Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
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Randomized Controlled Trial
Pemetrexed alone or in combination with cisplatin in previously treated malignant pleural mesothelioma: outcomes from a phase IIIB expanded access program.
In a randomized phase III trial, pemetrexed plus cisplatin was associated with improved survival compared with cisplatin alone for patients with malignant pleural mesothelioma (MPM). However, there are limited data available on the efficacy of these and other chemotherapy regimens in patients who have received previous systemic chemotherapy. To gather additional efficacy and safety data of pemetrexed/cisplatin and pemetrexed alone in previously treated patients, we examined patients treated on the Eli Lilly and Company expanded access program (EAP). ⋯ The data from this EAP study suggest that patients with previously treated MPM can benefit from treatment with pemetrexed alone or in combination with cisplatin. The treatment is associated with acceptable toxicity.
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Pleural fluid loculations or trapped lungs frequently render patients with symptomatic malignant pleural effusions (MPEs) unsuitable for pleurodesis. Thoracoscopic surgery or thoracotomy with decortication is generally not feasible for patients with a poor performance status. MPEs have augmented procoagulant and depressed fibrinolytic activity that contributes to fibrin deposition within the pleural space. The authors conducted an observational prospective cohort study to investigate the use of intrapleural urokinase (IPUK) for such patients and made a comparison with a historical control group. ⋯ These results suggest that IPUK is a safe and useful nonsurgical adjunct therapy for loculated MPEs or trapped lungs in medically inoperable cancer patients.
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The aim of this study was to investigate the yield of cervical mediastinoscopy (CM) for pathologically diagnosed non-small cell lung cancer (NSCLC), with respect to lymph node size on computed tomography (CT), cell type, and the location of the primary tumor. ⋯ Lymph node size and cell type of primary tumors should be taken into account when selecting patients for staging with standard MC in NSCLC. In patients with squamous-type tumors with lymph nodes <1 cm on CT, CM could be avoided because its low yield.