Lung cancer is one of the most common cancers worldwide , each year 1.2 million new cases , including non- small cell lung cancer accounts for about 80%. Lung cancer is China's first fatal cancer , there are 600,000 patients die each year of lung cancer . Since the early has a hidden , most non -small cell lung cancer patients have been found to be locally advanced or metastatic , more than half of lung cancer patients miss the chance of operation . Traditional chemotherapy efficacy is limited, and accompanied by intolerable toxicities , usually chemotherapy failed more times , the worse the effect of subsequent treatment . However, the emergence of targeted drugs to conquer cancer provides a new possibility.
Unlike traditional chemotherapy , targeted therapy in patients receiving stable even if the tumor can also lead to long-term survival benefit , therefore, the future cancer treatment might in the " survival zone " or " tumor- Centrum " development .
Treatment of Lung Cancer reproduction milestone - Tarceva ( erlotinib ) can prolong life :
This year's 33rd Annual Meeting of the European Society of Clinical Oncology (ESMO) , the report of the largest so far ? stage non-small cell lung cancer study - TRUST the latest data . These data show that the one-year survival rate of patients with lung cancer in Asia up to 60 %, the median progression-free survival time can reach 25.1 weeks ! Once again confirmed Tarceva ( erlotinib ) can give the majority of non-small cell lung cancer patients bring significant clinical benefit .
Unlike traditional chemotherapy , Tarceva by inhibition of epidermal growth factor receptor (EGFR) tyrosine kinase targeted to the tumor cells , inhibiting their growth, proliferation, thereby preventing cell growth . Tarceva delayed cough, dyspnea , pain and other symptoms associated with worsening of lung cancer , to avoid the traditional chemotherapy-induced leukopenia, nausea , vomiting and other side effects of the strong , and the only orally once daily , significantly improve the patient's quality of life.
Targeted therapy for non- small cell lung cancer is expected to first-line treatment :
1) IPASS study
Targeted drug gefitinib is now used for advanced non-small cell lung cancer second and third line treatment. As clinical studies continue to carry out , the data show EGFR-TKI ( epidermal growth factor receptor tyrosine kinase antagonist ) for patients brought new opportunities. The latest Asian advanced non-small cell lung cancer line treatment IPASS III of the findings in this year's meeting of the European Society of Clinical Oncology (ESMO) on the release. Data show that in selected based on clinical features Asian patients with advanced non-small cell lung cancer in the general population , as opposed to intravenous carboplatin / paclitaxel combination chemotherapy , oral gefitinib with no disease progression-free survival advantage. The study also showed that gefitinib treatment groups tolerated the situation and quality of life improvement rate than chemotherapy. This indicates that more is expected in Asian patients diagnosed after benefit from targeted therapy .
2) AVAiL study
European Cancer Conference revealed that a named AVAiL study confirms bevacizumab as the most common lung cancer - non-small cell lung cancer (NSCLC) first-line treatment regimens to help desperate patients survive a key step towards the . The study compared gemcitabine plus cisplatin ? bevacizumab treatment. The results showed that , with and without bevacizumab group compared to bevacizumab group was significantly prolonged PFS , even low -dose (7.5 mg / kg) bevacizumab extended PFS can play the same role .
It is noteworthy that , for security reasons, these two studies excluded squamous cell carcinoma , PS score lower and higher risk of bleeding in patients .
Early detection of EGFR gene markedly individualized targeted therapy Troops
1) IPASS study
September 2008 , the Chinese University of Hong Kong, China Professor Tony Mok behalf of the Asian Study Group , the European Society of Medical Oncology (ESMO) annual meeting announced ? randomized open-label clinical study preliminary results of IPASS : 1217 cases of non- smokers or light degree smoking Asian patients with advanced lung adenocarcinoma were receiving gefitinib monotherapy first-line therapy and paclitaxel / carboplatin first-line chemotherapy , the results of gefitinib monotherapy with paclitaxel / carboplatin compared to no superior progression-free survival (PFS), objective response rate (ORR) and quality of life , two similar overall survival ( survival follow-up is still in progress ) .
The overall result of this detailed analysis found that two groups of PFS advantage is changing over time . In the beginning of treatment , chemotherapy is superior PFS gefitinib group , while the latter gefitinib group showed a PFS advantage. For this seemingly inexplicable phenomenon , through into the group of patients with tumor tissue samples biomarker analysis found part of the answer . This phenomenon may be due to the different epidermal growth factor receptor (EGFR) mutation status of the patients on the two treatments caused different reactions : for EGFR mutation -positive patients , gefitinib treatment PFS was significantly superior to chemotherapy, while the wild-type EGFR , chemotherapy, PFS was significantly superior to gefitinib therapy respectively (P < 0.0001 ) . This difference is also reflected in the ORR on : EGFR mutation -positive patients gefitinib treatment effective rate of 71.2% , while the wild-type EGFR gefitinib treatment is effective rate is as low as 1.1%; EGFR mutation-positive patients with paclitaxel / carboplatin effective rate was 47.3% , compared with 23.5% in patients with wild-type .
Therefore, this study suggests , EGFR mutation status is gefitinib treatment of non- small cell lung cancer is an important predictor , EGFR gene mutations for the selection can really benefit from a targeted therapy for patients is important.
2 ) Spanish research
Spanish scholars Russell (Rosell) in this session of the annual meeting of the ESMO Another study also confirmed the importance of the EGFR gene testing . The study examined 2,312 cases of patients with advanced non-small cell lung tumor tissue EGFR status and found 307 cases of patients with EGFR exon 19 deletion or exon 21 mutation . Researchers have mutations in patients given erlotinib . Currently based on data analysis in 193 patients show : The total effective rate was 71 %, including 24 patients achieved complete remission (CR); median overall survival was 22 months, 28 months for women , for men 17 months ; the median time to progression (TTP) was 12 months, women than men. These results far exceed the current conventional first-line chemotherapy achieved in 20% to 30 % efficiency , 5 months and 11 months of TTP Median survival .
3) Pazopanib shows encouraging for early lung cancer activity
Research and development of the drug pazopanib (GlaxoSmithKline Pharmaceuticals ) , a new anti- angiogenesis inhibitors shows that for early non -small cell lung cancer (NSCLC) patients with a single agent activity ; however , the results are preliminary , they suggest that this agent such patients are highly active , and perhaps have an impact on the treatment of lung cancer .
The second phase of the study were published in the 33rd Congress of the European Society for Medical Oncology (ESMO) conference , display 35 patients with tumor shrinkage of 30 people , there are some cases of cancer by up to 85%. Lung cancer is difficult to treat , new agents have been slow , these results are quite encouraging.
According to lead author , New York Presbyterian Hospital -Weill Cornell Medical Center, chief of thoracic surgery , cardiac thoracic surgery professor Nasser Altorki physician, targeted therapy is mainly used in the failed standard chemotherapy prescriptions late lung cancer patients . Altorki physician , said at a press conference , we hope to prove the idea is that we can use these drugs in lung cancer early , and the response to these agents can be increased , because this period is not cancer gene composition is relatively complicated . Early lung cancer is generally treated surgically , without any type of preoperative treatment ; Altorki doctor explained that when you want to use the appropriate treatment, usually chemotherapy, either single agent or in combination with agents. To my knowledge, this is the first time this drug for lung cancer.
Pazopanib is an investigational oral angiogenesis inhibitor that targets vascular endothelial growth factor receptor , platelet -derived growth factor receptor and c-kit receptor ; purpose of this study is the use of targeted therapy as a preoperative treatment, and Confirm pazopanib clinical and biological activity and safety in patients with early-stage NSCLC preoperative administration of this drug . The researchers also selected it as a single treatment, so that any reaction observed only with this drug.
He said that we believe that if pazopanib on tumor effect might not detect by standard measurements , so we introduced the concept of tumor volume measured response .
The primary end point was change in tumor volume , before and after treatment in the pazopanib use high-resolution computed tomography ; Secondary end points included RECIST ( tumor response evaluation criteria ) and safety analysis of plasma samples before and after treatment , to enable researchers to correlate tumor volume changes in cytokine / angiogenic factors change .
Altorki MD, monitoring changes in plasma samples help us predict where those patients most likely to respond to this therapy .
All 35 patients, 60% had adenocarcinoma , 11% had squamous cell carcinoma , and 29% had other types of NSCLC; 29 patients with stage Ia disease , 20 with stage Ib disease , 13 belongs to the first phase IIa disease , a person belonging to Iib illness ; preoperative ( sliced ??) 2-6 weeks , once a day Pazopanib 800 mg, followed by seven days of washout period , the average duration of treatment was 16 days .
Altorki physician said that about 86% of the patients tumor regression , tumor volume reduction of up to 85% ; when you consider that the average treatment period of only two weeks , reduction in tumor volume is really very impressive. This drug is generally well tolerated, with five patients during the study period with grade 3 toxicities , including hypertension , rash and neutropenia syndrome. Altorki physicians emphasized that in addition to use as a preoperative pazopanib monotherapy , the study also proposed a new measuring tumor volume 3D imaging technology, is another feature of plasma samples collected before and after treatment .
Baselga, MD, from another perspective these results indicate shrink the tumor before surgery benefits : we can actually help the surgeons , you can have a nontoxic therapy and then to increase the ease of surgery and healing , this research in many areas there are profound implications .
Based on these data , to plan the use of pazopanib in many different stages of NSCLC study , some settings the drug in an adjuvant therapy.
In short, with medical advances and innovative anti-cancer drugs can significantly prolong survival of cancer patients , improve the patient 's quality of life , together with the patient's own has a good attitude , it is possible to create the miracle of life !
ref : http://www.articlesbase.com/cancer-articles/lung-cancer-is-no-longer-a-terminal-illness-6755297.html
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reff : http://nana772yo.blogspot.com/2013/10/lung-cancer-is-no-longer-terminal.html
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