New Combinations in Lung Cancer

Tom Dilling
University of Pennsylvania Cancer Center
Last Modified: May 18, 1996

Panelists

CHAIR: Paul A. Bunn, Jr., MD
University of Colorado Cancer Center

Robert Ginsberg, MD
Memorial Sloan-Kettering Cancer Center

William T. Sause, MD
LDS Hospital

Photo (l to r): Paul A. Bunn, Jr., MD.; Robert Ginsberg, MD; William T. Sause, MD

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.

Note:
Dr. Bunn has provided OncoLink with a short interview concerning this panel. It is available in Real Audio Format:
Interview with Paul A. Bunn, Jr., MD
Interview with Paul A. Bunn, Jr., MD (for 28.8 baud or faster Internet connections)