Chemotherapy vs Supportive Care in Advanced Non-Small-Cell Lung Cancer

Marino, Pietro Di; Pampallona, Sandro; Preatoni, Armando; Cantoni, Alessandra; Invernizzi, F

doi:10.1378/chest.106.3.861

Cited by 300 publications

(119 citation statements)

References 25 publications

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“…An expert panel of oncologists and oncology nurses with lung cancer expertise reviewed and identified standard treatment options accepted by the lung oncology community. Three meta-analyses of trials comparing chemotherapy with supportive care (one updated) (Souquet et al, 1993;Marino et al, 1994;Non-small Cell Lung Cancer Collaborative Group, 1995;Non-small Cell Lung Cancer Collaborative Group, 2000), and three systematic reviews were identified (Lopez et al, 1997;Sorenson et al, 2001;Paesmans, 2002). No additional randomised trials of first-line chemotherapy vs supportive care were identified.…”

Section: Decision Aid Developmentmentioning

confidence: 99%

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

et al. 2008

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We developed a decision aid (DA) for patients with metastatic non-small cell lung cancer (NSCLC), to better inform patients of their prognosis and treatment options, and facilitate involvement in decision-making. In a pilot study, 20 patients with metastatic NSCLC attending outpatient clinics at a major cancer centre, who had already made a treatment decision, reviewed acceptability of the DA. The median age of the patients was 61 years (range 37 -77 years), 35% were male, 20% had a university education, and most (75%) had English as a first language. Most had received chemotherapy, with 65% currently on treatment. Patients were not anxious at baseline and had clear understanding of the goals and toxicity of chemotherapy in advanced NSCLC. After reviewing the DA, patients' anxiety decreased slightly (P ¼ 0.04) and knowledge scores improved by 25% (Po0.001). Most improvements in understanding were of prognosis with and without chemotherapy, although patients still believed advanced NSCLC to be curable. Patients rated the DA highly with respect to information clarity, usefulness and were positive about its use in practice, although 40% found the prognostic information slightly upsetting. The DA for advanced NSCLC is feasible, acceptable to patients and improves understanding of advanced NSCLC without increasing patient anxiety.

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Section: Decision Aid Developmentmentioning

confidence: 99%

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

et al. 2008

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“…Non-small cell lung cancer (NSCLC) accounts for approximately 80% of lung cancers, and approximately 70% of patients present with locally advanced or metastatic disease. Metaanalysis demonstrated that cisplatin-based chemotherapy yielded a modest survival benefit in advanced NSCLC (Grilli et al, 1993;Souquet et al, 1993; Non-Small Cell Lung Cancer Collaborative Group, 1995;Marino et al, 1994).In the 1990's, several new agents, including vinorelbine, gemcitabine, paclitaxel, docetaxel, and irinotecan, became available for the treatment of NSCLC. Vinorelbine or gemcitabine combined with cisplatin was found to result in longer survival than cisplatin alone or vindesine plus cisplatin (Le Chevalier et al, 1994;Wozniak et al, 1998;Sandler et al, 2000).…”

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confidence: 99%

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confidence: 99%

Triplet chemotherapy with vinorelbine, gemcitabine, and cisplatin for advanced non-small cell lung cancer: a phase II study

et al. 2002

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We conducted a phase II trial of triplet chemotherapy consisting of vinorelbine, gemcitabine, and cisplatin in patients with advanced non-small cell lung cancer to assess its efficacy and toxicity. Thirty-three patients with chemotherapy-naïve stage IIIB disease (n=8), stage IV disease (n=23), or recurrence after surgical resection (n=2) were given intravenous infusions of vinorelbine 25 mg m 72 , gemcitabine 1000 mg m 72 , and cisplatin 40 mg m 72 on days 1 and 8 at 3-week intervals. There were 16 partial responses, and the objective response rate was 48% (95% confidence interval: 31 -66%). The median survival time was 13.5 months (95% confidence interval: 10.6 -16.4 months), and the one-year survival rate was 61%. Grade 4 haematologic toxicity consisted of neutropenia in 72% of patients, and febrile neutropenia occurred in 42% of the patients. There was one toxic death, and it was attributed to neutropenic fever and haemoptysis. Autopsy revealed diffuse pulmonary haemorrhage secondary to bacterial abscesses and vasculitis in both lungs. The common nonhaematologic toxicities included grade 2 -3 nausea (39%) and vomiting (18%). Triplet chemotherapy containing vinorelbine, gemcitabine, and cisplatin is effective in the treatment of chemo-näive patients with advanced non-small cell lung cancer, but produces unacceptable frequent febrile neutropenia. Lung cancer is a leading cause of cancer-related deaths in industrialised countries, including Japan, where 54 000 people died of lung cancer in 2000. Non-small cell lung cancer (NSCLC) accounts for approximately 80% of lung cancers, and approximately 70% of patients present with locally advanced or metastatic disease. Metaanalysis demonstrated that cisplatin-based chemotherapy yielded a modest survival benefit in advanced NSCLC (Grilli et al, 1993;Souquet et al, 1993; Non-Small Cell Lung Cancer Collaborative Group, 1995;Marino et al, 1994).In the 1990's, several new agents, including vinorelbine, gemcitabine, paclitaxel, docetaxel, and irinotecan, became available for the treatment of NSCLC. Vinorelbine or gemcitabine combined with cisplatin was found to result in longer survival than cisplatin alone or vindesine plus cisplatin (Le Chevalier et al, 1994;Wozniak et al, 1998;Sandler et al, 2000). Paclitaxel plus cisplatin was also superior to etoposide plus cisplatin (Bonomi et al, 2000). The Southwest Oncology Group (SWOG) conducted a randomised phase III trial in advanced NSCLC to compare vinorelbine plus cisplatin with paclitaxel plus carboplatin (Kelly et al, 2001), but there was no significant difference between the two arms with respect to response rate, survival, or quality of life. The Eastern Cooperative Oncology Group (ECOG) conducted a randomised phase III trial in advanced NSCLC comparing three platinumbased combination regimens containing gemcitabine, paclitaxel, and docetaxel to a reference regimen of paclitaxel plus cisplatin (Schiller et al, 2002), but none of the regimens, i.e. gemcitabine plus cisplatin, paclitaxel plus carboplatin, docetaxel plus cis...

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“…Each investigator independently extracted the data from the articles and disagreements were resolved by consensus. Randomized trials were evaluated for methodology by 2 quality scores calculated on the basis of the data reported in the publications: the score proposed by Chalmers et al (1981) and used by Marino in two meta-analyses (Marino et al, 1994(Marino et al, , 1995; and the score proposed by the ELCWP (European Lung Cancer Working Party) (Mascaux et al, 2000). Phase II trials were assessed by the ELCWP score for phase II studies (Meert et al, 1999).…”

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confidence: 99%

The role of mitomycin in the treatment of non-small cell lung cancer: a systematic review with meta-analysis of the literature

Sculier¹,

Ghisdal²,

Berghmans³

et al. 2001

Br J Cancer

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In the 1990s, chemotherapy has been shown able to improve survival of patients presenting with advanced non-small cell lung cancer (NSCLC, 1995). The survival benefit was obtained with first-generation active cytostatic agents -mainly ifosfamide, vinblastine, vindesine, mitomycin (MMC) -in combination with cisplatin (Donnadieu et al, 1991). New active drugs -the second generation -have appeared during the last decade, including gemcitabine, paclitaxel, docetaxel, vinorelbine and irinotecan. Their role in addition or in place of the first-generation agents, which should not be considered as obsolete for the unique reason that they are older and less fashionable, has yet to be defined (Meert et al, 1999).In this context, we have performed a systemic review of the literature about the role of one of the first-generation drugs, mitomycin (MMC), in the management of NSCLC. In order to determine if it is worthy to further conduct trials with that agent, we have searched answers to the 3 following questions: (1) is MMC an active drug against NSCLC? (2) does MMC improve the results when added to other active agents? (3) is MMC useful for salvage therapy? We have performed this investigation by using a methodology similar to that we have already used to conduct evidencebased medicine analyses of the literature. MATERIAL AND METHODSTo be eligible for the systematic review, a trial had to fulfil the following criteria: to deal only with NSCLC, to have been published as a full paper in the English or French language, to have a prospective design and to assess the effect of MMC in a randomized trial or in a first-line or second-line phase II trial according to the studied question.Trials were identified by an electronic search (Medline) in addition to the use of the personal bibliography of one of the authors and by consulting the references reported in the selected articles.Each trial was read and assessed for methodology by 12 investigators, including 11 physicians and 1 biostatistician. Each investigator independently extracted the data from the articles and disagreements were resolved by consensus. Randomized trials were evaluated for methodology by 2 quality scores calculated on the basis of the data reported in the publications: the score proposed by Chalmers et al (1981) and used by Marino in two meta-analyses (Marino et al, 1994(Marino et al, , 1995; and the score proposed by the ELCWP (European Lung Cancer Working Party) (Mascaux et al, 2000). Phase II trials were assessed by the ELCWP score for phase II studies (Meert et al, 1999).The result of a phase III trial was considered as conclusive if the P value for the statistical test comparing the survival distributions between arms for the overall patients populations was <0.05 in favour of the experimental arm. The trial was then called 'positive'. In the other situations (statistically significant survival benefit for the control arm or non-statistically significant difference in survival distributions), it was called 'negative'.The association between the quality s...

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Chemotherapy vs Supportive Care in Advanced Non-Small-Cell Lung Cancer

Cited by 300 publications

References 25 publications

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

Triplet chemotherapy with vinorelbine, gemcitabine, and cisplatin for advanced non-small cell lung cancer: a phase II study

The role of mitomycin in the treatment of non-small cell lung cancer: a systematic review with meta-analysis of the literature

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