The impact of induction chemotherapy on the outcome of second-line therapy with pemetrexed or docetaxel in patients with advanced non-small-cell lung cancer

Second-line treatment of advanced non-small cell lung cancer

After failure of first-line chemotherapy for advanced non-small cell lung cancer, many patients remain candidates to receive further antitumor treatment. To guide clinical management of these patients and to suggest priorities for clinical research, an International Panel of Experts met in Naples (Italy) in April 2007. Results and evidence-based conclusions are presented in this article. Single-agent chemotherapy with docetaxel or pemetrexed is the recommended option for unselected patients with performance status 0 to 2 who are candidates for second-line chemotherapy for advanced non-small cell lung cancer. Docetaxel has demonstrated superiority compared with best supportive care. Pemetrexed has been shown to be noninferior to docetaxel, with a more favorable toxicity profile. Erlotinib is effective in pretreated patients, and can be given second-line in patients not suitable or intolerant to chemotherapy, and in all patients as third-line treatment after failure of second-line chemotherapy. Gefitinib failed to show superiority to placebo as second- or third-line treatment, but it has been shown to be noninferior to docetaxel. In selected patients such as lifetime nonsmokers or those of East-Asian ethnicity, erlotinib, or gefitinib (where licensed) may be considered as second-line treatment even if they are fit for chemotherapy. Best supportive care in addition to active treatment remains important for all patients, but may be the exclusive option for patients unsuitable for more aggressive therapy. Further research is mandatory, to find better treatments, and to identify clinical and molecular predictive markers of efficacy, both for chemotherapy and for novel biologic agents.

Influence of previous chemotherapy on the efficacy of subsequent docetaxel therapy in advanced non-small cell lung cancer patients

PURPOSE

To identify factors, particularly the previous use of paclitaxel, that might influence the efficacy of subsequent docetaxel therapy.

PATIENTS AND METHODS

The patient characteristics, responses, and survivals were compared between the two groups that had received a combination of carboplatin and paclitaxel (group P), and a combination of a platinum and an agent other than paclitaxel (group NP).

RESULTS

A total of 227 patients (127 in group P, and 100 in group NP) were recruited from a hospital-based registry. Two hundred twenty patients were evaluated for the survival, and 210 patients were evaluated for the response of docetaxel therapy. The response rate to docetaxel therapy (14.2% versus 16.0%, p = 0.702) or the median survival time (10.9 months versus 11.1 month, p = 0.567) did not differ between groups P and NP. The results of multivariate analysis, adjusted for sex, age, and performance status at the start of docetaxel therapy, showed that not the regimen per se, but the response to previous chemotherapy significantly influenced the response rate of docetaxel therapy (odds ratio [OR]: 1.38, 95% confidential interval [CI]: 0.63-3.01; and OR: 2.93, 95% CI: 1.28-6.72, respectively). As for the overall survival, neither the response to nor the previous chemotherapy regimen had any impact (hazard ration [HR]: 0.90, 95% CI 0.66-1.22; HR 0.88, 95% CI 0.65-1.20, respectively).

CONCLUSION

The previous use of paclitaxel had no impact on the response or survival to subsequent docetaxel therapy. In contrast, the response to previous chemotherapy had a predictive value in relation to responses to subsequent docetaxel therapy in patients with advanced non-small cell lung cancer.

Docetaxel weekly regimen in conjunction with RF hyperthermia for pretreated locally advanced non-small cell lung cancer: a preliminary study

BACKGROUND

To evaluate the feasibility and therapeutic effect of chemotherapy combined with regional radio frequency hyperthermia for pretreated locally advanced non-small cell lung cancer.

METHODS

29 patients with stage III non-small cell lung cancer were enrolled in present study, received chemotherapy up to 4 cycles and radio frequency hyperthermia up to 32 times. The primary end points were grade 3,4 hematological or non-hematological toxicities and progression free survival, the secondary end points were response rate, tumor control rate and overall survival. Method of Kaplan-Meier was used for the survival analysis.

RESULTS

21 patients completed their arranged treatments. The most common grade 3,4 toxicity was neutropenia (24.1%). Median progression free survival was 4 months (range 0-13 months), one year progression free survival rate was 10.3%. Overall response rate was 25.9%, tumor control rate was 66.6%. Median overall survival was 11 months (range 2-18+ months), one year overall survival rate was 44.8%.

CONCLUSION

Treatment of chemotherapy in conjunction with regional hyperthermia was safe and well tolerant, it suggested an impressive tumor control rate and an acceptable one year progression free survival. Further study might be needed.