____________________________________________________________ CISPLATIN + ETOPOSIDE & CONCURRENT XRT (Intergroup Trial 0160) CISPLATIN 50 mg/m2 IV DAYS 1, 8, 29, 36 ETOPOSIDE 50 mg/m2 IV DAYS 1-5 & 29-33 XRT: 45 Gy @ 180 cGy/day over 5 weeks REF: J. Thoracic & Cardiovascular Surgery 121(3):472,2001 The initial results of phase II intergroup trial coordinated by the Southwest Oncology Group (SWOG). Pathologically proven & previously untreated NSCLC involving the superior sulcus with either a T3 or T4 primary tumor. ____________________________________________________________ TAXOL + CARBOPLATIN & concurrent XRT paclitaxel 45 mg/m(2) over 1 h; carboplatin AUC=2; six weekly cycles + XRT 60 Gy to the primary tumor & regional LN (40 Gy over 4 weeks) followed by a boost to the primary tumor (20 Gy in 2 weeks). After the initial phase of concurrent chemoradiation, patients received an additional 4 cycles of Taxol 175 mg/m(2) over 3 h + carboplatin AUC=6 Q 3 weeks. REF=Lung Cancer 2001 Feb;31(2-3):257-265 N=30 locally advanced inoperable NSCLC; ORR=76.7%. At the median follow-up time of 13.1 months, the median survival time = 14.5 months (95% CI, 10.59-18.48). The median PFS=10.5 months (95% CI, 7.72-13.28). Major toxicity:hematologic. Grade 3 esophagitis=10%. ____________________________________________________________ Weekly Cisplatin CISPLATIN 30 mg/m2 Qweek while receiving radiation therapy. Then may use other systemic regimen (combination chemotherapy). ____________________________________________________________ Taxol-Carboplatin 3 hours , AUC of 6 Taxol 175 mg/m2 CIV over 3 h* Carboplatin AUC=6 (IVPB as a 1-mg/min infusion.) Repeat every 4 weeks. *Dose adjusted for 3 hour infusion Ref. Paul D.M., Johnson D.H., et al.: Proc. ASCO 1994; 13:352 ____________________________________________________________ DOCETAXEL + CARBOPLATIN DOCETAXEL 75-100 mg/m2 CARBOPLATIN AUC=6 Q3 weeks REF: Lung Cancer 2001 Jun;32(3):281-287 Semin Oncol 2001 Jun;28(3Suppl 9):10-14 ____________________________________________________________ GEMZAR + CISPLATIN GEMCITIBINE 1000 mg/m2 DAYS 1,& 8 Q21 days CISPLATIN 100 mg/m2 DAY 1 Q21 days ***This regimen is indicated as first line therapy for inoperable IIIA/IIIB or IV. ------------ GEMCITIBINE 1000 mg/M2 Days 1,8,15 CISPLATIN 100mg/M2 day 15 28 day cycle Response Rate of 52% PR + CR: 1 yr Sur 61% RP Abratt et al. JCO 15: 744-749. 1997 ____________________________________________________________ Taxol-Carboplatin 3 hours Taxol 175 mg/m2 CIV over 3 h* Carboplatin 300 mg/m2 IV as a 1-mg/min infusion. Repeat every 4 weeks. *Dose adjusted for 3 hour infusion Ref. Paul D.M., Johnson D.H., et al.: Proc. ASCO 1994; 13:352 ____________________________________________________________ ADVANCED / METASTATIC Phase II GEMCITABIBE/DOCETAXEL GEMCITABIBE 800 mg/m2 infuse over 30 minutes DAYS 1,8,15 DOCETAXEL 100 mg/m2 infuse over 1 hour following gemcitabine on DAY 1 Repeat Q4 weeks REF: ASCO 2000 ____________________________________________________________ Weekly DOCETAXEL (elderly population) DOCETAXEL 36 mg/m2 infuse over 1 hour Note: dexamethasone 8 mg PO given 12 hours prior, immediately prior to, & 12 hours following docetaxel infusion. Repeat weekly X 6 weeks followed by 2 weeks without treatment. REF: ASCO 2000 19% Objective Response ; 36% minor response or stable disease. (Response by PS: ECOG0-1=26%,ECOG2=7%) ____________________________________________________________ CISPLATIN + NAVALBINE ____________________________________________________________
___________________________________________ PET scanning in lung cancer Comparing PET & CT in mediastinal Staging of Lung Cancer: Pieterman (NEJM 343:254;2000) N=102 PET Sensitivity=91%, Specificity=86%; CT(size criteria 1.0 cm) Sensitivity=75%, Specificity=66% (P<0.001) Vansteenkiste (Clin Pos Imag 2:223, 1999) N=105 PET Sensitivity=89%, Specificity=99%; CT(size criteria 1.5 cm) Sensitivity=79%, Specificity=54% (P<0.0003) --------------------------- Metastatic disease: PET useful to distinguish adrenal metastasis from adrenal hyperplasia or enlarged adrenal gland that may be noted on CT scans. > 10% of the pts who undergo PET scanning are shown to have distant metastasis that was not detected by CT scans. ___________________________________________
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