Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
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The limited efficacy and moderate toxicity of chemotherapy for non-small cell lung cancer (NSCLC) have given the search for a more effective and safer systemic treatment a sense of urgency. NSCLC has historically been regarded as a non-immunogenic cancer, and immunotherapy has yielded little benefit in humans. ⋯ In this review, we describe the scientific basis and updates the clinical results of three vaccine approaches (GVAX, Lucanix, and L-BLP25) and discuss preliminary work on a novel Ras mutation targeted immune therapy. Further studies are needed to demonstrate whether these novel therapies can potentially complement or replace current therapeutic approaches.
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Due to potent radiosensitization and potential serious or fatal toxicity, concurrent gemcitabine and irradiation should only be applied within clinical trials. We here present experience from a phase I-II clinical trial for patients with locally advanced non-small cell lung cancer (NSCLC) treated with hyperfractionated accelerated radiotherapy and concurrent low-dose gemcitabine. ⋯ Judging from current standards, the methods used in diagnostics and in planning of radiotherapy were suboptimal. Using modern radiotherapy planning, a higher MTD, possibly a different profile of toxicity, and better long-term results may be expected. The high incidence of brain relapse emphasizes the need for careful screening for unsuspected brain disease before treatment and the importance of clinical studies on prophylactic cranial irradiation for patients with locally advanced NSCLC. Although the small number of patients in this study precludes any definitive conclusion, it appears that our program of concurrent chemotherapy and radiotherapy offers a chance for disease control at least comparable to previously described programs for inoperable lung cancer.