Cancer Research and Treatment

Original Articles

Lung and Thoracic cancer

Strategies to Improve Smoking Cessation for Participants in Lung Cancer Screening Program: Analysis of Factors Associated with Smoking Cessation in Korean Lung Cancer Screening Project (K-LUCAS): Yeol Kim, Jaeho Lee, Eunju Lee, Juntae Lim, Yonghyun Kim, Choon-Taek Lee, Seung Hun Jang, Yu-Jin Paek, Won-Chul Lee, Chan Wha Lee, Hyae Young Kim, Jin Mo Goo, Kui Son Choi, Boyoung Park, Duk Hyoung Lee, Hong Gwan Seo; Cancer Res Treat. 2024;56(1):92-103. Published online August 7, 2023; DOI: https://doi.org/10.4143/crt.2022.1598

Purpose
Smoking cessation intervention is one of the key components of successful lung cancer screening program. We investigated the effectiveness and related factors of smoking cessation services provided to the participants in a population-based lung cancer screening trial.
Materials and Methods
The Korean Lung Cancer Screening Project (K-LUCAS) is a nationwide, multi-center lung cancer screening trial that evaluates the feasibility of implementing population-based lung cancer screening. All 5,144 current smokers who participated in the K-LUCAS received a mandatory smoking cessation counseling. Changes in smoking status were followed up using a telephone survey in 6 months after lung cancer screening participation. The lung cancer screening’s impact on smoking cessation is analyzed by variations in the smoking cessation interventions provided in screening units.
Results
Among 4,136 survey responders, participant’s motivation to quit smoking increased by 9.4% on average after lung cancer screening. After 6 months from the initial screening, 24.3% of participants stopped smoking, and 10.6% of participants had not smoked continuously for at least 6 months after screening. Over 80% of quitters stated that participation in lung cancer screening motivated them to quit smoking. Low-cost public smoking cessation program combined with lung cancer screening increased the abstinence rates. The smokers were three times more likely to quit smoking when the smoking cessation counseling was provided simultaneously with low-dose computed tomography screening results than when provided separately.
Conclusion
A mandatory smoking cessation intervention integrated with screening result counselling by a physician after participation in lung cancer screening could be effective for increasing smoking cessation attempts.

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p53 Genetics and Biology in Lung Carcinomas: Insights, Implications and Clinical Applications
Dixan A. Benitez, Guadalupe Cumplido-Laso, Marcos Olivera-Gómez, Nuria Del Valle-Del Pino, Alba Díaz-Pizarro, Sonia Mulero-Navarro, Angel Román-García, Jose Maria Carvajal-Gonzalez
Biomedicines.2024; 12(7): 1453. CrossRef
Problems and Alternatives for Korea National Lung Cancer Screening Program for Smoking Cessation: Analysis of a Survey Involving Experts
Cheol Min Lee, Sil Vi Han Park, Jinri Kim, Bumjo Oh, Kiheon Lee, Yeol Kim, Yu-Jin Paek
Journal of the Korean Society for Research on Nicotine and Tobacco.2024; 15(2): 49. CrossRef
The pros and cons of lung cancer screening
Roberta Eufrasia Ledda, Georg-Christian Funk, Nicola Sverzellati
European Radiology.2024; 35(1): 267. CrossRef
Effective Smoking Cessation Counseling for Participants in a Lung Cancer Screening
Choon-Young Kim, Yeol Kim, Cheol Min Lee
Journal of the Korean Society for Research on Nicotine and Tobacco.2024; 15(3): 88. CrossRef

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Tumor Microenvironment Modulation by Neoadjuvant Erlotinib Therapy and Its Clinical Impact on Operable EGFR-Mutant Non–Small Cell Lung Cancer: Beung-Chul Ahn, Charny Park, Moon Soo Kim, Jong Mog Lee, Jin Ho Choi, Hyae Young Kim, Geon Kook Lee, Namhee Yu, Youngjoo Lee, Ji-Youn Han; Cancer Res Treat. 2024;56(1):70-80. Published online June 21, 2023; DOI: https://doi.org/10.4143/crt.2023.482

Abstract PDF Supplementary Material PubReader ePub

Purpose
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors have greatly improved survival in EGFR-mutant (EGFRm) non–small cell lung cancer (NSCLC); however, their effects on the tumor microenvironment (TME) are unknown. We assessed the changes induced by neoadjuvant erlotinib therapy (NE) in the TME of operable EGFRm NSCLC.
Materials and Methods
This was a single-arm phase II trial for neoadjuvant/adjuvant erlotinib therapy in patients with stage II/IIIA EGFRm NSCLC (EGFR exon 19 deletion or L858R mutations). Patients received up to 2 cycles of NE (150 mg/day) for 4 weeks, followed by surgery and adjuvant erlotinib or vinorelbine plus cisplatin therapy depending on observed NE response. TME changes were assessed based on gene expression analysis and mutation profiling.
Results
A total of 26 patients were enrolled; the median age was 61, 69% were female, 88% were stage IIIA, and 62% had L858R mutation. Among 25 patients who received NE, the objective response rate was 72% (95% confidence interval [CI], 52.4 to 85.7). The median disease-free and overall survival (OS) were 17.9 (95% CI, 10.5 to 25.4) and 84.7 months (95% CI, 49.7 to 119.8), respectively. Gene set enrichment analysis in resected tissues revealed upregulation of interleukin, complement, cytokine, transforming growth factor β, and hedgehog pathways. Patients with upregulated pathogen defense, interleukins, and T-cell function pathways at baseline exhibited partial response to NE and longer OS. Patients with upregulated cell cycle pathways at baseline exhibited stable/progressive disease after NE and shorter OS.
Conclusion
NE modulated the TME in EGFRm NSCLC. Upregulation of immune-related pathways was associated with better outcomes.

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Dual Inhibition of SYK and EGFR Overcomes Chemoresistance by Inhibiting CDC6 and Blocking DNA Replication
Jayaprakash Mandal, Tiffany Nicole Jones, Juliane Marie Liberto, Stephanie Gaillard, Tian-Li Wang, Ie-Ming Shih
Cancer Research.2024; 84(22): 3881. CrossRef

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Lung cancer

Sequential Treatment with an Immune Checkpoint Inhibitor Followed by a Small-Molecule Targeted Agent Increases Drug-Induced Pneumonitis: Jongheon Jung, Hyae Young Kim, Dong-Gil Kim, Seog Yun Park, A Ra Ko, Ji-Youn Han, Heung Tae Kim, Jin Soo Lee, Youngjoo Lee; Cancer Res Treat. 2021;53(1):77-86. Published online August 6, 2020; DOI: https://doi.org/10.4143/crt.2020.543

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Purpose
Immune checkpoint inhibitors (ICI) and targeted small-molecule drugs are mainstay elements of lung cancer chemotherapy. However, they are associated with development of pneumonitis, a rare, but potentially life-threatening event. We analyzed lung cancer patients treated with ICI to evaluate the effect of sequential therapeutic administration on the incidence of pneumonitis.
Materials and Methods
In this retrospective study, 242 patients were included. Serial radiologic findings taken during and immediately after ICI treatment were reviewed. Factors that increased pneumonitis and the relationship between peri-ICI chemotherapy and the development of pneumonitis were evaluated.
Results
Pneumonitis developed in 23 patients (9.5%); severe pneumonitis (grade ≥ 3) occurred in 13 of 23 patients (56%); pneumonitis-related death occurred in six. High-dose thoracic radiation (≥ 6,000 cGy) revealed a tendency toward high risk of pneumonitis (odds ratio, 2.642; 95% confidence interval, 0.932 to 7.490; p=0.068). Among 149 patients followed for ≥ 8 weeks after the final ICI dose, more patients who received targeted agents within 8-weeks post-ICI experienced pneumonitis (3/16, 18.8%) compared with patients who received cytotoxic agents (4/54, 7.4%) or no chemotherapy (4/79, 5.1%) (p=0.162). Targeted therapy was associated with earlier-onset pneumonitis than treatment with cytotoxic agents (35 vs. 62 days post-ICI, p=0.007); the resulting pneumonitis was more severe (grade ≥ 3, 100% vs. 0%, p=0.031).
Conclusion
Sequential administration of small-molecule targeted agents immediately after ICI may increase the risk of severe pneumonitis. The sequence of chemotherapy regimens that include ICI and targeted agents should be carefully planned to reduce the risk of pneumonitis in lung cancer patients.

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Toxicities associated with sequential or combined use of immune checkpoint inhibitors and small targeted therapies in non-small cell lung cancer: A critical review of the literature
Anne-Laure Désage, Michael Duruisseaux, Claire Lafitte, Sophie Bayle-Bleuez, Christos Chouaid, Pierre Fournel, Thomas Pierret
Cancer Treatment Reviews.2024; 129: 102805. CrossRef
Deep learning for predicting the risk of immune checkpoint inhibitor-related pneumonitis in lung cancer
M. Cheng, R. Lin, N. Bai, Y. Zhang, H. Wang, M. Guo, X. Duan, J. Zheng, Z. Qiu, Y. Zhao
Clinical Radiology.2023; 78(5): e377. CrossRef
Evaluating Pneumonitis Incidence in Patients with Non–small Cell Lung Cancer Treated with Immunotherapy and/or Chemotherapy Using Real-world and Clinical Trial Data
Qi Liu, Chenan Zhang, Yue Huang, Ruihao Huang, Shiew-Mei Huang, Erin Larkins, Liza Stapleford, Donna R. Rivera, Paul G. Kluetz, Shenggang Wang, Hao Zhu, James Weese, Elizabeth Cromartie, Mahder Teka, Sheetal Walters, Frank Wolf, Thomas D. Brown
Cancer Research Communications.2023; 3(2): 258. CrossRef
Pulmonary toxicity in driver gene positive non-small cell lung cancer therapy
Yi-Pu Zhao, Yong Long
Current Medical Research and Opinion.2022; 38(8): 1369. CrossRef
Immune checkpoint inhibitor-related pneumonitis in non-small cell lung cancer: A review
Yuxuan Hao, Xiaoye Zhang, Li Yu
Frontiers in Oncology.2022;[Epub] CrossRef
Improving Time-to-Treatment for Advanced Non-Small Cell Lung Cancer Patients through Faster Single Gene EGFR Testing Using the Idylla™ EGFR Testing Platform
Norbert Banyi, Deepu Alex, Curtis Hughesman, Kelly McNeil, Diana N. Ionescu, Carmen Ma, Stephen Yip, Barbara Melosky
Current Oncology.2022; 29(10): 7900. CrossRef
Sequential or combined immune checkpoint inhibitors and targeted therapy: Navigating uncharted waters
K. El Husseini, M. Wislez
Respiratory Medicine and Research.2021; 79: 100820. CrossRef
Multiple drugs

Reactions Weekly.2021; 1863(1): 255. CrossRef
Deep learning model enables the discovery of a novel immunotherapeutic agent regulating the kynurenine pathway
Jeong Hun Kim, Won Suk Lee, Hye Jin Lee, Hannah Yang, Seung Joon Lee, So Jung Kong, Soyeon Je, Hyun-Jin Yang, Jongsun Jung, Jaekyung Cheon, Beodeul Kang, Hong Jae Chon, Chan Kim
OncoImmunology.2021;[Epub] CrossRef

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Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Re-biopsy in Previously Treated Lung Cancer: Joohae Kim, Hyo Jae Kang, Sung Ho Moon, Jong Mog Lee, Hyae Young Kim, Geon-Kook Lee, Jin Soo Lee, Bin Hwangbo; Cancer Res Treat. 2019;51(4):1488-1499. Published online March 15, 2019; DOI: https://doi.org/10.4143/crt.2019.031

Abstract PDF Supplementary Material PubReader ePub

Purpose
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for the diagnosis and staging of lung cancer. However, evidence of its usefulness for re-biopsy in treated lung cancer, especially according to the previous treatment, is limited. We evaluated the role of EBUS-TBNA for re-biopsy and its diagnostic values in patients with different treatment histories.
Materials and Methods
We reviewed the medical records of patients who underwent EBUS-TBNA for re-biopsy of suspicious recurrent or progressive lesions between January 2006 and December 2016 at the National Cancer Center in South Korea. Patients were categorized into three groups based on the previous treatment modalities: surgery, radiation, and palliation.
Results
Among the 367 patients (surgery, n=192; radiation, n=40; palliation, n=135) who underwent EBUS-TBNA for re-biopsy, the overall sensitivity, negative predictive value (NPV), and diagnostic accuracy of EBUS-TBNA in detecting malignancy were 95.6%, 82.7%, and 96.3%, respectively. The sensitivity was lower in the radiation group (83.3%) when compared with the surgery (95.7%, p=0.042) and palliation (97.7%, p=0.012) groups. The NPV was lower in the palliation group (50.0%) than in the surgery group (88.5%, p=0.042). The sample adequacy of EBUS-TBNA specimens was lower in the radiation group (80.3%) than in the surgery (95.4%, p < 0.001) or palliation (97.8%, p < 0.001) groups. EGFR mutation analysis was feasible in 94.6% of the 92 cases, in which mutation analysis was requested. There were no major complications. Minor complications were reported in 12 patients (3.3%).
Conclusion
EBUS-TBNA showed high diagnostic values and high suitability for EGFR mutation analysis with regard to re-biopsy in patients with previously treated lung cancer. The sensitivity was lower in the radiation group and NPV was lower in the palliation group. The complication rate was low.

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Repeat biopsy versus initial biopsy in terms of complication risk factors and clinical outcomes for patients with non-small cell lung cancer: a comparative study of 113 CT-guided needle biopsy of lung lesions
Yangyang Wang, Yongyuan Zhang, Nana Ren, Fangting Li, Lin Lu, Xin Zhao, Zhigang Zhou, Mengyu Gao, Meng Wang
Frontiers in Oncology.2024;[Epub] CrossRef
Artificial Intelligence Algorithm Can Predict Lymph Node Malignancy from Endobronchial Ultrasound Transbronchial Needle Aspiration Images for Non-Small Cell Lung Cancer
Yogita S. Patel, Anthony A. Gatti, Forough Farrokhyar, Feng Xie, Waël C. Hanna
Respiration.2024; : 1. CrossRef
Place de l’endoscopie dans l’exploration du médiastin, indications et résultats
F. Wallyn, C. Fournier, V. Jounieaux, D. Basille
Revue des Maladies Respiratoires.2023; 40(1): 78. CrossRef
Prognostic Impact of EBUS TBNA for Lung Adenocarcinoma Patients with Postoperative Recurrences
Ying-Yi Chen, Ying-Shian Chen, Tsai-Wang Huang
Diagnostics.2022; 12(10): 2547. CrossRef
Endobronchial ultrasound-guided transbronchial needle aspiration in patients with previously treated malignancies: diagnostic performance and predictive value
Yan Yan, Zhilong Wang, Wanpu Yan, Shijie Li, Qi Wu
BMC Pulmonary Medicine.2022;[Epub] CrossRef
The Feasibility of Interventional Pulmonology Methods for Detecting the T790M Mutation after the First or Second-Generation EGFR-TKI Resistance of Non-Small Cell Lung Cancer
Wen-Chien Cheng, Yi-Cheng Shen, Chieh-Lung Chen, Wei-Chih Liao, Hung-Jen Chen, Te-Chun Hsia, Chia-Hung Chen, Chih-Yen Tu
Diagnostics.2022; 13(1): 129. CrossRef
Impact of EBUS-TBNA in addition to [18F]FDG-PET/CT imaging on target volume definition for radiochemotherapy in stage III NSCLC
Maja Guberina, Kaid Darwiche, Hubertus Hautzel, Till Ploenes, Christoph Pöttgen, Nika Guberina, Ken Herrmann, Lale Umutlu, Axel Wetter, Dirk Theegarten, Clemens Aigner, Wilfried Ernst Erich Eberhardt, Martin Schuler, Rüdiger Karpf-Wissel, Martin Stuschke
European Journal of Nuclear Medicine and Molecular Imaging.2021; 48(9): 2894. CrossRef
Tissue Adequacy and Safety of Percutaneous Transthoracic Needle Biopsy for Molecular Analysis in Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis
Bo Da Nam, Soon Ho Yoon, Hyunsook Hong, Jung Hwa Hwang, Jin Mo Goo, Suyeon Park
Korean Journal of Radiology.2021; 22(12): 2082. CrossRef

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Development of Protocol for Korean Lung Cancer Screening Project (K-LUCAS) to Evaluate Effectiveness and Feasibility to Implement National Cancer Screening Program: Jaeho Lee, Juntae Lim, Yeol Kim, Hyae Young Kim, Jin Mo Goo, Choon-Taek Lee, Seung Hun Jang, Won-Chul Lee, Chan Wha Lee, Jin Young An, Ki Dong Ko, Min Ki Lee, Kui Son Choi, Boyoung Park, Duk Hyoung Lee; Cancer Res Treat. 2019;51(4):1285-1294. Published online February 19, 2019; DOI: https://doi.org/10.4143/crt.2018.464

Abstract PDF PubReader ePub

Purpose
To reduce lung cancer mortality, lung cancer screening was recommended using low-dose computed tomography (LDCT) to high-risk population. A protocol for multicenter lung cancer screening pilot project was developed to evaluate the effectiveness and feasibility of lung cancer screening to implement National Cancer Screening Program in Korea.
Materials and Methods
Multidisciplinary expert committee was comprised to develop a standardized protocol for Korean Lung Cancer Screening Project (K-LUCAS). K-LUCAS is a population-based single arm trial that targets high-risk population aged 55-74 years with at least 30 pack-year smoking history. LDCT results are reported by Lung-RADS suggested by American Radiology Society. Network-based system using computer-aided detection program is prepared to assist reducing diagnostic errors. Smoking cessation counselling is provided to all currently smoking participants. A small pilot test was conducted to check the feasibility and compliance of the protocols for K-LUCAS.
Results
In pilot test, 256 were participated. The average age of participants was 63.2 years and only three participants (1.2%) were female. The participants had a smoking history of 40.5 pack-year on average and 53.9% were current smokers. Among them, 86.3% had willing to participate in lung cancer screening again. The average willingness to quit smoking among current smokers was 12.7% higher than before screening. In Lung-RADS reports, 10 (3.9%) were grade 3 and nine (3.5%) were grade 4. One participant was diagnosed as lung cancer.
Conclusion
The protocol developed by this study is assessed to be feasible to perform K-LUCAS in multicenter nationwide scale.

Citations

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Factors influencing the intention for lung cancer screening in high-risk populations for lung cancer
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Asia-Pacific Journal of Oncology Nursing.2024; 11(1): 100332. CrossRef
Strategies to Improve Smoking Cessation for Participants in Lung Cancer Screening Program: Analysis of Factors Associated with Smoking Cessation in Korean Lung Cancer Screening Project (K-LUCAS)
Yeol Kim, Jaeho Lee, Eunju Lee, Juntae Lim, Yonghyun Kim, Choon-Taek Lee, Seung Hun Jang, Yu-Jin Paek, Won-Chul Lee, Chan Wha Lee, Hyae Young Kim, Jin Mo Goo, Kui Son Choi, Boyoung Park, Duk Hyoung Lee, Hong Gwan Seo
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Jacob Sands, Martin C. Tammemägi, Sebastien Couraud, David R. Baldwin, Andrea Borondy-Kitts, David Yankelevitz, Jennifer Lewis, Fred Grannis, Hans-Ulrich Kauczor, Oyunbileg von Stackelberg, Lecia Sequist, Ugo Pastorino, Brady McKee
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Seung Hun Jang
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WITHDRAWN:The Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Re-biopsy in Previously Treated Lung Cancer: Joohae Kim, Hyo Jae Kang, Sung Ho Moon, Jong Mog Lee, Hyae Young Kim, Geon-Kook Lee, Jin Soo Lee, Bin Hwangbo; Received April 16, 2018 Accepted August 21, 2018 Published online September 3, 2018; DOI: https://doi.org/10.4143/crt.2018.222 [Accepted]

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Lung Cancer Screening with Low-Dose CT in Female Never Smokers: Retrospective Cohort Study with Long-term National Data Follow-up: Hyae Young Kim, Kyu-Won Jung, Kun Young Lim, Soo-Hyun Lee, Jae Kwan Jun, Jeongseon Kim, Bin Hwangbo, Jin Soo Lee; Cancer Res Treat. 2018;50(3):748-756. Published online July 17, 2017; DOI: https://doi.org/10.4143/crt.2017.312

Abstract PDF Supplementary Material PubReader ePub

Purpose
Because of growing concerns about lung cancer in female never smokers, chest low-dose computed tomography (LDCT) screening is often performed although it has never shown clinical benefits. We examinewhether or not female never smokers really need annual LDCT screening when the initial LDCT showed negative findings.
Materials and Methods
This retrospective cohort study included 4,365 female never smokers aged 40 to 79 years who performed initial LDCT from Aug 2002 to Dec 2007. Lung cancer diagnosis was identified from the Korea Central Cancer Registry Database registered until December 31, 2013. We calculated the incidence, cumulative probability, and standardized incidence ratio (SIR) of lung cancer by Lung Imaging Reporting and Data System (Lung-RADS) categories showed on initial LDCT.
Results
After median follow-up of 9.69 years, 22 (0.5%) had lung cancer. Lung cancer incidence for Lung-RADS category 4 was 1,848.4 (95% confidence interval [CI], 1,132.4 to 3,017.2) per 100,000 person-years and 16.4 (95% CI, 7.4 to 36.4) for categories 1, 2, and 3 combined. The cumulative probability of lung cancer for category 4 was 10.6% at 5 years and 14.8% at 10 years while they were 0.07% and 0.17% when categories 1, 2, and 3 were combined. The SIR for subjects with category 4 was 43.80 (95% CI, 25.03 to 71.14), which was much higher than 0.47 (95% CI, 0.17 to 1.02) for categories 1, 2, and 3 combined.
Conclusion
Considering the low risk of lung cancer development in female never smokers, it seems unnecessary to repeat annual LDCT screening for at least 5 years or even longer unless the initial LDCT showed Lung-RADS category 4 findings.

Citations

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A Phase II Study of Poziotinib in Patients with Epidermal Growth Factor Receptor (EGFR)-Mutant Lung Adenocarcinoma Who Have Acquired Resistance to EGFR–Tyrosine Kinase Inhibitors: Ji-Youn Han, Ki Hyeong Lee, Sang-We Kim, Young Joo Min, Eunkyung Cho, Youngjoo Lee, Soo-Hyun Lee, Hyae Young Kim, Geon Kook Lee, Byung Ho Nam, Hyesun Han, Jina Jung, Jin Soo Lee; Cancer Res Treat. 2017;49(1):10-19. Published online May 3, 2016; DOI: https://doi.org/10.4143/crt.2016.058

Abstract PDF Supplementary Material PubReader ePub

Purpose
We examined the efficacy of poziotinib, a second-generation epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitor (TKI) in patients with lung adenocarcinoma with activating EGFR mutations, who developed acquired resistance (AR) to EGFR-TKIs.
Materials and Methods
This single-arm phase II study included EGFR-mutant lung adenocarcinoma with AR to erlotinib or gefitinib based on the Jackman criteria. Patients received poziotinib 16 mg orally once daily in a 28-day cycle. The primary endpoint was progression-free survival (PFS). Prestudy tumor biopsies and blood samples were obtained to determine resistance mechanisms.
Results
Thirty-nine patients were treated. Tumor genotyping was determined in 37 patients; 19 EGFR T790M mutations and two PIK3CAmutations were detected in the prestudy tumors, and seven T790M mutations were detected in the plasma assay. Three (8%; 95% confidence interval [CI], 2 to 21) and 17 (44%; 95% CI, 28 to 60) patients had partial response and stable disease, respectively. The median PFS and overall survival were 2.7 months (95% CI, 1.8 to 3.7) and 15.0 months (95% CI, 9.5 to not estimable), respectively. A longer PFS was observed for patients without T790M or PIK3CA mutations in tumor or plasma compared to those with these mutations (5.5 months vs. 1.8 months, p=0.003). The most frequent grade 3 adverse events were rash (59%), mucosal inflammation (26%), and stomatitis (18%). Most patients required one (n=15) or two (n=15) dose reductions.
Conclusion
Low activity of poziotinib was detected in patients with EGFR-mutant non-small cell lung cancer who developed AR to gefitinib or erlotinib, potentially because of severe-toxicityimposed dose limitation.

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A Phase II Study of Weekly Paclitaxel Plus Gemcitabine as a Second-Line Therapy in Patients with Metastatic or Recurrent Small Cell Lung Cancer: Tak Yun, Heung Tae Kim, Ji-Youn Han, Sung Jin Yoon, Hyae Young Kim, Byung-Ho Nam, Jin Soo Lee; Cancer Res Treat. 2016;48(2):465-472. Published online May 26, 2015; DOI: https://doi.org/10.4143/crt.2015.061

Abstract PDF PubReader ePub

Purpose
Paclitaxel (P) and gemcitabine (G) are clinically synergistic in small cell lung cancer (SCLC). We evaluated the efficacy of PG as a salvage treatment for SCLC patients whose disease progressed after a platinum-containing regimen.
Materials and Methods
Eligibility included histologically confirmed SCLC, one dimensionally measurable disease, Eastern Cooperative Oncology Group performance status 0-2, and progressive disease after platinum-based chemotherapy. Treatment consisted of P (80 mg/m2) and G (1,000 mg/m2) on days 1 and 8 of each cycle of 21 days until disease progression.
Results
Thirty-three patients seen between December 2005 and February 2009 were selected into this study. Thirty patients (91%) had received irinotecan-platinum, and three had received etoposide-platinum. Sixteen patients (49%) had a treatment-free interval of less than 3 months. The overall response rate was 30.3% (29.4% in sensitive relapse and 31.3% in refractory relapse). The median time to progression was 12.0 weeks and median overall survival (OS) 31.0 weeks, with a 1-year OS rate of 30.3%. Toxicities were moderate and manageable with 18.2% grade (G) 4 neutropenia, 24.2% G3 thrombocytopenia, 6.1% G3 sensory neuropathy, and 3% G3 asthenia. One patient developed febrile neutropenia.
Conclusion
Second-line paclitaxel and gemcitabine were well-tolerated and moderately active in SCLC patients previously treated with platinum-based chemotherapy.

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