Cisplatin, continuous-infusion 5-fluorouracil, and intermediate-dose methotrexate in the treatment of unresectable non-small cell carcinoma of the lung

Article Abstract:

The prognosis for non-small cell lung cancer is generally poor. Of patients whose disease has progressed past Stage I, 70 percent of those with surgically treatable cancer succumb to metastatic disease, while among those with unresectable (inoperable) cancer, less than 5 percent enjoy long-term survival. There is, therefore, a great deal of room for improvement in the chemotherapeutic treatment of non-small cell lung cancer. Methotrexate induces responses in about 21 percent of patients with non-small cell lung cancer, and cisplatin induces responses in from 20 to 50 percent of patients when used in combination with other drugs. Since cisplatin can be synergistic with 5-fluorouracil (the effect of the two drugs in combination is greater than the effect of both separately), a study was conducted to evaluate the combination of cisplatin, 5-fluorouracil, and methotrexate in the treatment of non-small cell lung cancer. Cisplatin was administered in five daily infusions and 5-fluorouracil was administered continuously over five days; these schedules are thought to minimize kidney toxicity and bone marrow suppression. A total of 41 patients with unresectable non-small cell lung cancer were treated. The overall response rate was 60 percent, though only one response was considered to be complete. The median (middle) duration of the responses was six months, and the median survival of all 41 patients was 10 months. It is worth noting, however, that two of the patients with previously unresectable lung cancer became good candidates for surgery after the chemotherapeutic treatment. These two patients remain disease-free at 46 and 53 months. This observation suggests that the chemotherapeutic regimen may be useful as a ''neoadjuvant'' therapy, that is, chemotherapy to enhance the success of subsequent primary surgical treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lung cancer, Methotrexate, Cisplatin

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5-fluorouracil with oral leucovorin and hydroxyurea and concomitant radiotherapy for stage III non-small cell lung cancer

Article Abstract:

Patients with advanced non-small cell lung cancer (NSCLC) have a poor prognosis. These patients die as a result of metastasis, the spreading of cancer cells to other body sites, or from recurrent and persistent cancer within the lung. The combined use of chemotherapy and radiation treatment may be effective in preventing metastasis and eliminating cancer cells within the lung. The anticancer agents 5-fluorouracil and hydroxyurea were shown to enhance the anticancer effects of radiation treatment in patients with cancer of the pancreas, head and neck, cervix, and brain. Leucovorin was also shown to increase the anticancer activity of 5-fluorouracil. The effectiveness of the combined use of 5-fluorouracil, hydroxyurea, leucovorin, and radiation treatment was assessed in 23 patients with advanced NSCLC. The chemoradiotherapy was given for five days every other week for six cycles. The combined treatment prevented disease progression in three patients, produced a partial response in 13 patients, and a complete response in one patient. Overall, chemoradiotherapy achieved a response in 61 percent of patients. Most patients survived for 12 months. The progression of the disease resumed at six months in most patients, occurring outside of the chest area in 12 patients and at the original site in three patients. Toxic effects of this treatment regimen included myelosuppression (decreased bone marrow function), dermatitis (inflammation of the skin), and mucositis, (inflammation of the mucous membranes). This treatment regimen was more effective against the progression of cancer locally than systemically. Hence, the cancer tended to frequently recur at sites other than the lung, and survival was no different from that produced by standard treatment. Based on these findings, the use of this chemoradiotherapy is not recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Radiotherapy, Lung cancer, Non-small cell, Non-small cell lung cancer, Hydroxyurea

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