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| |  DG DISPATCH - NCCN: Additional Chemotherapy Seen As Viable Option For Recurrent Lung Cancer By Ed Susman Special to DG News
FORT LAUDERDALE, FL -- March 2, 2001 - Researchers say that as long as a patient with recurrent small cell lung cancer has a good performance status, additional courses of chemotherapy is a viable treatment option, in spite of the sometimes disappointing outcomes. The addition of second, third and maybe even fourth lines of treatment was recommended yesterday (March 1) by doctors preparing updated treatment algorithms for patients with lung cancer at the 6th annual guidelines meeting National Comprehensive Cancer Network here. Bruce Johnson, MD, of Dana-Farber Cancer Institute, Boston, Massachusetts, and acting chairman of the small-cell lung panel, presented the new guidelines. He said the guidelines incorporated the use of methotrexate and lomustine into salvage therapies, based on clinical trials which indicated that about one in five relapsed patients respond to the regimen, and patients on the regimen have survival extended about four months. Two of the original 34 patients in the Italian study, Dr. Johnson said, survived at least 18 months. The revised guidelines list a number of anticancer agents that can be employed in the salvage setting, including topotecan, irinotecan and taxanes. "Studies indicate that if the performance status of the patient is okay, then the patient can handle the additional courses of chemotherapy," Dr. Johnson said. The new guidelines also recommend that patients presenting with lung cancer undergo prophylactic radiation to the head in an attempt to prevent brain metastases. "The number of people who go on to have brain metastases without irradiation is about 40 to 60 percent," he said. Prophylactic cranial irradiation can reduce that occurrence by nearly half. He said doctors have been reluctant to give radiation to the head in fears of causing mental deficits, but newer studies indicate that this is not as much of a problem as once thought. The guidelines also tell doctors to continually counsel patients to stop smoking. A high percentage of lung cancer patients continue to smoke after diagnosis and surgery, said Dr. Mark Kris, chief of thoracic oncology service at Memorial Sloan-Kettering Cancer Center, in New York. "Doctors should discuss smoking cessation at every visit," he said. Smoking, even in lung cancer patients, worsens the outcome, especially if the patient is undergoing some form of radiation therapy, he said.
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