. She finds great support in her husband and two teenage children, who she says were first on her mind as a mother getting a terminal illness. "All you do is think of your children," Parles said. "To think you weren't going to see them grow up or they weren't going to have a mother is just devastating." Dr. Mark Kris of the Memorial Sloane-Kettering Cancer Center says that as more is learned about the gender differences in lung cancer, better and more targeted treatments will benefit both women and men.

"If you saw that lung cancer was caused by a certain mutation which is more common in women, then you could target a drug against that mutation to a woman more directly than you would to a man," Kris says. For Corrine Lamb, talking about her personal struggle with lung cancer publicly is one way she hopes to find some good in her diagnosis. She hopes she might be able to help others avoid the same fate she has met. "If smoking caused this," Lamb says, "Then if I could just reach one person, I don't care. I'd like them to quit, but if they don't quit, I'd at least like them to be aware and cut down, so eventually they'll quit."

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Faulty Cell Cycle Checkpoints Linked To Lung Cancer Risk In African-Americans Washington D.C.- (Yahoo News)

Faulty cell cycle "checkpoints" that fail to respond to DNA damage effectively may contribute to the high incidence of lung cancer in African-Americans, say researchers at Georgetown University's Lombardi Comprehensive Cancer Center and the National Cancer Institute (NCI).

Their study, reported in the October 15 issue of Cancer Research, is the first epidemiological study to show the association of lung cancer risk in African-Americans and efficiency of the critical "G2/M checkpoint." While the researchers report that this checkpoint was generally less effective in the group of African-American lung cancer patients they studied, they found this risk to be especially high in African-American women and nearly a five-fold increase in lung cancer risk in women with faulty G2-M checkpoint compared to women with efficient G2-M checkpoint. The study did not found any association of this checkpoint with lung cancer risk in whites."Although the study has limitations, our findings suggest one possible explanation for the higher incidence of lung cancer in African Americans, who as a group smoke less than whites, yet still develop more lung cancer at comparatively younger ages," said the study's lead author, Yun-Ling Zheng, M.D., Ph.D., an assistant professor in the Department of Oncology at the Lombardi Comprehensive Cancer Center.

"Epidemiologists have long known that cancers are expressed at varying rates in different racial groups, but we are only now able to use advanced research techniques to look at the molecular reasons for these disparities," Zheng said. "The value of such research is that it can provide new tools for risk calculation." According to a 2002 report by the Surveillance, Epidemiology, and End Results (SEER), the incidence of lung cancer in African-American men was 42 percent higher compared with the incidence in white men, and the risk of lung cancer for African-American women was 13 percent higher.

Cell cycle checkpoints are mechanisms that regulate progression through the cell cycle of growth and division, ensuring that each step takes place only once and in the right sequence. This study looked at the G2/M checkpoint, a specific point in the cell cycle that determines if the cell should temporarily halt its march toward division, allowing more time for the damage to be repaired. This checkpoint can be activated if a cell's genetic material is damaged or if mistakes were made when DNA was replicated. A less efficient checkpoint, however, would not catch and repair all DNA abnormalities, which could lead to genetic instability and the development of cancer, Zheng said.

To conduct the study, Zheng and her colleagues at the National Cancer Institute collected information as well as blood samples from 216 patients with lung cancer and from 340 cancer-free control participants from the Baltimore, Maryland area. They then cultured the white blood cells, exposed them to gamma radiation, which inflicts genetic damage, and then they evaluated the cell cycle checkpoint. After adjusting for age, gender and a patient's history of smoking, the researchers found that a lower level of radiation-induced G2/M arrest was associated with an increased risk of lung cancer among African-Americans.

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New Technology Cuts Lung Cancer Surgery (HealthDay News-23/08/2005) 

A new technique for taking tiny tissue samples from the chest reduces unwarranted surgery for people suffering with advanced lung cancer, Dutch surgeons report. The method goes under the cumbersome name of transesophageal ultrasound-guided fine needle aspiration -- abbreviated EUS-FNA. And a study of 107 lung cancer patients showed that, when used in combination with another diagnostic technique, EUS-FNA identified cases in which surgery was unnecessary. The findings appear in the Aug. 24-31 issue of the Journal of the American Medical Association. All the patients had non-small cell lung cancer, which is found in 80 percent of cases; it's the type of cancer that killed news broadcaster Peter Jennings earlier this month, said Dr. Robert J. Cerfolio, chief of thoracic surgery at the University of Alabama, Birmingham. The issue in all these cases is the "stage" of the disease -- the extent to which it has spread. Staging determines whether and what kind of surgery should be done. Jennings had stage 4 cancer, the most advanced form, and was not operated on, Cerfolio said.


The report by surgeons at Leiden University Medical Center said EUS-FNA was used in combination with mediastinoscopy, an examination of the middle of the chest cavity with a specialized scope. The researchers said the combination of the two techniques identified more patients in whom the cancer had spread widely (and thus for whom surgery was not recommended) than either technique alone -- 36 percent with the combination compared to 28 percent with UES-FNA and 20 percent with mediastinoscopy. Overall, this meant that 16 percent of thoracotomies -- invasive surgeries involving the opening of the chest wall -- could have been avoided using the dual-detection technique, the researchers conclude. "We have routinely incorporated EUS-FNA in the diagnosis and staging of lung cancer in our hospital," said Dr. Jouke Annema, professor of surgery at Leiden and lead author of the report.


The Leiden physicians are continuing their studies of the technique, he said. "Another study in 242 patients demonstrates that EUS-FNA can prevent 70 percent of scheduled surgical procedures (mainly mediastinoscopies) in patients with suspected lung cancer," Annema said. The Leiden study is one of a number showing the value of EUS-FNA, said Cerfolio, an expert in the method. "This technique is very, very vital in the staging of patients with non-small cell lung cancer," Cerfolio said. "It allows you to get to all the lymph nodes." Lymph nodes are small cell-collecting organs that are routinely examined to determine whether cancer has spread. "There is no question that it reduces unnecessary surgery," he said. "It enables us to stage cancers better, and the better we stage them, the better we treat."


When lung cancer is suspected, the usual procedure is to perform scans such as computerized automated tomography to help identify the lymph nodes that might have cancer in them, Cerfolio said. Until recently, the way to test those lymph nodes would have been to open the chest surgically. Advanced technology such as EUS-FNA has eliminated that surgery in a large number of cases, he said. "This has changed the treatment of lung cancer across the world, and yet few have it," Cerfolio said. Fewer than 5 percent of U.S. hospitals are equipped for EUS-FNA, he said.

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New cancer drug headed to FDA- (Reuters- 24/08/2005)

Cell Therapeutics says it will submit experimental treatment Xyotax for women's lung cancer. Cell Therapeutics Inc. said Wednesday it plans to seek U.S. and European approval to market an experimental treatment for advanced non-small cell lung cancer. Cell Therapeutics said it will submit a New Drug Application to the Food and Drug Administration for the drug, known as Xyotax, as first-line monotherapy for women with advanced non-small cell lung cancer who have poor performance status. The filing in Europe will also seek use as monotherapy in first-line patients with non-small cell lung cancer, but is not expected to be limited to women.

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Cancer test is debated- (Yahoo News)

Smokers rush to get lung scan that detects tiny growths but often gives false positives. If a simple, painless test can find the world's deadliest cancer when it is smaller than a pea -- and such a test does indeed exist -- shouldn't people who are most at risk have one? Surprisingly, the federal government, American Cancer Society and a raft of cancer specialists say the answer is "no."

They are waging an uphill battle as frightened current and former smokers rush to get a special kind of X-ray that other physicians are urging for lung cancer detection but that has not yet conclusively been shown to save lives. A huge federal study is under way to see if it can, and answers may come as soon as next year. In the meantime, it's generating a classic "can't wait for science" stampede. The clamor rose last week with the deaths of newsman Peter Jennings and "Dallas" star Barbara Bel Geddes, and the news that "Superman" widow Dana Reeve has lung cancer.

Patricia Dowds and her husband, David Byrom, psychologists from Long Island, are among the many former smokers who voted with their wallets and had the $300 test on Friday. "We do it for our own peace of mind," Dowds said. No one disputes that the test, called a spiral or helical CT scan, detects lung abnormalities as small as 5 millimeters -- less than a fifth of an inch. The argument is over whether that's a good thing.

For every cancer these scans detect, many more "false positives" occur -- harmless bumps and lumps leading to painful, expensive and unnecessary biopsies and surgeries. Complications can include lung collapse, bleeding and infection. "The concern that we have is false positive rates," which range from 25 percent to as high as 60 percent, said Tom Glynn, the cancer society's director of science and trends. "What we don't want to do is create even more anxiety."

 

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