New Treatments for Tough Cancers Show Promise

Studies found radiation, additional drugs slowed spread of lung, head/neck malignancies

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HealthDay Reporter

SATURDAY, June 2, 2007 (HealthDay News) -- Advances in treating lung and head/neck cancers could have immediate implications for patients, new research suggests.

Three studies detailing the findings were presented at a press conference Saturday at the American Society of Clinical Oncology annual meeting, in Chicago.

These types of cancer are notoriously difficult to treat, and have extremely low survival rates. Lung cancer is currently the number one cancer killer in the world. Head and neck cancers rank sixth, with 500,000 new cases and 300,000 deaths worldwide each year. Progress, particularly with lung cancer, comes in small increments.

"These are two very difficult-to-treat cancers," said Dr. Roy S. Herbst, moderator of the press conference and a professor of medicine and cancer biology at the University of Texas M.D. Anderson Cancer Center in Houston.

One study found, for the first time, that giving Avastin (bevacizumab) to patients with advanced non-small cell lung cancer, along with the chemotherapy drugs cisplatin and gemcitabine, slowed the growth of the cancer by up to 25 percent. The data confirms earlier results.

"This cancer is very hard to treat. There have been some advances, but we have reached a treatment plateau and we need more agents which may help us to offer better treatment to patients," said study author Dr. Christian Manegold, a professor of medicine at the University of Heidelberg in Germany. "We were able to confirm that Avastin adds efficacy to standard chemotherapy and provides hope for patients suffering from a deadly disease."

The U.S. Food and Drug Administration approved Avastin in October to be used in combination with chemotherapy drugs carboplatin and paclitaxel. The new study looked at Avastin with chemotherapy drugs cisplatin and gemcitabine. The study was funded by Hoffman-La Roche, parent company of Genentech, which makes Avastin.

Thirty-four percent of patients in the low-dose Avastin group and 30 percent of those in the high-dose Avastin group saw their tumors shrink, compared with only 20 percent in the chemotherapy-alone group. The duration of response was 6.1 months in both Avastin groups vs. 4.7 months in the control group.

A second study found that radiation delivered directly to the head in patients who have advanced-stage small cell lung cancer cut the risk that the cancer would spread to the brain by about two-thirds.

This type of lung cancer represents about 15 percent of all lung cancer cases in the United States, and tends to be more aggressive. "At diagnosis, about two-thirds of patients already have disseminated disease," said study author Dr. Ben Slotman, professor and chairman of radiation oncology at VU University Medical Center in Amsterdam, the Netherlands.

"The prognosis is poor," agreed Dr. Corey Langer, a medical oncologist at Fox Chase Cancer Center in Philadelphia. "The first shot [of treatment] is the best shot."

In the study, 286 patients who had already responded to chemotherapy were randomly chosen to receive radiation to the head or no radiation.

One year later, 14.6 of patients in the radiation group had developed brain metastases, vs. 40.4 percent in the control group. Also, 27 percent in the radiation group were alive at one year, compared with only 13.3 percent in the control group.

"This study shows that prophylactic cranial radiation [PCI] significantly reduces the risk of brain metastases at one year and it also shows that PCI prolongs survival," Slotman said. "It was well-tolerated, and it didn't adversely influence quality of life. Based on these results, PCI should now routinely be offered to all patients responding with small cell lung cancer who respond to chemotherapy."

Other experts aren't so sure, however. For one thing, study participants in the control group had a shorter survival than usually seen, making it unclear if the participants were representative, Langer said. "I don't know if this will make a wholesale adoption of PCI possible, but it offers justification for giving PCI to certain patients."

In a third study, adding the targeted therapy Erbitux (cetuximab) to a first-line chemotherapy that included cisplatin or carboplatin extended survival for patients with head and neck cancer that had spread to other parts of the body.

"The worst category are patients who have recurrent or metastatic disease," said study author Dr. Jan B. Vermorken, a professor of oncology at the University of Antwerp, in Belgium. "These patients are being treated in general with chemotherapy but, over the last 25 years, not much has changed in outcome when we treat these patients with chemotherapy. The median survival is six to seven months."

But patients who received Erbitux plus chemotherapy lived a median of 10.1 months, compared to 7.4 months in the control group, which had received only chemotherapy.

"This is a very unique observation. We have never seen this before in the last 25 years -- that adding a drug to chemotherapy is giving a better survival for these patients," Vermorken said.

One side effect, a skin rash, is particularly problematic, however. "It's not a mild rash," Langer said. "It potentially compromises quality of life. This isn't a free ride."

Two additional studies presented at the press conference looked at markers of lung and head and neck cancers.

Researchers at Duke University identified molecular pathways that are altered in advanced non-small cell lung cancer that could offer a new target for treatment.

The final study, funded by Bristol-Myers-Squibb, showed that variations in genes involved with metabolizing chemotherapy drugs may help explain why American and Japanese patients with advanced non-small cell lung cancer respond differently to therapies.

"We looked at normal DNA within the host [patient] and how to exploit these molecular profiles to improve therapeutic outcome," explained study author Dr. David Gandara, director of clinical research at the University of California, Davis.

More information

The National Cancer Institute has more on lung cancer.

SOURCES: Corey Langer, M.D., medical oncology, Fox Chase Cancer Center, Philadelphia; June 2, 2007, press conference with Roy S. Herbst, M.D., Ph.D., professor, medicine and cancer biology, University of Texas M.D. Anderson Cancer Center, Houston; Ben Slotman, M.D., Ph.D., professor and chairman, radiation oncology, VU University Medical Center, Amsterdam, the Netherlands; Christian Manegold, M.D., professor, medicine, University of Heidelberg, Germany; Jan B. Vermorken, M.D., Ph.D., professor, oncology, University of Antwerp, Belgium; David Gandara, M.D., director, clinical research, University of California, Davis; June 2, 2007, presentation, American Society of Clinical Oncology annual meeting, Chicago

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