| Abstract: |
Cisplatin (Platinol®; Bristol-Myers Squibb, Princeton, NJ, http://www.bms.com) and carboplatin (Paraplatin®; Bristol-Myers Squibb), together with newer chemotherapies, such as docetaxel (Taxotere ®; Aventis Pharmaceuticals Inc., Bridgewater, NJ, http://www. aventispharma-us.com), paclitaxel (Taxol®; Bristol-Myers Squibb), vinorelbine (Navelbine®; GlaxoSmithKline, Philadelphia, http://www.gsk.com), pemetrexed (Alimta®; Eli Lilly and Company, Indianapolis, http:// www.lilly.com), and gemcitabine (Gemzar®; Eli Lilly and Company), have improved treatment outcomes in both advanced non-small cell lung cancer (NSCLC) and in the adjuvant/neoadjuvant setting. Newer systemic treatments for NSCLC, used in advanced stage IV management, are beginning to be studied in earlier stages of the disease, when treatment is better tolerated and potentially curative. Hopefully, newer agents with proven efficacies in advanced disease will enhance curability. Following the successful addition of bevacizumab (Avastin®; Genentech, Inc., South San Francisco, CA, http://www.gene.com) to carboplatin/paclitaxel in advanced disease, bevacizumab is now being incorporated into adjuvant and neoadjuvant trials. Trials in stage IB-IIIA patients will study neoadjuvant docetaxel/cisplatin/bevacizumab. The discovery that patients with exon 19 and 21 mutations in the epidermal growth factor receptor gene EGFR have around an 80% response rate to gefitinib (Iressa®; AstraZeneca Pharmaceuticals, Wilmington, DE, http:// www.astrazeneca-us.com) and that this response confers survival benefit indicates its potential utility for mutation-positive patients with advanced- and earlier-stage disease. Clinical characteristics, such as never smoking status and adenocarcinoma, and especially bronchioloalveolar carcinoma histological features, can also identify individuals likely to respond to EGFR tyrosine kinase inhibitors. Studies of neoadjuvant erlotinib (Tarceva®; OSI Pharmaceuticals, Inc., Melville, NY, http://www.osip.com) in operable NSCLC are planned. One such study includes cisplatin and docetaxel. Effective development of active agents and disease management based on molecular profiling of lung tumors will change tomorrow's standard of care. © AlphaMed Press. |
| Keywords: |
cancer chemotherapy; cancer survival; controlled study; treatment outcome; survival rate; gene mutation; major clinical study; mutation; clinical trial; disease course; cigarette smoking; bevacizumab; cisplatin; erlotinib; fluorouracil; placebo; advanced cancer; conference paper; drug targeting; gemcitabine; paclitaxel; cancer adjuvant therapy; chemotherapy, adjuvant; methotrexate; antineoplastic agent; treatment indication; carboplatin; computer assisted tomography; controlled clinical trial; phase 2 clinical trial; breast cancer; lung non small cell cancer; carcinoma, non-small-cell lung; lung neoplasms; epidermal growth factor receptor; lung cancer; cyclophosphamide; receptor, epidermal growth factor; oncology; docetaxel; monoclonal antibody; protein tyrosine kinase inhibitor; antibodies, monoclonal; lung adenocarcinoma; systematic review; multicenter study; needle biopsy; gefitinib; vinca alkaloid; continuing education; lung squamous cell carcinoma; taxane derivative; egfr; molecular biology; navelbine; pemetrexed; receptor gene; meta analysis; neoadjuvant; hemoptysis; nsclc; adjuvant; clinical trials, phase ii
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