Adjuvant chemotherapy for lung cancer a new standard of care,natural treatment nerve pain feet,cancer care 275 7th ave longview,thomson medical chinese medicine - You Shoud Know

02.01.2015

Two randomized phase III trials in N2-positive patients (stage IIIA) failed to show any survival benefit for surgery following induction chemotherapy or chemoradiotherapy compared with chemoradiotherapy alone,3,4 thereby making the role of routine surgery in this subset of NSCLC questionable.
The cure rate of surgery is dependent on the pathologic stage of the patient determined at the time of resection.
Table 2 summarizes the five major cisplatin-based trials8-12 reported since the 1995 meta-analysis.6 The trials included slightly different patient populations and used various cisplatin-based approaches for 3-4 cycles administered generally within 60 days of resection.
The Cancer and Leukemia Group B (CALGB) has reported the only trial14 in which only stage IB patients were included. In all adjuvant settings, significant numbers of patients receive treatment who would have otherwise been cured by surgery alone. In the trial reported by the National Cancer Institute of Canada (NCI-C),12 K-ras mutation was a stratification variable. Along the same lines, certain patients are cured by surgery alone, and several investigators have attempted to define low-risk versus high-risk patients. Another group of investigators20 identified a five-gene signature that distinguished good prognostic from poor prognostic groups of patients with early-stage, resected NSCLC.
Adjuvant radiotherapy improves lymph node-field control in patients at high risk of relapse after therapeutic lymphadenectomy for metastatic melanoma, an Australian-New Zealand study has confirmed. The use of radiotherapy in these circumstances had been controversial, with treatment decisions based on retrospective, non-randomised studies, the Australian and New Zealand Melanoma Trials Group and the Trans-Tasman Radiation Oncology Group researchers noted in Lancet Oncology. They initiated the study in patients judged at high risk of lymph node-filed relapse because of factors such as the number and size of the nodes involved, and extranodal spread.
In the 217 patients eligible for analysis, the primary endpoint of lymph node-field relapse was significantly reduced by radiotherapy (20 vs 34, hazard ratio 0.56), but there were no significant differences in relapse-free survival (70 vs 73 events) or overall survival (59 vs 47 deaths). Draining lymph nodes were usually the first site of recurrence after definitive excision of primary cutaneous melanoma, the researchers said. Once the nodes had been removed because of relapse, patients with a substantial disease burden had a high risk of recurrence, leading to pain, ulceration, malodour, lymphoedema and impaired function. Oncology Update offers the latest news and opinion on a wide range of clinical and political issues relevant to Australian oncologists, as well as coverage of the leading national and international conferences. Treatment strategies for refractory lung cancer may be transformed by the immunotherapy atezolizumab, following results from the POPLAR and BIRCH studies that demonstrated its efficacy. This opinion piece explores potential opportunities in NSCLC therapy in the second-line setting, with a particular focus on patients who are molecularly unselected or ineligible for clinical trials. An unprecedented large number of agents capable of prolonging survival is presently available for patients with castration-resistant prostate cancer (CRPC) [1,2]. The taxanes, paclitaxel, docetaxel and nab-paclitaxel, are among the most active cytotoxic agents for treatment of breast cancer.


More often than not, this process involves mediastinoscopy, which remains the gold standard for evaluation of the mediastinal contents. Surgical resection remains the standard of care for patients with stages I-II NSCLC who have adequate cardiopulmonary function and are candidates for resection. Only one trial8 reported on the rate of complete lymph node dissection, leaving the issue of surgical quality undefined in the other four trials.
The median age of the patients included was 59 years (only 9% were > 70 years), and 80% were male. This trial randomized 344 stage IB patients to undergo observation versus 4 cycles of carboplatin and paclitaxel. Likewise, many patients receive adjuvant chemotherapy (and its associated toxicities) and relapse and die despite it. Potti et al19 identified gene-expression profiles that predicted the risk of recurrence in 89 patients with early-stage NSCLC who were resected for cure. These interesting observations will require prospective validation, but the possibility of refining the prognosis of individual patients and influencing clinical decisions regarding the use of adjuvant chemotherapy is an exciting prospect and should be evaluated in well-designed, prospective clinical trials such as the CALGB trial previously mentioned. The most common grade 3 and 4 adverse event related to radiotherapy was radiation dermatitis, experienced by 19 patients. If you are not yet registered with DISQUS then please sign up by clicking on the DISQUS logo below. In order to register, please make sure JavaScript and Cookies are enabled, and reload the page.
Documentation of mediastinal lymph node involvement certainly should preclude surgery as the initial treatment.
There is general agreement that surgical resection should be performed in those patients who go to the operating room (presumably following a negative mediastinal evaluation) and are found to have resectable stage IIIA disease that was unsuspected previously (incidental N2 disease).
Three of the trials8,10,12 defined a specific regimen to be used, whereas two trials allowed physicians a choice of regimen.9,11 The only regimen considered to be a “modern” platinum-based regimen was cisplatin plus vinorelbine, and only two of the trials10,12 mandated treatment with this regimen.
Thirty-one percent of the patients had undergone pneumonectomy, and squamous cell was the dominant histology (48% versus 39% adenocarcinoma). The effect of therapy was clearly significantly positive in the node-positive (stages II and III) patients but not in the node-negative (stage I) patients.
The observation of a possible detrimental effect in stage IA in the LACE meta-analysis should provide a level of caution about the use of adjuvant therapy in this stage of NSCLC.
Olaussen and colleagues16 analyzed patients’ surgical specimens on an international trial9 for excision repair cross-complementation group 1 (ERCC1) enzyme expression and correlated its expression with the benefit of adjuvant cisplatin-based therapy. A lung metagene model that identified a low-risk and high-risk metagene profile was developed; it was more predictive of 5-year survival than clinical or pathologic stage.


Although these molecular profiles may be prognostic, they may not be predictive with regard to the benefit of adjuvant cisplatin-based chemotherapy. Four8,9,11,12 of the five trials allowed adjuvant thoracic radiotherapy (TRT) to be delivered following chemotherapy.
The main objective was to identify trial or patient characteristics associated with the benefit of adjuvant cisplatin-based therapy. In fact, there was a suggestion of a detriment in survival in the stage IA patients, although the CIs for the survival HR overlapped 1.0.
Samples were available on 761 of the 1,867 patients enrolled (specimens were only collected from centers that enrolled at least 10 patients). The metagene approach was validated in an independent group with resected NSCLC obtained from an American College of Surgeons and CALGB trial. In subset analyses of the three positive trials,9,10,12 there did not appear to be a benefit from treatment in stage IB patients. An unplanned retrospective analysis suggested a benefit to adjuvant carboplatin and paclitaxel in patients whose tumor was > 4 cm. Given the potential usefulness of this approach, CALGB investigators are planning a trial in which patients with resected stage IA will be categorized as either low risk versus high risk based on the metagene analysis. All trials demonstrated that the delivery of adjuvant cisplatin-based regimens was difficult, with compliance rates ranging from 45%-74% in patients receiving the full prescribed course of therapy. Along with the individual trials, the LACE meta-analysis solidified the role of adjuvant cisplatin-based chemotherapy in stages II and III (node-positive) resected NSCLC. However, these subset analyses should be viewed with skepticism, as they were not powered to detect the small differences expected in this setting in a group of patients less likely to relapse and die (Table 1). A final analysis of this trial is yet to come, but it has questioned the routine recommendation for adjuvant chemotherapy in the node-negative patient. No further therapy will be given to the low-risk patients; however, the high-risk patients will be randomized to undergo either observation or adjuvant chemotherapy. Whether the most recent negative results were secondary to the use of carboplatin versus cisplatin or related to the relatively small numbers of patients with an overall better prognosis remains uncertain. This trial did show that carboplatin-based therapy may be better tolerated in this setting; 85% of patients received 4 cycles of treatment, with 55% receiving those cycles at full dose.



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