[MOL] Adenocarcinoma/lung/Reply [02928] Medicine On Line


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[MOL] Adenocarcinoma/lung/Reply



Dear Friend:  Welcome to our wonderful forum.  I hope that what I have
researcher and attached for you will be of help.  It appears (as you will
see) that taxol and carboplatin have good results.  Should you need more
information pls. tell me if you know if you have Small cell lung cancer or
Non Small cell lung cancer.
I understand this is a time of great trials for you, I always felt it was a
way to separate the men from the boys as the expression goes.  One needs to
draw on every ounce of strength they have and to hang in tough.  The cancer
journey is a roller coaster ride; but please know we are here for you at
all times. Please keep us posted as to how you are responding to your
therapy and if you feel uncomfortable by all means go to another doctor for
a second opinion.  Two things of great value, always listen to what your
body is telling you and make sure your doctors  listens to what you are
telling them and responding to you in a positive manner.  The second is to
look at chemo like Pac Man (remember that video game?)
think of it as just opening it's mouth to gobble those nasty cancer cells. 
At all times you must work on keeping hope.  Know that we are all praying
for you and you may just find that this is the right chat line for you.  It
helps to talk with people who have been on the journey.  Your friend,
lillian


Adenocarcinoma (AD-in-o-kar-sin-O-ma): Cancer that begins in cells that
line certain internal organs.
				~~~~~~~~~~~~~~~~~~~~~
Any T, any N, M1 

Cisplatin-containing and carboplatin-containing combination chemotherapy
regimens produce objective response rates (including a few complete
responses) that are higher than those achieved with single-agent
chemotherapy. Although toxic effects may vary, outcome is similar with most
cisplatin-containing regimens; a randomized trial comparing five
cisplatin-containing regimens showed no significant difference in response,
duration of response, or survival.[1] Patients with good performance status
and a limited number of sites of distant metastases have superior response
and survival when given chemotherapy when compared to other patients.[2] A
prospective randomized comparison of vinorelbine plus cisplatin versus
vindesine plus cisplatin versus single agent vinorelbine has reported
improved response rate (30%) and median survival (40 weeks) with the
vinorelbine plus cisplatin regimen.[3] Two small phase II studies reported
that paclitaxel (Taxol) has single-agent activity in stage IV patients,
with response rates in the range of 21%- 24%.[4,5] Reports of paclitaxel
combinations have shown relatively high response rates, significant 1 year
survival, and palliation of lung cancer symptoms.[6] With the paclitaxel
plus carboplatin regimen, response rates have been in the range of 27%-53%
with 1-year survival rates of 32%-54%.[6,7] The combination of cisplatin
and paclitaxel was shown to have a higher response rate and higher 1 year
survival rate than the combination of cisplatin and etoposide.[8]
Additional clinical studies should better define the role of these newer
combination chemotherapy regimens in the treatment of advanced non- small
cell lung cancer.[8] Meta-analyses have shown that chemotherapy produces
modest benefits in short-term survival compared to supportive care alone in
patients with inoperable stages IIIb and IV disease.[9-11] 

Although these results support further evaluation of chemotherapeutic
approaches for both metastatic and locally advanced non-small cell lung
cancer (NSCLC), efficacy of current programs is such that no specific
regimen can be regarded as standard therapy. Appropriate patients should be
encouraged to participate in clinical trials. Outside of a clinical trial
setting, chemotherapy should be given only to patients with good
performance status and evaluable tumor lesions who desire such treatment
after being fully informed of its anticipated risks and limited benefits. 

 Chemotherapy. The following regimens produce similar survival outcomes:
cisplatin plus vinblastine.[1] cisplatin plus vinblastine plus
mitomycin.[15] cisplatin plus vinorelbine.[3] cisplatin plus vindesine.[3]
cisplatin plus paclitaxel.[8] carboplatin plus paclitaxel.[6,7] 

Date Last Modified: 11/98
University of Pennsylvania
				~~~~~~~~~~~~~~~~~~~~

Cell  Culture Drug Resistance Testing Labs

				~~~~~~~~~~~~~~~~~~~~~


SUMMARY:
The primary focus of this session was to compare and contrast the various
treatment modalities for stage III and IV small cell and non-small cell
lung cancers. 

Stage IV Small Cell Lung Cancer:
Six new chemotherapeutic agents hold great promise in the treatment of
patients with advanced stage small cell lung cancer. All of these have been
approved or will be approved for use in patients with lung cancer. These
agents could potentially improve survival of patients to a greater degree
than current chemotherapeutic regimens. are: 

Taxanes (paclitaxel, docetaxel) 

Paclitaxel has demonstrated a 59% response rate in patients and docetaxel
has demonstrated a 25% response rate in patients previously treated by
other means. Both of these numbers are promising. 

Topoisomerases (CPT-11, Topotecan) 
Gemcitabine, Navelbine 
Stage III:
For small cell lung cancer, the various studies and meta-analyses
demonstrate a general trend: Chemotherapeutic agents, in combination with
radiation therapy, tend to improve median survival over use of radiation
therapy alone. However, these combination treatments also tend tend to be
more toxic to the patient. 

The question then becomes one of optimizing dosages for these combination
treatments, so as to maximize patient benefit while simultaneously
minimizing toxicity. In general, according to the various studies cited, it
is preferable to begin radiation therapy as early as possible during the
chemotherapy regimen. 

While chemotherapy and radiation treatments administered in combination
tend to provide a greater median survival than radiation therapy alone, the
survival at 3 years is statistically the same for both groups, however. The
benefit of higher median survival must therefore be balanced by
consideration of treatment toxicity to the patient. 

These are labs that do the testing:

Analytical Biosystems, Inc. 
Providence, Rhode Island 
Ken Blackman, PhD 
Solid Tumors Only 
1-800-262-6520 

Anticancer, Inc. 
San Diego, CA 
Robert Hoffman, PhD 
Solid Tumors Only 
1-619-654-2555 

Oncotech, Inc. 
Irvine, CA 
John Fruehauf, MD 
Solid Tumors and Hematologics 
1-714-474-9262 
FAX 1-714-474-8147 

Sylvester Cancer Institute 
Miami, FL 
Bernd-Uwe Sevin, MD 
Solid Tumors Only (especially GYN) 
1-305-547-6875 

Human Tumor Cloning Laboratory 
San Antonio, TX 
Daniel D. Von Hoff, MD 
Solid Tumors Only 
1-210-677-3827 

Rational Therapeutics Institute 
Long Beach, CA 
Robert A. Nagourney, MD 
Solid Tumors and Hematologics 
1-310-427-3052 
FAX 1-310-424-0735 

Weisenthal Cancer Group 
Huntington Beach, CA 
Larry M. Weisenthal, MD, PhD 
Solid Tumors and Hematologics 
1-714-894-0011 
FAX 1-714-893-3659 
e-mail: 72203,2235@compuserve.com 
				`~~~~~~~~~~~~~~~~~~~~~~

>From Ocono Link, Univ. of Pa.

SUMMARY:

The primary focus of this session was to compare and contrast the various
treatment modalities for stage III and IV small cell and non-small cell
lung cancers. 

Stage IV Small Cell Lung Cancer:
Six new chemotherapeutic agents hold great promise in the treatment of
patients with advanced stage small cell lung cancer. All of these have been
approved or will be approved for use in patients with lung cancer. These
agents could potentially improve survival of patients to a greater degree
than current chemotherapeutic regimens. are: 

Taxanes (paclitaxel, docetaxel) 

Any T, any N, M1 

Cisplatin-containing and carboplatin-containing combination chemotherapy
regimens produce objective response rates (including a few complete
responses) that are higher than those achieved with single-agent
chemotherapy. Although toxic effects may vary, outcome is similar with most
cisplatin-containing regimens; a randomized trial comparing five
cisplatin-containing regimens showed no significant difference in response,
duration of response, or survival.[1] Patients with good performance status
and a limited number of sites of distant metastases have superior response
and survival when given chemotherapy when compared to other patients.[2] A
prospective randomized comparison of vinorelbine plus cisplatin versus
vindesine plus cisplatin versus single agent vinorelbine has reported
improved response rate (30%) and median survival (40 weeks) with the
vinorelbine plus cisplatin regimen.[3] Two small phase II studies reported
that paclitaxel (Taxol) has single-agent activity in stage IV patients,
with response rates in the range of 21%- 24%.[4,5] Reports of paclitaxel
combinations have shown relatively high response rates, significant 1 year
survival, and palliation of lung cancer symptoms.[6] With the paclitaxel
plus carboplatin regimen, response rates have been in the range of 27%-53%
with 1-year survival rates of 32%-54%.[6,7] The combination of cisplatin
and paclitaxel was shown to have a higher response rate and higher 1 year
survival rate than the combination of cisplatin and etoposide.[8]
Additional clinical studies should better define the role of these newer
combination chemotherapy regimens in the treatment of advanced non- small
cell lung cancer.[8] Meta-analyses have shown that chemotherapy produces
modest benefits in short-term survival compared to supportive care alone in
patients with inoperable stages IIIb and IV disease.[9-11] 

Although these results support further evaluation of chemotherapeutic
approaches for both metastatic and locally advanced non-small cell lung
cancer (NSCLC), efficacy of current programs is such that no specific
regimen can be regarded as standard therapy. 

 Chemotherapy. The following regimens produce similar survival outcomes:
cisplatin plus vinblastine.[1] cisplatin plus vinblastine plus
mitomycin.[15] cisplatin plus vinorelbine.[3] cisplatin plus vindesine.[3]
cisplatin plus paclitaxel.[8] carboplatin plus paclitaxel.[6,7] 








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