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12.09.2014 admin
The incidence of early-stage non–small cell lung cancer (NSCLC) in an increasingly elderly population is on the rise. Here, the authors compared the three most commonly used therapies for elderly patients with early-stage NSCLC – lobectomy (removal of a lung lobe), sublobar resection (partial removal of affected lung), and stereotactic ablative radiotherapy (SABR).
This is the most comprehensive population-based study evaluating current treatments for early-stage NSCLC.
In the study, the authors analyzed the Surveillance, Epidemiology and End Results (SEER) Medicare database and identified 9,093 patients with NSCLC treated with either of the following treatments — lobectomy (7,215 patients), sub lobar resection (1,496 patients), and SABR (382 patients). In summary, the authors found lobectomy associated with better lung-specific survival when compared to sublobar resection.
When they compared lobectomy with SABR, both groups of patients exhibited the same lung-specific survival. ABSTRACT: Non–small-cell lung cancer (NSCLC) remains a difficult-to-treat malignancy, and durable long-term survival is elusive for patients with advanced-stage disease. A variety of agents and drug combinations (see Table 1) are used for the management of patients with non–small-cell lung cancer (NSCLC), depending on the stage of the disease and a number of patient factors that will be discussed in this article.
Cisplatin-based combinations (doublets) continue to be the cornerstone of treatment for patients with advanced NSCLC, following results of early studies that demonstrated a modest 1-year survival benefit (20% to 25%) with this modality.[1] For years, researchers have tried to determine the most effective doublet therapy, in terms of patient response and survival.
In 2008, Scagliotti et al published the findings of their phase III study comparing the efficacy of cisplatin-based doublets (gemcitabine, pemetrexed [Alimta]) in untreated patients with advanced-stage NSCLC. There is still some question as to which platin (cisplatin or carboplatin) is the more effective agent. Carboplatin side effects are milder nausea and vomiting (compared with cisplatin) and hematologic issues such as thrombocytopenia. For years, researchers have been investigating various combinations of drugs and other means of overcoming the plateau effect of standard chemotherapy.
In 2006, the US Food and Drug Administration (FDA) approved bevacizumab as first-line treatment for advanced NSCLC in combination with carboplatin and paclitaxel.[7] Bevacizumab is a recombinant monoclonal antibody that prevents vascular endothelial growth factor (VEGF) from binding to its receptor, thereby slowing tumor growth and preventing metastasis.
Small tyrosine kinase inhibitors (TKIs) target the intracellular EGFR pathways, thereby blocking downstream signaling as well as growth and proliferation of cancer.[7] Two such agents are gefitinib (Iressa) and erlotinib (Tarceva).
Recent studies have evaluated the oral TKIs as monotherapy (single-agent) first-line treatment for advanced NSCLC. Another phase III randomized clinical trial evaluated erlotinib vs carboplatin-gemcitabine as first-line treatment for NSCLC. Crizotinib (Xalkori), another small-molecule agent, may also be used as first-line treatment providing that the patient’s tumor expresses the EML4-ALK mutation, and that this mutation status is known at the time of treatment intiation. Related topics at this site; lung cancer and lung diseases, lung ailments and conditions, lung cancer photos, pictures and images, lung cancer signs, symptoms and prognosis.
Modulation of ?-catenin signaling by natural agents induces apoptotic cell death in many common cancers, including colon cancer, breast cancer and prostate cancer. However, in most patients, there is no evidence of distant metastasis at the time of surgery, but the cancer has penetrated deeply into the colon wall or reached adjacent lymph nodes. Chemo is used to kill any remaining cells after removal; it is usually targeted towards the infected organs at this stage. The keys may be a protein called HIF (hypoxia-inducing factor), the chemokine receptor CXCR4 and FAS (fatty acid synthase) a key lipogenic enzyme catalyzing the terminal steps in the synthesis of fatty acids.
HIF-1alpha modulates energy metabolism in cancer cells by inducing over-expression of specific glycolytic isoforms.
Expression levels and significance of hypoxia inducible factor-1 alpha and vascular endothelial growth factor in human colorectal adenocarcinoma. Effect of HIF-1 modulation on the response of two- and three-dimensional cultures of human colon cancer cells to 5-fluorouracil.
Radiation-induced HIF-1alpha cell survival pathway is inhibited by soy isoflavones in prostate cancer cells.
Antiangiogenic activity of genistein in pancreatic carcinoma cells is mediated by the inhibition of hypoxia-inducible factor-1 and the down-regulation of VEGF gene expression. Sulforaphane inhibited expression of hypoxia-inducible factor-1alpha in human tongue squamous cancer cells and prostate cancer cells. Inhibition of HIF-1 alpha and VEGF expression by the chemopreventive bioflavonoid apigenin is accompanied by Akt inhibition in human prostate carcinoma PC3-M cells.

Metastasis is the ability of cancer cells to spread from a primary site, to form tumours at distant sites.
Autocrine Induction of Invasive and Metastatic Phenotypes by the MIF-CXCR4 Axis in Drug-Resistant Human Colon Cancer Cells. SinnolZym, a natural inhibitor of FAS, inhibit growth and induce apoptosis in the metastatic colon cancer. Positive feedback regulation between AKT activation and fatty acid synthase expression in ovarian carcinoma cells. Why does tumor-associated fatty acid synthase (oncogenic antigen-519) ignore dietary fatty acids? Saturated fatty acid metabolism is key link between cell division, cancer, and senescence in cellular and whole organism aging.
Fatty acid synthase inhibitor cerulenin suppresses liver metastasis of colon cancer in mice. Lung cancer is a very serious disease on which your chances of survival will greatly improve with the proper treatment.
There are different types of treatment for lung cancer, including surgery, radiation therapy and chemotherapy. Radiation therapy is an option for lung cancer patients who can’t go through surgery, like the elderly or those with other chronic health problems. Chemotherapy is successful in prolonging the life of cancer patients who are already in good general health. According to Oncology Channel, the 5-year survival rate of lung cancer patients with primary lung cancer jumps from 10 percent to 35 to 40 percent after surgically removing cancer that has not spread from the lung.
Frequently associated co-morbidities are chronic obstructive pulmonary disease (COPD), coronary artery disease, and renal failure. Accordingly, Shirvani noted, “In the absence of clinical trials, it was important to analyze observational data from a very large database to compare these three modalities. Shirvani added, “The assumption was that for an elderly patient with a number of co-morbidities, the smaller surgery would be better than a whole lobectomy because there would be fewer surgical complications.
Thus, the authors suggest that SABR is a potential therapeutic strategy for elderly patients with multiple comorbidities. Chemotherapy, especially with platinum-based combinations, is the mainstay of treatment, yet these regimens yield only modest response and survival rates.
Although both combinations had equivocal efficacy, the main finding of the meta-analysis was that patients with either adenocarcinoma or large cell carcinoma who had received cisplatin-pemetrexed had better survival rates than those treated with cisplatin-gemcitabine. Numerous studies have tried to answer this question.[2,4–6] Both drugs have benefits and toxicities. Results of phase III randomized clinical trials comparing chemotherapy plus an oral TKI (gefitinib, erlotinib) against chemotherapy alone did not show improved survival with addition of the oral TKI.[19–22] Therefore, oral TKIs in combination with chemotherapy were not approved for first-line treatment of patients with advanced NSCLC. This was a smaller study in which 549 patients were screened but 384 patients were excluded because their tumor did not express the EGFR-activating mutation (exon 19 deletion or exon 21 L858R point mutation); therefore, 165 patients were randomized to the two arms. With 300,000 new cases per year, it is the second commonest cancer and is therefore highly relevant to general medical practice.
These patients are at risk of tumor recurrence either locally or in distant organs such as liver and lungs.
One method, hepatic artery infusion for metastatic colon cancer, targets the chemo straight into the liver.
As an adjuvant to surgery for colon cancer it confers an absolute survival benefit of less than 5%; in colon cancer it is largely palliative, improving quality of life and lengthening survival by 6-8 months.
Radiation and chemotherapy do kill some solid tumor cells, but in the cells that survive, the therapies drive an increase in a regulatory factor called HIF (hypoxia-inducible factor), which cells use to get the oxygen they need by increasing blood vessel growth into the tumor. This pathway is always active in cancer cells, providing growth stimuli and protection from apoptosis.
It removes the cancer by taking out either the tumor, the infected lobe of the lung or the entire lung. Three different treatments are available for NSCLC patients, however, differences in clinical characteristics and survival outcomes have not been the subject of a comprehensive study.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Outcomes of recent clinical trials have shown that histology, mutation analyses, and biomarkers have an impact on the selection and combination of chemotherapeutic agents. It should be noted that patients with squamous cell carcinoma treated with the cisplatin-gemcitabine combination had improved survival rates compared with patients who received the cisplatin-pemetrexed doublet. Treatment with cisplatin requires pre- and post-treatment hydration, thus prolonging the treatment time.[7] Side effects of cisplatin include, but are not limited to, nausea, vomiting, neurotoxicity, nephrotoxicity, and ototoxicity.
If, after treatment is started, the patient’s tumor does express the EML4-ALK mutation, then crizotinib could be used after initial treatment is completed (see section on Second and Third-Line Therapy). Solid tumors generally have low supplies of oxygen, and HIF helps them get the oxygen they need.
Recent studies have demonstrated that the chemokine receptor CXCR4 plays a crucial role in organ-specific metastasis formation. As previously discussed, recent data has demonstrated that fatty acid metabolism plays a critical role in cancer. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Oral tyrosine kinase inhibitors and monoclonal antibodies are now part of the treatment schema. This study was the first to demonstrate survival differences based on histology.[3] Based on the results of this phase III clinical trial, histology is a significant factor in selection of chemotherapeutic agents for patients with untreated, advanced-stage NSCLC. Doctors can remove the section of the colon with the tumor and sew the healthier sections together. Surgery has its cost – it forces the immune system to divert its attention to healing the wounds. The prevailing belief in cancer therapy is that retreatment with a given drug after the emergence of resistance is ineffective.
Fatty acid synthase (FAS) is highly expressed in many kinds of human cancers, including colon cancer.
It is the inhibition of AKT activity by the FAS inhibitors that actually induces apoptosis.
Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Other changes to the treatment paradigm include the duration of treatment and the use of maintenance therapy. By stripping methyl groups from the gene, they re-activate the survival, anti-cell death pathways, rendering themselves invincible to chemo drugs. Organs to which these cancers metastasize secrete CXCL12, the unique ligand for CXCR4, which stimulates invasion and metastasis to these sites. Government, university, and drug-company researchers are racing to develop new drugs that inhibit HIF and FAS. Those are people who chose to cure lung cancer using herbal remedies, or using the medical treatment. Additionally, chemotherapy is now employed in earlier-stage disease in neoadjuvant, adjuvant, and combined-modality treatments. Surgery may also be an option to remove other infected body parts, depending on the size of the areas infected. At the same time, though, they retain many of the harmful gene mutations acquired during their wild, rapid-growth days. Fortunately, we have novel, natural compounds that can selectively inhibit FAS activity without affecting fatty acid oxidation and demonstrated that these compounds effectively inhibit growth of human colon cancer without causing toxicity.
Therefore, you must be prepared, and to know what treatments will work best, you need to know how cancer cells survive radiation and chemo.

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