When patients honest, multi-disciplinary smoking cessation program successful, but more work needed

In 2005 the Peter MacCallum Cancer Centre in Melbourne, Australia launched a multidisciplinary smoking cessation program which included the provision of counseling and behavior techniques as well as free access to pharmacological smoking cessation agents.

While more than 2,000 patients registered as smokers only 178 enrolled in the program; interestingly, a further 134 patients enrolled in the program did not disclose their smoking status at hospital registration.

Of 30 patients interviewed, a promising 66 percent reported successful outcomes, cessation or reduction in consumption.

“Despite low recruitment rates and high magnitude of smoking, the multidisciplinary model was able to achieve successful outcomes at minimal cost in this vulnerable patient cohort, spurring our enthusiasm to catch a more statistically significant sample in future studies,” says Marliese Alexander, researcher in the Dept. of Cancer Medicine at the Peter MacCallum Cancer Centre. “Improving disclosure practices may enable future targeted recruitment of patients by health-care professionals and increase the participation of smokers in proven healthcare interventions.”

Focus should be on prevention to reduce economic inequities in lung cancer, French study finds

One goal of the current French National Cancer Plan is to reduce health inequities in cancer control. In this study, an underprivileged population was investigated to analyze exposure to lung cancer risk factors and health care access in order to highlight ways to improve lung cancer control in that population.

A nationwide questionnaire was conducted via phone, gathering information from 1,603 people between the ages of 40 and 75. The underserved people had higher rates of lung cancer and more risk factors for cancer. However, 85 percent of underserved people thought lung cancer could be efficiently screened.

“Underserved subjects have a high level of trust in lung cancer screening but a riskier behavior in terms of smoking,” says Jean-Francois Morere, professor at the Hospital Paul Brousse in Villejuif, France. “This constitutes new targets for specific communication campaigns and Health authorities’ interventions.”
 

Two screening trials compared to better understand regimen of screening, small nodules

The goal of CT screening is to maximize lung cancer cure rates by early diagnosis and treatment of lung cancer. To achieve this, a regimen of screening is important, particularly for small nodules. To better understand the importance of a regimen, researchers from the Icahn School of Medicine at Mount Sinai, New York, compared two large databases of screen-diagnosed lung cancers, the International Early Lung Cancer Action Program (I-ELCAP) and the National Lung Screening Trial (NLST) CT arm as the former had a specified diagnostic workup algorithm while the latter did not mandate any specific approach.

Stage I disease, both clinical and pathologic, was significantly higher in I-ELCAP than NLST.

“This is important because Stage I lung cancers have the highest cure rates as the cancer has not spread to adjacent lymph nodes and other organs,” says Dr. Claudia Henschke, professor of Radiology, Icahn School of Medicine at Mount Sinai. The tumour size was significantly lower in I-ELCAP than NLST, all strongly suggestive of the importance of a specified regimen of screening.

“This is important as the smaller the tumour size, the more likely it is to be in Stage I,” Henscke says.

Improvement in progression-free survival when using pemetrexed in second-line setting for EGFR advanced non-squamous non-small cell lung cancer

Both pemetrexed and gefitinib are standard second-line treatments for advanced non-squamous non-small cell lung cancer (NSCLC) in East Asia. The CTONG 0806, a multi-center, randomized, controlled, open-label phase II trial was designed to explore the efficacy of pemetrexed versus gefitinib as second-line treatment in advanced non-squamous NSCLC with wild-type EGFR.

From Feb. 2009 to Aug. 2012, 157 patients with locally advanced or metastaic non-squamous NSCLC were enrolled in the study. The patients had previously been treated with platinum-based chemotherapy and had wild-type EGFR. The patients who received pemetrexed compared to gefitinib in the second-line setting showed a significant improvement in progression-free survival and there was a trend of improving overall survival.

“This study will likely change the way patients with advanced non-squamous NSCLC are treated with second-line therapy,” says Dr. Qing Zhou, medical oncologist from the Guangdong Lung Cancer Institute.

Results of keyhole surgery study in patients with mesothelioma

The incidence of malignant pleural mesothelioma is increasing and the disease has no known cure. Previously talc pleurodesis has been used to control the build-up of fluid around the lung (pleural effusion). Non-randomized studies have suggested that video assisted thoracoscopic (VAT) partial pleurectomy may lead to increased survival compared to using talc pleurodesis.

Researchers at Papworth Hospital in Cambridge, U.K. undertook a randomized controlled trial comparing VAT partial pleurectomy with talc pleurodesis.  They studied 196 patients with mesothelioma between 2003 and 2012.

The study showed that there was no difference in survival between the two groups.  However, there was some evidence that VAT partial pleurectomy improved control of recurrent fluid build-up around the lungs and improved quality of life compared to talc pleurodesis.

“Although VAT partial pleurectomy did not increase survival, the improvement in secondary endpoints raises the question of whether patients with mesothelioma should be offered this procedure to help improve their symptoms,” says Dr. Robert Rintoul, respiratory physician and professor at Papworth Hospital in Cambridge, U.K.

Cetuximab provides no survival benefit in addition to chemo-radiotherapy for patients with stage III non-small cell lung cancer

The results of the RTOG 0617 Phase III trial were presented at the Conference. The study had two primary objectives. The first was to compare the overall survival differences of standard-dose (60Gy) versus high-dose (74Gy) radiotherapy with concurrent chemotherapy. The second was to compare standard chemoradiotherapy with the addition of cetuximab. The EGFR targeting drug is used in combination with chemotherapy in metastatic non-small cell lung cancer (NSCLC) and head and neck cancer, and with radiotherapy in locally advanced head and neck cancer.

Researchers found that the high-dose radiotherapy (74Gy) was not superior. They also found that cetuximab provided no survival benefit in addition to chemo-radiotherapy for patients with stage III NSCLC.

“This study helps clarify radiation dosing in locally advanced, stage III non-small cell lung cancer,” says Dr. Gregory A. Masters, medical oncologist at the Helen F. Graham Cancer Center in Delaware, USA.

“It also tells us that cetuximab should not be considered a standard component in the treatment of stage III NSCLC patients. Newly designed Cooperative Group trials are underway to help individualize therapy for this patient population.”

Researchers test more potent and specific ALK inhibitor on NSCLC patients

Patients with NSCLC who have the ALK gene rearrangement usually respond to the drug crizotinib.

Alectinib (RG7853/RO5424802/CH5424802) is a more potent and specific investigational ALK inhibitor that is being studied as a treatment for NSCLC patients with ALK gene rearrangement, and which has recently been granted Breakthrough Therapy Designation by the U.S. F.D.A.

A Phase 1 dose-escalation study of alectinib, the first trial of this drug in a Western population, was performed on 47 NSCLC patients who had failed crizotinib. The patients were enrolled in the study from six sites in the U.S.A. from May 2012 to May 2013.

Researchers found promising anti-tumour activity: in the 37 patients who received a therapeutic dose (i.e. ≥460 mg BID), alectinib demonstrated an overall response rate of 59.5%; after over 5 months of follow-up median PFS had not been reached. In addition, alectinib showed significant shrinkage of brain metastases, with only 4 of the 21 patients who were enrolled with pre-existing brain metastases having discontinued treatment due to disease progression. Alectinib also demonstrated a promising tolerability profile in this study.

“It is estimated that there are over 60,000 cases of ALK-positive NSCLC each year worldwide, and there is a critical need for effective treatments in these patients,” says Prof. Shirish Gadgeel of the Karmanos Cancer Institute, Detroit, Michigan, U.S.A. “Based on these and other Phase 1 findings, alectinib is now being studied in a global phase 2 trial in patients with ALK-positive, crizotinib-resistant NSCLC.”

Source: 15th WCLC