Irinotecan: future directions in small-cell lung cancer

Reference intervals for plasma pro-gastrin releasing peptide (ProGRP) levels in healthy adults of Chinese Han ethnicity

OBJECTIVES

To determine the upper limits of the 95th percentile reference intervals (RIs) for the detection of the pro-gastrin releasing peptide (ProGRP) in plasma according to the Clinical and Laboratory Standards Institute (CLSI) C28-A3 guideline in a population of adult Chinese of Han ethnicity.

METHODS

Plasma samples were collected from 578 healthy adults. Plasma ProGRP values were measured by chemiluminescent microparticle immunoassay (CMIA) on Abbot ARCHITECT i2000 system analyzers.

RESULTS

Plasma ProGRP values did not conform to a Gaussian distribution, and thus non-parametric statistical methods were used to calculate RIs. Plasma ProGRP levels significantly increased with age, thus age-dependent RIs were determined. The upper limit of the 95th percentile RIs for plasma ProGRP was ≤57.26 pg/mL for young adults (18-50 years) and ≤81.42 pg/mL for old adults (>50 years).

CONCLUSIONS

By CMIA, we established distinct age-dependent RIs for plasma ProGRP in healthy adults of Chinese Han ethnicity, thus generating a valuable reference for future clinical and laboratory studies.

Split-course versus continuous thoracic radiation therapy for limited-stage small-cell lung cancer: final report of a randomized phase III trial

The optimal integration of radiation and chemotherapy for limited-stage small-cell lung cancer (SCLC) remains unclear. This phase III trial was conducted to determine whether chemotherapy plus interdigitating split-course thoracic radiation therapy (RT) improved survival compared with standard-dose continuous thoracic RT. One hundred fourteen patients were randomized to receive 50 Gy thoracic RT delivered in 2.0-Gy fractions given continuously (5 weeks) concurrent with the first 2 cycles of chemotherapy (arm A) or 50 Gy delivered via an interdigitating split course in 2.5-Gy fractions (8 weeks) concurrent with the first 3 cycles of chemotherapy (arm B). During the split-course RT, once-daily radiation was delivered on days 8-17 of each of the first two 21-day cycles and days 8-11 of the third 21-day cycle. All patients received the following chemotherapy: cisplatin/etoposide on cycles 1, 2, and 5 and cyclophosphamide/vincristine/doxorubicin on cycles 3, 4, and 6. Prophylactic cranial irradiation was recommended after a complete response to all therapy. One hundred ten eligible patients were randomized. Grade 3/4 esophagitis was reported in 9% of patients receiving continuous thoracic RT versus 4% of patients receiving split-course RT. Grade 3/4 hematologic toxicity was common in both treatment arms. Complete/partial response was observed in 80% of patients on arm A versus 84% on arm B. Overall survival rates at 5 years were 18% and 17% for arms A and B, respectively. Interdigitating split-course thoracic RT delivered in 2.5-Gy fractions was tolerable in patients with limited-stage SCLC but did not provide a survival advantage.

Progress in treatment of small-cell lung cancer: role of CPT-11

Small-cell lung cancer (SCLC) accounts for approximately 15% of all cases of lung cancer and is a particularly aggressive form of lung cancer characterised by a poor prognosis, rapid tumour growth, and early metastasis. Roughly, two-thirds of patients with SCLC present with extensive disease (ED) and one-third with limited disease (LD). Combination chemotherapy is the most effective treatment modality for SCLC, and several new agents, including carboplatin, ifosfamide, taxans, and topotecan, have been demonstrated to be active; however, there are no data on the survival benefit of these drugs. A CPT-11+ cisplatin regimen has shown improvement in overall survival over the global gold standard regimen, etoposide + cisplatin (Japanese Clinical Oncology Group: JCOG 9511), and three confirmatory randomised controlled trials are in progress to determine the reproducibility of the JCOG 9511 study. JCOG is evaluating the role of CPT-11 and a new triplet regimen containing CPT-11 in limited-stage SCLC. Strategies and the current protocols of the JCOG are presented and discussed. In the future, it will be essential to evaluate molecular target-based drugs for LD and ED SCLC with new standard combination chemotherapy regimens that include CPT-11.