Lung cancer : journal of the International Association for the Study of Lung Cancer
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Multicenter Study
Weekly docetaxel with concurrent radiotherapy in locally advanced non-small cell lung cancer: a phase I/II study with 5 years' follow-up.
This Phase I/II study investigated weekly docetaxel (Taxotere) with concurrent radiotherapy in 42 patients with untreated stage III non-small cell lung cancer (NSCLC). All patients were treated with chest irradiation: 2Gy administered 5 days/week for 5 weeks, to a total of 50Gy. Docetaxel (1-h infusion) was administered on days 1, 8, 22, and 29< or =2 h before radiation fractions 1, 6, 16, and 21 (i.e. every week excluding the third week of treatment). ⋯ The 1-year survival rate was 60.6%. Five patients (one from Phase I and four from Phase II) were alive after >5 years. In conclusion, weekly docetaxel 30 mg/m2 plus radiotherapy is active and well tolerated in stage III NSCLC.
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Fluorescence flexible bronchoscopy (FFB) has proved to be very useful for detecting carcinoma in situ (CIS) and pre-cancerous lesions of the lung that are generally occult to white light reflectance bronchoscopy (WLRB). However, the increased sensitivity has caused a significant decrease of specificity, resulting in a large number of false positive signals that lead to a significant number of unnecessary biopsies. We have been planning to test a hypothesis that reflectance spectra and fluorescence spectra could be used to distinguish the true positive lesions from the false positive ones. To properly test such hypothesis, several thousand patients will need to be examined to obtain sufficient data from different lung lesions. Towards this goal, we have developed and have been testing a special system (ClearVu Elite ) that facilitates acquisition of both WLRB and FFB spectra during routine bronchoscopy examinations. In this pilot study we examined (1) if such could be used in a practical, routine clinical conditions without affecting commonly used bronchoscopy procedures; (2) if the spectral data obtained from the images are identical to those obtained with fiber-optic probes; and (3) if the few malignant and early neoplastic lesions available for this pilot study show any differences from normal lung tissue. ⋯ The experimental system provides excellent real time WLRB and FFB that can be switched from one to another mode instantaneously. Acquisition of both white light reflectance spectra and fluorescence spectra is acquired in real time through the images and does not prolong the routine WLRB and FFB procedures. The experimental bronchoscopy procedure is as simple as conventional bronchoscopy, adding on average less than 5 min to the 20 min procedure. The acquired spectra are identical to those obtained by fiber-optic probes. In all of the limited number of malignant and early neoplastic lesions, there were differences found which are sufficiently pronounced to warrant initiation of a large, multicenter study for development of differentiating algorithms of statistical validity.
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Clinical Trial
Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter.
Many patients with various forms of cancer develop sooner or later malignant pleural effusions, resulting in feelings of discomfort and reduced quality of life. Several palliative options exist, including repeated thoracocentesis and pleurodesis with a sclerosing agent. However, these "therapeutic" possibilities are not always successful and sometimes even contraindicated. ⋯ In the final analysis, catheter use was unsatisfactory in two patients (12%). We conclude that a chronic indwelling catheter is a very useful tool in the management of recurrent malignant pleural effusions. Treatment can be accomplished completely at home, whereas complications are rare.
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Gefitinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is an active agent in non-small cell lung cancer, and rapidly relieves bronchorrhea in patients with bronchioloalveolar carcinoma before the improvement of radiological findings. In addition, epidermal growth factor regulates mucin secretion in normal airway goblet cells. The present study was designed to clarify whether gefitinib modifies mucin production in lung cancer cell lines apart from its anti-proliferative effects, using A549 adenocarcinoma and NCI-H292 mucoepidermoid carcinoma cells expressing EGFR and MUC5AC mRNA. ⋯ Gefitinib also inhibited the phosphorylation of MAPK and Akt, and the selective inhibitors PD98059 and LY294002 also suppressed MUC5AC protein synthesis. These findings suggest that gefitinib may inhibits MUC5AC synthesis, at least in part, through MAPK and Akt signaling pathways. Thus, gefitinib inhibits mucin production, which is encouraging for trials involving its use against bronchorrhea in patients with lung cancer.