Public Release: 

Multimodality treatments effective in halting lung cancer progression

Combination therapies improve survivability

International Association for the Study of Lung Cancer

SAN FRANCISCO, August 3, 2009 -- The world's top lung cancer specialists, medical professionals and researchers are convening this week in San Francisco, CA for the 13th World Conference on Lung Cancer (WCLC), organized by the International Association for the Study of Lung Cancer (IASLC). As non-small cell lung cancer (NSCLC) is one of the most common types of lung cancer affecting a heterogeneous population, researchers have focused on multi-modality treatment regimens to improve patient outcomes. According to research showcased today at the WCLC, multi-modality, tailored treatment regimens increased patient survival rates compared to single-agent therapies.

"Researchers found that combination therapies tailored to patient prognosis to treat NSCLC significantly improved patient outcomes," said David Gandara, M.D., WCLC program chair. "The combination of effective treatments for NSCLC provides a patient with a more robust therapy platform to tackle the disease from multiple angles."

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A Phase III Randomized Trial of Surgery Alone, Preoperative Paclitaxel/Carboplatin Chemotherapy Followed by Surgery or Surgery Followed by Adjuvant Paclitaxel/Carboplatin Chemotherapy in Early Stage Non-Small Cell Lung Cancer: NATCH Follow-up Data (Abstract # PRS.3)

When doctors are presented with a patient living with early stage non-small cell lung cancer (NSCLC), surgery is the clear choice for treatment, and there are several additional options available to further treat the patient and improve his or her prognosis and survival. In this study, researchers assessed whether surgery alone, chemotherapy before surgery or chemotherapy after surgery improved the disease-free survival of patients.

The study looked at 624 adult patients with early stage NSCLC over a seven-year period. The researchers randomized these chemo-naïve patients into three groups according to their treatment regimen: three cycles of chemotherapy before surgery (pre-op), three cycles of chemotherapy after surgery (adjuvant) or surgery alone, and compared the five-year, disease-free survival. Researchers found that the five-year, disease-free survival rate was 38 percent in the pre-op group, 37 percent in the adjuvant arm and 34 percent in the surgery alone arm. More patients in the pre-operative arm (97 percent of the patients) received the planned chemotherapy treatment when compared with the adjuvant arm (only 66 percent of the patients received the planned adjuvant treatment).

"These findings suggest that pre-operative chemotherapy had a non-significant trend towards improved five-year, disease-free survival when compared to surgery alone" said Enriqueta Felip, M.D. of Vall d'Hebron University in Barcelona, Spain and lead author of the study.

Dr. Felip will present this study during the Presidential Symposium on Monday, August 3, at 9:20 am PT in Moscone West, Ballroom, Level 3.

A Phase III Comparison of Prophylactic Cranial Irradiation (PCI) Versus Observation in Patients with Locally Advanced Non-Small Cell Lung Cancer (LA-NSCLC): Initial Analysis of Primary and Secondary Endpoints RTOG 0214 (Abstract # C6.6)

The brain is one of the most frequent sites to which cancer can spread after successful treatment in patients with locally advanced non-small cell lung cancer (LA-NSCLC). However, researchers believe the use of prophylactic cranial irradiation (PCI) following effective loco-regional/systemic therapy could improve survival rates and impact the incidence of brain metastases in patients with stage III NSCLC.

In this Radiation Therapy Oncology Group (RTOG) study, 356 patients were randomized to receive PCI or observation after loco-regional/systemic treatment. Researchers sought to determine if PCI improves survival or impacts brain metastases, neuro-psychological function and quality of life in NSCLC patients.

At one year, there was no significant difference in overall survival rates between patients receiving PCI and those being observed. However, patients in the observation arm of the study were more than two times more likely to develop brain metastases (18 percent) than those in the PCI arm (7.7 percent). There were no significant differences at one year in quality of life or neurocognitive function between the two arms of the study.

"Prophylactic cranial irradiation has the ability to significantly decrease the risk for brain metastases in NSCLC patients," says Alexander Sun, M.D., lead author of the study and radiation oncologist at Princess Margaret Hospital/University of Toronto. "Longer follow up of patients is needed to determine the significance of these findings, but the data should be considered as doctors discuss the benefits and risks of PCI with their patients."

This study was coordinated by the RTOG and available for patient enrollment through the NCI Clinical Trials Support Unit (CTSU) to members of the National Cancer Institute of Canada (NCIC), the Eastern Cooperative Oncology Group (ECOG), the North Central Cancer Treatment Group (NCCTG), the Southwest Oncology Group (SWOG) and the Cancer & Leukemia Group B (CALGB).

Dr. Sun will present this study on Monday, August 3, 2009 at 11:30am PT in Moscone West, Room 2002-2004, Level 2.

A randomized phase III study of gefitinib versus standard chemotherapy (gemcitabine plus cisplatin) as a first-line treatment for never-smokers with advanced or metastatic adenocarcinoma of the lung (ABSTRACT # PRS.4)

Doctors are constantly on the look out for advancements to better treat and tailor cancer treatment to the individual. Targeted therapies have been introduced that have improved standard chemotherapy approaches. Combining targeted therapies in specific patients with lung cancer may reduce the need for chemotherapy, and increased understanding of the targets involved in the pathogenesis of lung cancer may help to individualize drug therapy. One of these targeted therapies is gefitinib, a tyrosine kinase inhibitor (TKI) that targets the epidermal growth factor receptor (EGFR), a protein that causes cancer cells to divide. Gefitinib has shown high response rate and extended survival in never-smoker lung cancer patients, especially in those with an EGFR mutation.

In this randomized phase III trial, researchers sought to compare the efficacy of gefitinib as a first-line treatment with standard chemotherapy in patients who were never-smokers. Investigators randomized 309 never-smokers living with late-stage lung cancer into two groups. One group received gefitinib and the other group received chemotherapy.

While the gefitinib did not show an improved overall survival, results showed the group receiving gefitinib had a higher response rate and a significantly better progression-free survival (PFS, length of time during and after treatment when a patient's disease does not worsen) than those receiving chemo. Also, high-grade toxicity was less common in the gefitinib group than in the chemotherapy group.

Additionally, in the gefitinib group, PFS in the mutation-negative subgroup was shorter than that of the mutation-positive group (with a median of 2.1 vs. 8.4 months). There was no difference between these two subgroups in the chemotherapy group.

"Gefitinib did not improve overall survival over the standard chemotherapy," said Jin S. Lee, M.D. of the National Cancer Center Korea in Goyang, Korea. "However, a promising survival outcome along with high overall response rate and better toxicity profile suggests that gefitinib might be a reasonable first-line therapy for this group of never-smoker lung cancer patients."

Dr. Lee will present this study on Monday, August 3 at 9:35 am PT in Moscone West, Ballroom, Level 3.

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About Lung Cancer

Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. As they grow, the abnormal cells can form tumors and impede the function of the lung, which is to provide oxygen to the body via the blood. Approximately 1.3 million new cases of lung cancer will be diagnosed this year, and the disease remains the leading cause of cancer deaths worldwide.

Founded in 1972, the International Association for the Study of Lung Cancer (IASLC) is an international organization of 2,000 lung cancer specialists, spanning 53 countries. IASLC members work towards developing and promoting the study of etiology, epidemiology, prevention, diagnosis, treatment and all other aspects of lung cancer. IASLC's mission is to enhance the understanding and education of lung cancer to scientists, members of the medical community and the public. In addition to the biannual meeting, the IASLC publishes the Journal of Thoracic Oncology, a prized resource for medical specialists and scientists who focus on the detection, prevention, diagnosis and treatment of lung cancer.

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