[MOL] Lung cancer info.... [00059] Medicine On Line

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[MOL] Lung cancer info....

Study Questions Value of Chemo for Lung Cancer
By Hooman Dilmanian

Adding chemotherapy to radiation is no more effective than radiation alone in extending survival in certain lung cancer patients who have already had their tumors surgically removed, a new study concludes.

The findings add to an ongoing controversy surrounding the value of chemotherapy for non-small cell lung cancer (NSCLC) patients (see a related story).

The study tested a combination of two chemotherapy drugs plus radiation on patients with NSCLC who had undergone successful tumor-removal surgery to treat the later stages of the disease, and compared that to radiation alone following surgery. Not only was there no difference in survival between the two groups, but also a higher number of those on the combined regimen suffered serious side effects, with 31 percent unable to finish the entire regimen of chemotherapy.

“The morbidity associated with combination therapy must be considered in the design of future trials,” wrote authors David H. Johnson, M.D., of Vanderbilt University in Nashville, Steven M. Keller, M.D., of Beth-Israel Medical Center in New York, and colleagues.

In spite of these findings, Frank Anthony Greco, M.D., of the Centennial Medical Center’s Sarah Cannon Cancer Center in Nashville, said in an interview that he sees a “very good future” for chemotherapy for NSCLC. He noted that newer chemotherapy drugs developed since the Keller study began are less toxic and have fewer side effects. Whether these newer drugs will be better tolerated by patients and will extend survival remains to be seen, he said.

NSCLC is the most common form of lung cancer, accounting for 75 to 80 percent of all cases. The best chance for a cure is resection, or surgical removal, of the affected area of the lung.

Even if the cancer appears to be completely resected, the procedure may still leave behind microscopic amounts of cancer cells that can potentially spread to other parts of the body. For this reason, chemotherapy, which most commonly consists of the drug cisplatin by itself or with other drugs, is widely used as a post-operative supplement to destroy any residual cancer.

But the widespread use of post-operative chemotherapy for NSCLC has not been without controversy. In an editorial accompanying the new study, Desmond N. Carney, M.D., of the Mater Hospital in Dublin, Ireland wrote, “Only a few of the many published trials of adjuvant [supplemental] chemotherapy after curative resection have reported any meaningful survival benefit from the addition of chemotherapy.”

The Keller study sought to further elucidate the role of chemotherapy in a clinical trial of 488 NSCLC patients at nine cancer centers throughout the United States.

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