 meeting.)
In a nutshell
The authors summarized the approved guidelines obtained from the ESMO meeting on the treatment options for advanced non-small cell lung cancer.
Some background
In non-small-cell lung cancer (NSCLC), almost 70% of patients are diagnosed at an advanced stage of the disease. Most of these patients are unsuitable for the curative treatments available, such as, chemotherapy. Other treatments are also available which are specific for certain genetic mutations (permanent change in cell make-up) in NSCLC. Comprehensive guidelines on different treatment options for advanced NSCLC will be helpful towards deciding the most effective treatment.
Methods & findings
The authors aimed to summarize the guidelines for the treatment of advanced NSCLC.
A total of 35 experts were involved in the decision-making process. Guidelines were made based on previously published relevant data.
Reports from several clinical trials showed that overall survival (patients who did not die following treatment) in patients was increased when cisplatin (Platinol) was combined with any of the third generation lung cancer drugs (such as vinorelbine [Navelbine] or gemcitabine [Gemzar]). This was compared to carboplatin (Paraplatin) when administered with a third generation drug. Cisplatin, along with any of the third generation chemotherapy drugs, are recommended to be used for fit, NSCLC patients.
One trial concluded that patients who received 6 cycles of platinum-based chemotherapy (a specific group of chemotherapy drugs) had a 37% reduced risk of experiencing shorter progression-free survival (patients who did not experience cancer growth after treatment). This was compared to patients who received 4 cycles. In another study, patients who received 6 cycles of chemotherapy had a 25% reduced risk of cancer spread and a small increase in survival. This was compared to patients who received 4 cycles of chemotherapy. 4 cycles of chemotherapy was recommended as the standard treatment.
Several studies were carried out to determine the effectiveness of different chemotherapies in fit, elderly patients compared to younger adults. A clinical trial compared using a combination of carboplatin and paclitaxel (Taxol) with either vinorelbine or gemcitabine. There was an increase in response rate (disappearance of tumors), survival and patient side-effects when combination therapy was used. Carboplatin or other platinum-based chemotherapy might be recommended for fit elderly patients.
Some NSCLC patients may have mutations in their EGFR genes that causes increased cancer cell growth. Patients with EGFR mutations who received EGFR-TKI (drug that slows down the growth of cancer cells) saw an increased response rate and progression-free survival. This was compared to patients who received chemotherapy. EGFR-TKI drugs were recommended as a primary treatment in patients with EGFR mutations.
The bottom line
In conclusion, the authors recommended the types of chemotherapy, the cycles of chemotherapy and the treatments specific for certain genetic mutations in NSCLC, among others.
Published By :
Annals of oncology
Date :
Mar 25, 2014
