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New Drug Regimens Improve Lung Cancer Survival

Chemotherapy combinations can extend life for a year or two

WEDNESDAY, Jan. 9, 2002 (HealthDayNews) -- Sophisticated drug regimens can buy time for patients with advanced lung cancer, research groups in the United States and Japan report.

While the life expectancies for most of these patients has typically been measured in months or weeks, newer chemotherapy combinations can give a significant portion of them a year or two of life, say two studies in tomorrow's issue of the New England Journal of Medicine.

One report, from the Japan Clinical Oncology Group, found that two drugs -- irinotecan and cisplatin -- gave an average survival time of 12.8 months for patients with advanced small-cell lung cancer, compared to the average 9.4-month survival time for the standard drug combination of etoposide and cisplatin. Nearly 20 percent of the patients receiving the new combination survived for two years, compared to 5 percent of those who receiving the old treatment.

Those numbers "certainly have captured our imagination," says Dr. Corey Langer, medical director of thoracic oncology at the Fox Chase Cancer Center in Philadelphia. "In the past, patients with extensive small-cell lung cancer have been dead in six weeks."

However, he cautions the report "merits further investigation, but is not flawless." The numbers were small -- about 160 patients -- so American specialists are working to reproduce those results, Langer says.

"There are two separate trials, one planned and one ongoing, in the United States that will either confirm or refute it," he adds.

Langer is a member of an American group reporting less promising results for a major trial of different drug combinations for advanced non-small-cell lung cancer, which accounts for 80 percent of all cases.

The study, done in a number of institutions under sponsorship of the Eastern Cooperative Oncology Group, used four different drug combinations to treat more than 1,155 patients.

"None of the four chemotherapy regimens offered a significant advantage over the other," the journal report says.

"On face value, it looks like we're not making progress," Langer says, but that appearance is deceptive.

By historical standards, the results are impressive, he says. While in the past, only 12 percent of patients survived for one year and 3 to 5 percent survived for two years, 33 percent of patients getting the newer combination therapy survive for one year, and 11 percent survive for two years.

"The regimens are virtually interchangeable," Langer says. "Where they are not interchangeable is in terms of toxicity."

For example, one combination, using cisplatin and gemcitabine, significantly slowed progression of the disease but caused kidney problems in a much larger percentage of patients than those treated with cisplatin and paciltaxel. More studies will clarify the advantages and disadvantages of the different treatments, Langer says.

What To Do

Prevention is always better than treatment, and smoking causes the overwhelming majority of lung cancer cases. If all Americans stopped smoking, lung cancer incidence would drop from 370,000 to no more than 30,000 cases a year, Langer says.

Information about lung cancer, smoking and how to give up the habit is available from the National Cancer Institute or the American Lung Association.

SOURCES: Interview with Corey Langer, M.D., medical director, thoracic oncology, Fox Chase Cancer Center, Philadelphia; Jan. 10, 2002, New England Journal of Medicine
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