RESUMEN
OBJECTIVE: Even though there have been considerable improvements in the diagnosis and treatment of lung cancer, the prognostic factors for elderly patients with advanced nonsmall-cell lung cancer (NSCLC) remain insufficient. Therefore, our aim is to compare the prognostic factors for elderly and young cases with advanced stage NSCLC. METHODS: The data of 370 advanced stage young (<65 years old) and elderly (>or=65 years old) NSCLC patients (Stage IIIB or IV) treated between 1995 and 2008 were retrospectively evaluated for the study at the oncology department. Demographic characteristics, treatment response, comorbidities, pleural effusion, performance status, and overall survival (OS) were correlated with patient clinical features and smoking habits at the time of diagnosis. RESULTS: Of the 370 patients, 284 (76.8%) were in the younger group and 86 (23.2%) were in the older group. The rates of stages (IIIB, IV) were similar in the elderly and younger groups. At the time of diagnosis, poor performance status, comorbidity, weight loss, anemia, and smoking status were more effective prognostic factors for elderly cases than younger ones. The treatment responses were also significantly different between the two age groups when the presenting symptom was weight loss: 18.7% of the younger group had progressive disease compared with 57.1% of the older group (P = 0.017). CONCLUSION: We concluded that treatment responses of the younger group were less affected by weight loss. These analyses suggest that weight loss at presentation can be useful in predicting disease response in patients with advanced stage elderly NSCLC.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Adulto , Anciano , Anciano de 80 o más Años , Anemia/epidemiología , Antineoplásicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Comorbilidad , Progresión de la Enfermedad , Femenino , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Fumar/efectos adversos , Pérdida de PesoRESUMEN
OBJECTIVES: Currently, cisplatin-based doublet combinations are accepted to be the first-line chemotherapy for advanced nonsmall cell lung cancer (NSCLC). Although triplet chemotherapeutics have been shown to be more effective and active than doublets, their toxicity was higher as expected. Therefore, we conducted this phase II trial using the combination of gemcitabine-cisplatin-vinorelbine with lower than usual but acceptable doses of gemcitabine and cisplatin to obtain higher response rate than doublet but less toxicity than triplet combinations. METHODS: In this trial, stage IIIB and IV chemotherapy naive NSCLC patients with measurable disease and performance status of 0 to 2 were included. Gemcitabine and vinorelbine at the doses of 900 mg/m and 25 mg/m, respectively were administered on days 1 and 8, and cisplatin at a dose of 50 mg/m on day 1, every 21 days. RESULTS: Three of the 39 patients included in the trial were complete responders (7.7%). The overall response rate was 56.4%, median time to the progression was 6 months, median overall survival time was 12 months, and 1-year survival rate was 49.6%. Grade II to III neutropenia and thrombocytopenia occurred in 24% and 30% of the patients, respectively. Febrile neutropenia was observed in 13.5% of the patients and only these patients received G-CSF. Platelet and erythrocyte transfusions were required in 12 (32.4%) patients. No toxic or early death was observed. CONCLUSIONS: This combination of gemcitabine-cisplatin-vinorelbine with lower doses of cisplatin and gemcitabine was effective and active in advanced NSCLC. The overall response rate, 1-year survival and median survival time were nearly similar to previous trials in which higher doses of these 3 drugs were used. The toxicities were more acceptable and manageable than the regimes with higher doses; therefore, we may suggest a treatment option for advanced stage NSCLC.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Células Escamosas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Adenocarcinoma/secundario , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/secundario , Carcinoma de Células Escamosas/secundario , Cisplatino/administración & dosificación , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Tasa de Supervivencia , Resultado del Tratamiento , Vinblastina/administración & dosificación , Vinblastina/análogos & derivados , Vinorelbina , GemcitabinaRESUMEN
BACKGROUND: Helicobacter pylori infection is a world-wide common disease and leads to many gastrointestinal and respiratory illnesses. It is suggested that one of these respiratory illnesses is lung cancer. METHODS: Forty-three patients with non-small cell lung cancer and 28 control subjects have been included to this study. H. pylori status of the patients and controls was determined by immunoblot for the detection of IgG (RIDA Blot Helicobacter). All subjects were examined to evaluate the presence of VacA and CagA gene. RESULTS: Seropositivity of anti H. pylori IgG was significantly higher in cancer patients than in control groups, 40 (93%) and 12 (42%), respectively (P<0.01). Although both VacA and CagA seropositivity was high in lung cancer patients, only VacA positivity was statistically significant when compared with control subjects, 35 (81%) and 11 (42%), respectively (P<0.05). CONCLUSION: H. pylori infection may be associated with development of lung cancer.
Asunto(s)
Antígenos Bacterianos/inmunología , Proteínas Bacterianas/inmunología , Carcinoma de Pulmón de Células no Pequeñas/microbiología , Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Neoplasias Pulmonares/microbiología , Adenocarcinoma/microbiología , Anciano , Antígenos Bacterianos/genética , Proteínas Bacterianas/genética , Western Blotting/métodos , Carcinoma de Células Escamosas/microbiología , Estudios de Casos y Controles , Femenino , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Both paclitaxel (P) and carboplatin (C) have significant activity in non-small cell lung cancer (NSCLC). The weekly administration of P is active, dose intense, and has a favorable toxicity profile. We retrospectively reviewed the data of 51 consecutive patients receiving C and day 1 and 8 P chemotherapy (CT) regimen in advanced stage NSCLC to evaluate the efficacy and toxicity. METHODS: Patients treated in our institutions having pathologically proven NSCLC, no CNS metastases, adequate organ function and performance status (PS) ECOG 0-2 were given P 112.5 mg/m2 intravenously (IV) over 1 hour on day 1 and 8, followed by C AUC 5 IV over 1 hour, repeated in every three weeks. PC was given for maximum of 6 cycles. RESULTS: Median age was 58 (age range 39-77) and 41 patients (80%) were male. PS was 0/1/2 in 29/17/5 patients and stage was IIIA/IIIB/IV in 3/14/34 patients respectively. The median number of cycles administered was 3 (1-6). Seven patients (14%) did not complete the first 3 cycles either due to death, progression, grade 3 hypersensitivity reactions to P or lost to follow up. Best evaluable response was partial response (PR) in 45% and stable disease (SD) in 18%. Twelve patients (24%) received local RT. Thirteen patients (25%) received 2nd line CT at progression. At a median follow-up of 7 months (range, 1-20), 25 (49%) patients died and 35 patients (69%) progressed. Median overall survival (OS) was 11 +/- 2 months (95% CI; 6 to 16), 1-year OS ratio was 44%. Median time to progression (TTP) was 6 +/- 1 months (95% CI; 4 to 8), 1-year progression free survival (PFS) ratio was 20%. We observed following grade 3 toxicities: asthenia (10%), neuropathy (4%), anorexia (4%), anemia (4%), hypersensitivity to P (2%), nausea/vomiting (2%), diarrhea (2%) and neutropenia (2%). Two patients (4%) died of febrile neutropenia. Doses of CT were reduced or delayed in 12 patients (24%). CONCLUSIONS: P on day 1 and 8 and C every three weeks is practical and fairly well tolerated outpatient regimen. This regimen seems to be comparably active to regimens given once in every three weeks.