Paclitaxel plus platinum or gemcitabine plus platinum in first-line treatment of advanced non-small-cell lung cancer: results from 6 randomized controlled trials

A Randomized Controlled Study of rhTPO and rhIL-11 for the Prophylactic Treatment of Chemotherapy-Induced Thrombocytopenia in Non-Small Cell Lung Cancer

Background: rhTPO and rhIL-11 are both recommended for the prophylactic treatment of chemotherapy-induced thrombocytopenia (CIT). However, there has been no head to head comparative study on the prophylactic administration of rhTPO and rhIL-11 to alleviate CIT in non-small cell lung cancer (NSCLC). Methods: In this open-label prospective multi-center phase II clinical trial, 108 NSCLC patients who experienced severe CIT after prior chemotherapy were randomized into study and control arms. Patients in the study arm were prophylactically administered rhTPO on day 2, day 4, day 6 and day 9 of the subsequent chemotherapy cycle, while patients in the control arm accepted prophylactic rhIL-11 from day 9 to day 15 of the subsequent chemotherapy cycle. Results: During the trial, the median time required for recovery of the platelet count to ≥ 75 × 10⁹/L was 3 days (range: 2-4) in the study arm and 4 days (range: 2-6) in the control arm (P = 0.398). The lowest platelet counts were 61.8 ± 39.9 × 10⁹/L in the study arm, values higher than those measured in the control arm 52.8 ± 36.8 × 10⁹/L (P = 1.044). Platelet counts < 50 × 10⁹/L occurred in 46.2% of patients in the study arm vs 58.6% in the control arm (P = 0.368). There were no drug-related adverse reactions in the study arm, but 4 cases (12.9%) in the control arm (P = 0.008), especially cardiotoxicity (P = 0.022). Conclusion: Prophylactic administration of rhTPO helps to alleviate CIT in NSCLC as well as rhIL-11, but is safer to use and more convenient to administer.

Efflux transporter variants as predictors of drug toxicity in lung cancer patients: systematic review and meta-analysis

Chemotherapeutic drugs are underutilized in lung cancer management due in part to serious adverse drug reactions (ADRs).

AIM

With studies revealing an association between interindividual patient ADR variation and efflux transporter variants, we carried out a meta-analysis and systemic review, in order to highlight current knowledge regarding the strength of association between efflux transporter SNPs variants and chemotherapeutic-drug induced ADRs.

MATERIALS & METHODS

Papers were sourced from MEDLINE, Cochrane Library, CINHL, EMBASE, Web of Knowledge, Scopus. The Cochrane Collaboration Risk of Bias Tool v13 was used to evaluate six types of bias domains for each of the publications reviewed.

RESULTS

Twenty-five publications comprising three randomised control trials, two retrospective case-controls and 20 clinical observation studies, totalling 3578 patients, were deemed eligible for review. Of the known efflux drug transporters, we report findings on the ABC members ABCB1, ABCC1, ABCC2, ABCG2, ABCA1, ABCC4 and ABCC5. Meta-analysis showed an decreased risk of irinotecan-induced neutropenia in patients expressing ABCB1 2677G>T/G (odds ratio [OR]: 0.24; 95% CI: 0.1-0.59; p = 0.002) but increased risk for ABCC2 3972T>T (OR: 1.67; 95% CI: 1.01-2.74; p = 0.04). ABCG2 34G>A was associated with a threefold increased risk of irinotecan-induced diarrhea (95% CI: 1.00-6.24; p = 0.05).

CONCLUSION

The majority of studies have identified a role for variants in effluxdrug transporters in contributing to lung cancer treatment-associated ADRs. However, for implementation of use of these transporter genetic variants as prognostic markers for ADR risk, future studies must incorporate larger patient numbers.

Reactivation of pulmonary tuberculosis during cancer treatment

Reactivation of Mycobacterium tuberculosis can occur in patients with latent tuberculosis (TB) with risk factors including chronic disease (i.e., malignancy). We herein describe the case of an immigrant from Hong Kong with lung cancer and no known TB disease who presents with reactivation of TB in the setting of chemotherapy and radiation therapy.