Note: The information on this website is not a substitute for
diagnosis and treatment by a qualified, licensed professional.
Outcome of combination chemotherapy in extensive stage small-cell lung cancer: any treatment related progress?
Lassen UN, Hirsch FR, Osterlind K, Bergman B, Dombernowsky P.
Lung Cancer 1998 Jun;20(3):151-60.The results of this study show that the development of new treatments during the past 20 years did not result in improved survival in patients with diffuse small-cell lung cancer. Average survival of patients treated during the period 1973-1981 was 208 days. Average survival of patients treated in the period 1981-1992 was 215 days. Treatment did not improve outcome in patients with extensive stage small-call lung cancer.
Outcome of patients with small-cell lung cancer during 20 years of clinical research at the US National Cancer Institute.
Chute JP, et al.
Mayo Clin Proc 1997 Oct;72(10):901-12.The results of this study show that survival rates of patients with small-cell lung cancer remained unchanged from 1973 through 1993. New treatments did not result in better outcomes in patients with both limited stage and extensive stage small-cell lung cancer.
Long-term survival in small-cell lung cancer: posttreatment characteristics in patients surviving 5 to 18+ years--an analysis of 1,714 consecutive patients.
Lassen U, Osterlind K, Hansen M, Dombernowsky P, Bergman B, Hansen HH.
J Clin Oncol 1995 May;13(5):1215-20.This study shows that over the last decade new treatments did not improve survival rates in patients with small cell lung cancer.
The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer.
Feinstein AR; Sosin DM; Wells CK.
N Engl J Med, 312(25):1604-8 1985 Jun 20.The results of this study show that survival rates in patients treated for lung cancer in 1953 through 1964 were similar to those of patients first treated for lung cancer in 1977.
Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials.
PORT Meta-analysis Trialists Group.
Lancet 1998 Jul 25;352(9124):257-63.The results of this study show that patients with non-small-cell lung cancer who undergo radiation treatment after surgery have significantly lower survival rates, compared to those who receive surgery only. The study analyzed the results of nine published and unpublished randomized trials conducted on 2128 patients. During a 4-year follow-up period, patients receiving radiation treatment had a 21% increased risk of death, compared to those who did not received it. There were 707 deaths among the 1056 patients who underwent radiotherapy, and 661 among the 1072 patients who underwent surgery alone. Extrapolation of this data indicates an excess of 7 deaths for every 100 patients treated with radiation therapy after surgery rather than with surgery alone. The detrimental effect of radiotherapy was exerted predominantly in patients with early-stage non-small-cell lung cancer (stage I and II, with or without lymph node involvement).
Is there a role for chemotherapy of non-small cell lung cancer?
Hansen HH.
Ann Oncol 1995;6 Suppl 1:79-82.This article reviewed the published literature on the role of chemotherapy in the treatment of non-small cell lung cancer, and concluded that, based on the available information it is not possible to accurately determine whether chemotherapy confers a survival advantage compared to no treatment. Some studies have reported benefits, others no advantages, associated with treatment. In both cases, however, the differences were small. The author concludes that, based on available information, routine use of chemotherapy is not recommended in the management of patients with non-small cell lung cancer.
Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews.
Silvestri, G.
BMJ 1998;317:771-775 ( 19 September ).This study evaluated treatment preferences in a sample population of 81 patients with advanced non-small-call lung cancer who underwent at least 1 cycle of cisplatin-based chemotherapy. Less than half the patients reported that they would choose to undergo chemotherapy if the expected survival benefit derived from treatment was 3 months. Furthermore, only 22% of patients would choose chemotherapy over supportive care if they could only expect a 3-month survival benefit. However, it has been shown that cisplatin-based chemotherapy in patients with non-small-call lung cancer improves survival by an average of 1.5 months. Based on their preferences then, only 22% (18) of the 81 patients should have received chemotherapy, when in reality, all of them did. These results imply that most patients are not getting the treatment they would choose if they were fully informed.
Do doctors know when their patients don't? A survey of doctor-patient communication in lung cancer.
Quirt CF, et al.
Lung Cancer, 18(1):1-20 1997 Aug.The results of this study show that patients with lung cancer who are receiving chemotherapy or radiation therapy have perception of their probability of cure and expectations from treatment that are significantly different from those of doctors. Thirty-six percent of patients who were being treated disagreed with their doctors about the extension of the disease, with most of them underestimating the extent of the disease. Sixty-four percent of them disagreed with their doctors about the probability of cure, and most of them overestimated their chance of cure. Eighty-six percent of patients who were receiving palliative treatment (treatment aimed at reducing symptoms of the disease but with no intent of cure) thought that treatment would prolong their life, contrary to doctors' belief. These data show that patients often have wrong expectations about treatment, and these misconceptions may influence their decision as to whether undergo or not treatment. On the other hand, doctors are often unaware that their patients misunderstand the intent of treatment.
Relationship between cancer patients' predictions of prognosis and their treatment preferences.
Weeks JC, et al.
JAMA 1998 Jun 3;279(21):1709-14.The results of this study show that patients with advanced-stage lung or colon cancer often overestimate their chance of surviving at 6 months, and these false expectations affect their choice of treatment. For example patients who thought that they were going to live at least 6 months were more likely to choose aggressive treatment instead of palliative care (treatment aimed at relieving symptoms but with no attempt to cure the disease). Those who thought that their chances of surviving at 6 months were 90%, were 8.5 times more likely to undergo aggressive treatment instead of palliation, even if in reality their physicians thought that their chances of surviving 6 months were 10%. It was also demonstrated that aggressive treatment did not result in improved 6-months survival. These results show that the lack of clear communication between patients and their doctors induce patients' to be over-optimistic about their chance of survival and to undergo aggressive treatment, this choice being largely motivated on false expectations. Furthermore, this study demonstrated that aggressive treatment did not prolog life in patients with end stage lung or colon cancer.
Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study.
Christakis, N.A. et al.
BMJ 2000;320:469-473 ( 19 February ).The results of this study show that 80% of doctors wrongly predict how long their terminally ill patients have to live. The results of a survey conducted on 343 doctors caring for 468 patients, showed that in 63% of cases, survival was overestimated, and in 17% of cases it was underestimated. Sixty-five percent of patients had cancer, 12% had AIDS, and 23% had other conditions. Overall, doctors estimated that patients had 5 times longer to live than what proved to be the case. Patients who were overoptimistic about their chance of survival were significantly more likely to opt for unnecessary aggressive care rather than more valuable palliative treatment.
Non-small cell lung cancer: how oncologists want to be treated.
Mackillop WJ; O'Sullivan B; Ward GK.
Int J Radiat Oncol Biol Phys, 13(6):929-34 1987 Jun.In this study 118 physicians specialized in cancer treatment were asked if they wanted to be treated with chemotherapy if they were diagnosed with non-small cell lung cancer. Only 3% of doctors wanted chemotherapy after surgery for localized disease, 9% of them wanted chemotherapy for extensive disease, and only15% of them wanted chemotherapy for the treatment of symptoms of distant metastasis (palliative chemotherapy).
Clinical trials in cancer: the role of surrogate patients in defining what constitutes an ethically acceptable clinical experiment.
Mackillop WJ; Palmer MJ; O'Sullivan B; Ward GK; Steele R; Dotsikas G.
Br J Cancer, 59(3):388-95 1989 Mar.This study shows that the proportion of doctors who would participate to clinical trials, should they be diagnosed with non-small-cell lung cancer, ranges from 11% to 64%, according to the type of trial. For example, only 19% of physicians would participate to a randomized trial testing five different types of chemotherapy. This rate of doctors' participation is well below that of lay people. In fact, approximately 50% of lay individuals said they would participate to such a trial, should they be diagnosed with lung cancer. This proportion decreased by 40% when individuals were informed about the rate of doctors' participation. The results of this study show that the type of information delivered to patients has substantial impact on their decision to participate or not to a clinical trial.
Locally advanced non-small cell lung cancer: do we know the questions? A survey of randomized trials from 1966-1993.
Brundage MD; Mackillop WJ.
J Clin Epidemiol, 49(2):183-92 1996 Feb.This study tried to determine why 30 years of research have not yet clarified the role of adjuvant chemotherapy and radiotherapy in the management of patients with non-small cell lung cancer. The main reason was identified in the lack of a well-defined method for determining the objectives of clinical research.
Does knowledge guide practice? Another look at the management of non-small-cell lung cancer.
Raby B; Pater J; Mackillop WJ.
J Clin Oncol, 13(8):1904-11 1995 Aug.The results of this study show that 75% of Canadian lung cancer specialists who participated to a survey believed that chemotherapy and radiation therapy do not increase survival in patients with stage II non-small-cell lung cancer (NSCLC). Furthermore, 80% of them would not recommended any active treatment for asymptomatic patients with stage IV NSCLC. As for chemotherapy, only 4% of doctors recommended it for patients with stage II cancer, 18% recommended it for patients with stage IIIb cancer, and only 20% recommended it for patients with stage IV cancer.
Quality of life was ignored in meta-analysis.
Higginson, I.
BMJ 1996;312:249 (27 January).This letter comments on the results of a meta-analysis indicating that chemotherapy treatment with cisplatin-based regimens may be associated with a small survival advantage in patients with non-small cell lung cancer. In the study, patients receiving cisplatin-containing chemotherapy had an average improved survival of 1.5 months, compared to those receiving only supportive treatment, but the study did not report any information on the impact of chemotherapy on their quality of life. The author argues that no further studies on the effect of chemotherapy on survival should be undertaken, unless quality of life assessments are included in them.
Supportive care versus supportive care and combination chemotherapy in metastatic non-small cell lung cancer. Does chemotherapy make a difference?
Ganz PA; Figlin RA; Haskell CM; La Soto N; Siau J.
Cancer, 63(7):1271-8 1989 Apr 1.This study evaluated the results of a trial were patients with diffuse non-small cell lung cancer were randomized to receive either support treatment only (consisting of palliative radiation, pain management, nutritional counseling, and psychological counseling) or support treatment plus cisplatin-based combination chemotherapy. Survival was increased in patients in the chemotherapy group compared to those in the support group (20 weeks vs. 13 weeks), but the results were not significant. Furthermore, patients receiving chemotherapy experienced serious toxicity and did not show any benefit in improved quality of life.
Adjuvant chemotherapy with cyclophosphamide, doxorubicin, and cisplatin in patients with completely resected stage I non-small-cell lung cancer.
The Lung Cancer Study Group.
Feld R, Rubinstein L, Thomas PA.
J Natl Cancer Inst 1993 Feb 17;85(4):299-306.The results of this study show that chemotherapy with cyclophosphamide, doxorubicin, and cisplatin does not improve relapse free or overall survival in patients with stage II and stage III non-small-cell lung cancer.
A phase III study of radiotherapy with and without continuous-infusion fluorouracil as palliation for non-small-cell lung cancer.
Ball D et al.
Br J Cancer, 75(5):690-7 1997.This study evaluated the effects of adding single agent chemotherapy to radiation therapy in patients with advanced non-small-cell lung cancer. Although combination chemo and radiotherapy resulted in higher rates of tumor response compared to radiation therapy alone (29% vs. 16%), this effect did not translate in improved relapse-free or overall survival, nor in improved control of symptoms. In addition, patients receiving combination therapy experienced significantly more nausea, vomiting, inflammation of the esophagus and of the mouth, and skin toxicity, compared to those who received radiotherapy only.
Etoposide versus etoposide plus high-dose cisplatin in the management of advanced non-small cell lung cancer. Results of a prospective randomized FONICAP trial.
Italian Lung Cancer Task Force.
Rosso R, et al.
Cancer, 66(1):130-4 1990 Jul 1.The results of this study show that patients with diffuse non-small cell lung cancer who receive cisplatin in addition to the chemotherapy drug etoposide have higher rates of tumor regression compared to patients receiving only etoposide, (26% vs. 7%). However, improved tumor response did not result in any significant improvement of relapse-free and long-term survival. In addition patients receiving cisplatin experienced significantly more nausea, vomiting, ringing in the year, hearing loss, nerve degeneration, and decreased number of white and red blood cells, than patients receiving single agent chemotherapy.
Treatment of inoperable non-small cell carcinoma of the lung with radiation therapy, with or without levamisole.
A randomized trial of the Southeastern Cancer Study group.
Krauss S; et al.
Am J Clin Oncol, 7(5):405-12 1984 Oct.The results of this study show that patients with diffuse non-small cell lung cancer receiving levamisole in addition to radiation therapy have lower rates of tumor regression, and higher rates of tumor relapse, compared to patients receiving radiation therapy only. In addition levamisole treatment was associated in reduced rates of survival, although not significantly so.
Phase II study of intravenous adenosine 5'-triphosphate in patients with previously untreated stage IIIB and stage IV non-small cell lung cancer.
Haskell CM; Mendoza E; Pisters KM; Fossella FV; Figlin RA.
Invest New Drugs, 16(1):81-5 1998.This trial investigated the effects of intravenous injection of ATP in 15 patients who consented to participate to the trial. No tumor response was observed. Side effects of treatment included chest pain and shortness of breath, of such intensity that 5 patients had to interrupt treatment.
Early death during chemotherapy in patients with small-cell lung cancer: derivation of a prognostic index for toxic death and progression.
Lassen UN; et al.
Br J Cancer, 79(3-4):515-9 1999 Feb.The results of this study, conducted on 937 patients with small cell lung cancer enrolled in two randomized trials, show that 118 of them (12.6%) died after receiving the first cycle of chemotherapy.
Treatment of extensive stage small cell bronchogenic carcinoma. Effects of variation in intensity of induction chemotherapy.
Brower M; et al.
Am J Med, 75(6):993-1000 1983 Dec.This study evaluated the effects of high- versus moderate-dose combination chemotherapy in 48 patients with diffuse small-cell lung cancer. Among the 33 patients receiving high dose chemotherapy, there were 31 tumor remissions (94%) compared to 11 remissions among 15 patients receiving moderate dose chemotherapy (73%). Rate of remission did not influence rates of survival, which were similar in the two groups. Six patients (18%) died from treatment-related complications in the high-dose group, compared to 1 death (7%) in the moderate-dose group. Patients in the high-dose group also experienced significantly high rates of congestive heart failure, severe nerve degeneration, and inflammations of the mucous membranes.
Unexpected high toxicity in a phase II study of teniposide (VM-26) in elderly patients with untreated small cell lung cancer (SCLC).
Cerny T; Pedrazzini A; Joss RA; Brunner KW.
Eur J Cancer Clin Oncol, 24(11):1791-4 1988 Nov.This study reports on the results of a trial conducted to test the efficacy of the drug teniposide in the management of elderly patients with advanced small cell lung cancer. Thirty-two patients participated, but only 30 were available for evaluation. Treatment-related death occurred in 9 patients (30%). Partial responses were observed in 33% of patients. Overall average survival was 5.6 months.
