Ten Best Readings On Lung Cancer
and Mesothelioma

Scott Antonia, MD
H. Lee Moffitt Cancer Center & Research Institute

The ten best recent articles in the medical literature relating to lung cancer and mesothelioma are reviewed here.

Thatcher N, Niven RM, Anderson H. Aggressive vs nonaggressive therapy for metastatic NSCLC.
Chest. 1996;109(suppl 5):87S-92S.

Clinicians tend to underestimate potential modest benefits of chemotherapy. However, patients are much more ready to accept chemotherapy, even when the likely benefits are small. Quality of life, change in performance status, and relief of tumor-related symptoms are important additional parameters of treatment assessment.

Anderson H, Lund B, Bach F, et al. Single-agent activity of weekly gemcitabine in advanced non-small-cell lung cancer: a phase II study. J Clin Oncol. 1994;12:1821-1826.

Gemcitabine is an active new agent in the treatment of NSCLC. This schedule was associated with little alopecia or myelosuppression.

Le Chevalier T, Brisgand D, Douillard JY, et al. Randomized study of vinorelbine and cisplatin versus vindesine and cisplatin versus vinorelbine alone in advanced non-small-cell lung cancer: results of a European multicenter trial including 612 patients. J Clin Oncol. 1994;12:360-367.

Since vinorelbine plus cisplatin yields a longer survival duration and a higher response rate than vindesine plus cisplatin or vinorelbine alone -- and with acceptable toxicity -- this combination should be considered a relevant regimen in advanced NSCLC.

Fossella FV, Lee JS, Shin DM, et al. Phase II study of docetaxel for advanced or metastatic platinum-refractory non-small-cell lung cancer. J Clin Oncol. 1995;13:645-651.

Docetaxel administered at 100 mg/m² intravenously every three weeks had notable activity against platinum-refractory non-small-cell lung cancer, with a 21% major response rate. Primary side effects were neutropenia, hypersensitivity, and fluid retention.

Johnson DH, Paul DM, Hande KR, et al. Paclitaxel plus carboplatin in advanced non-small-cell lung cancer: a phase II trial. J Clin Oncol. 1996;14:2054-2060.

Paclitaxel plus carboplatin is a moderately active regimen in patients with advanced NSCLC and warrants comparison with existing cisplatin-based regimens in a prospective randomized trial. The toxicities of this combination are well tolerated in patients with a good performance status.

Sugarbaker DJ, Garcia JP, Richards WG, et al. Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma: results in 120 consecutive patients. Ann Surg. 1996;224:288-294.

Overall survival rates were 45% at two years and 22% at five years. Extrapleural pneumonectomy with adjuvant therapy is appropriate treatment for patients with malignant mesothelioma who are selected based on a revised staging system.

Marino P, Pampallona S, Preatoni A, et al. Chemotherapy vs supportive care in advanced non-small-cell lung cancer: results of a meta-analysis of the literature. Chest. 1994;106:861-865.

The results of the favored chemotherapy must be considered in light of their actual clinical relevance and the balance among quality of life, toxicity, and costs of chemotherapy and best supportive care.

Rosell R, Gomez-Codina J, Camps C, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med. 1994;330:153-158.

The median period of survival was 26 months in patients treated with chemotherapy plus surgery compared with eight months in patients treated with surgery alone. This result will stimulate other neoadjuvant trials.

Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl Cancer Inst. 1994;86:673-680.

This clinical trial strengthens the validity of using perioperative chemotherapy in the management of patients with resectable stage IIIA non-small-cell lung cancer.

Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small-cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Br Med J. 1995;311:899-909.

There was considerable pessimism at the onset of this meta-analysis about the role of chemotherapy in non-small-cell lung cancer. These results offer hope of progress and suggest that chemotherapy may have a role in treating this disease.

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