Adjuvant therapy for non-small cell lung cancer

Adjuvant chemotherapy for non-small cell lung cancer

In the late 1970s and early 1980s, the Lung Cancer Study Group conducted a series of adjuvant chemotherapy trials in patients with resected non-small cell lung cancer. Although some of these trials yielded modest survival benefit, the length of improved survival essentially equaled the time spent receiving chemotherapy. Consequently, few physicians routinely employ postoperative chemotherapy in spite of its theoretical appeal. Possible explanations for the failure of adjuvant chemotherapy to provide meaningful prolongation of survival in non-small cell lung cancer include lack of effective chemotherapy, incorrect chemotherapy regimen, inadequate dose intensity, and possibly inadequate trial design. Future postoperative adjuvant trials should focus on treating patients with resected early stage lesions (T1N1, T2N1, T2N0). What role, if any, newer antineoplastic agents will play in the postoperative setting remains to be determined. Neoadjuvant induction chemotherapy may well prove to be a superior treatment strategy and deserves further investigation.

Immunohistochemical study of glutathione-related enzymes and proliferative antigens in lung cancer. Relation to cisplatin sensitivity

BACKGROUND

With resected tumor tissue from 84 patients with lung cancer, the expression of glutathione peroxidase (GPX), glutathione reductase (GR), proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR) was examined in relation to cisdiamminedichloroplatinum (CDDP) sensitivity.

METHODS

The CDDP sensitivity was assessed from an increase of cells in the S-phase or G2M-phase by a DNA histogram after the tumor cells were incubated in a CDDP solution. The expression of GPX, GR, PCNA, and EGFR for each tumor was studied with an indirect immunoperoxidase technique on paraffin-embedded tissues.

RESULTS

The percentage of patients sensitive to CDDP according to the histologic type was 86% for small cell carcinomas, 40% for large cell carcinomas, 31% for squamous cell carcinomas, and 6% for adenocarcinomas. There was an inverse relationship between CDDP sensitivity and the frequency of GPX and GR expression, and both were significantly different among histologic types. The GPX and GR expression was significantly lower in the CDDP-sensitive group than in the resistant group (P < 0.01). However, the expression of PCNA and EGFR was significantly lower in the sensitive group in non-small cell carcinomas and squamous cell carcinomas (P < 0.05).

CONCLUSIONS

From the above findings, an immunohistochemical study of these antigens may be useful for predicting CDDP sensitivity in lung cancer.

Prognostic value of c-erbB-2 protein expression in human lung adenocarcinoma and squamous cell carcinoma

203 primary human lung tumours, of which 119 were adenocarcinoma and 84 were squamous cell carcinoma, were investigated immunohistochemically for the expression of c-erbB-2 protein. Positive staining was evident in 33 (28%) of adenocarcinomas and 2 (2%) of squamous cell carcinomas. In cases of adenocarcinoma, c-erbB-2 was present in 18% of those with stage I disease. In stage IIIA, stage IIIB and stage IV cases, c-erbB-2 was present in 39%, 50% and 60%, respectively (I vs. IIIA and I vs. IIIB: P less than 0.05, I vs. IV: P less than 0.01). The 5-year survival rates of c-erbB-2 positive patients and those who were negative were 30% and 52%, respectively, with a statistically significant difference (P less than 0.01). These observations suggest that when the expression of c-erbB-2 correlates with invasiveness of the tumour, this correlation may serve as a prognostic indicator, particularly in cases of adenocarcinoma of the lung.