Adoptive immunotherapy for nonsmall cell lung carcinoma: A fourth treatment modality, complicated radiation sensitizer, or none of the above
✍ Scribed by Daniel D. Karp; Michael B. Atkins
- Book ID
- 101228373
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 397 KB
- Volume
- 78
- Category
- Article
- ISSN
- 0008-543X
No coin nor oath required. For personal study only.
✦ Synopsis
onsmall cell lung carcinoma (NSCLC) is the most frequent cause N of cancer mortality in the world. The incidence continues to rise globally by 0.5% per year and, in 1996, several million patients will be diagnosed worldwide with this disease. In Western countries, between one-third and half of the patients will have intermediate stage disease with involvement of lobar or bronchial lymph nodes (Stage 11) or mediastinal (Stage 111) disease at diagnosis. Unfortunately, the great majority of these patients succumb to their illness. While surgery alone can produce 5-year survivals of 40 to 54% of patients with Stage I1 disease,' single modality treatment, either surgery or radiation therapy, in Stage IIIA or IIIB NSCLC offers very little hope for long term success. Surgery alone is associated with a 3-year survival of only 9% of patients with mediastinal lymph node disease2 and radiation alone produces only 5% long term ~urvival.~ Historically, chemotherapy has been relegated to the palliation of patients with Stage IV disease. These disappointing survival data have prompted intensive investigations of combination modality therapy for patients with intermediate stage NSCLC.
Such multiple combination modality regimens have been developed over the past decade and have produced considerable improvement in survival rates relative to single modality therapy. Radiation therapy has enhanced long term local control when added to surgery in patients with IIIA and resected IIIB disease. Combinations of chemotherapy and radiation earlier in the disease process have produced durable responses and long term survival-even in some patients with highly unfavorable disease. For example, in 1990 the Cancer & Acute Leukemia Group B (CALGB) Study of Dillman et al. showed a marked sunival advantage for patients with unresectable Stage 111 NSCLC treated with 2 cycles of vinblastine and cisplatin prior to 6,000 centigray (cGy) thoracic radiation (TRT).4 In addition, Schaake-Koning et al., in a 3-arm study of 308 patients, showed a marked superiority of low dose daily or weekly cisplatin given simultaneously with 5500 cGy TRT in unresectable patients5 Survival at 3 years was 13 to 16% for the cisplatinlradiation groups versus only 2% for the radiation only group.
Other studies have also shown an important role for adding chemotherapy to surgery and TRT. Rose11 et al. reported results of a