Clinical lung cancer
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Clinical lung cancer · Jan 2008
ReviewNew options for integrating antiangiogenic therapy and platinum-based first-line chemotherapy for advanced non-small-cell lung cancer.
The essential role of angiogenesis in tumor growth and metastasis is well established. The key mediator of angiogenesis, vascular endothelial growth factor (VEGF), is a rational target for novel therapy. High VEGF levels correlate positively with reduced overall survival (OS) and relapse-free survival. ⋯ Herein, key clinical data from trials of antiangiogenic agents in the first-line treatment of NSCLC are discussed, with a focus on bevacizumab, currently the only approved antiangiogenic agent for the treatment of NSCLC. The optimal integration of these agents into current and future first-line treatment regimens will be discussed, stressing the importance of therapeutic administration until disease progression. The promising activity of antiangiogenic agents in the advanced disease setting, allied with growing understanding of their novel modes of action, holds therapeutic promise for their future application in early-stage disease.
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Clinical lung cancer · Jan 2008
ReviewIntegrating epidermal growth factor receptor-targeted therapies into platinum-based chemotherapy regimens for newly diagnosed non-small-cell lung cancer.
Cytotoxic chemotherapy treatment for patients with advanced non-small-cell lung cancer (NSCLC) has reached a plateau, but further improvements are expected with integration of targeted therapies. Epidermal growth factor receptor (EGFR)-directed therapies are of particular interest because the EGFR is frequently expressed in tumors and associated with poorer outcome. Thus, blockade of the EGFR should improve outcome. ⋯ In contrast, MoAbs in combination with platinum-based first-line chemotherapy showed promising efficacy in phase II trials. Two phase III trials with chemotherapy with or without cetuximab have been performed in patients with advanced NSCLC. Other EGFR-directed MoAbs and TKIs are in earlier stages of clinical development.
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Novel therapies have been added to the treatment arsenal of physicians treating lung cancer in recent years. Most promising are agents that target the major pathways involved in cancer evolution, mostly proliferation and angiogenesis. Some of these treatments have been shown to synergize with traditional chemotherapy and radiation therapy. ⋯ This can refer not only to molecules that autonomously inhibit several pathways but also to combinations of therapies that, by targeting more than one pathway, act in concert to inhibit the malignant growth. In this review, we present the background and current status of multitargeted treatments in the management of patients with lung cancer, mostly non-small-cell lung cancer (NSCLC). Novel agents in clinical use and important ongoing clinical trials are reviewed.