No abstract available.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Hope*

Radiation therapy has played a key role, together with surgery and systemic chemotherapy, in treating in all stages of non-small cell lung cancer. We have witnessed remarkable improvements in radiation therapy techniques, with the innovations in hardware and software. Stereotactic ablative radiation therapy, which can deliver high radiation dose focused to small target volume, represents one of the state-of-the-art radiation therapy techniques. The technical development of radiation therapy and the role of stereotactic ablative radiation therapy in treating inoperable stage I non-small cell lung cancer are briefly reviewed.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Radiotherapy ; Stereotaxic Techniques

No abstract available.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy, Combination*

PURPOSE: To determine the prognostic value of pre- treatment serum LDH levels and the LDH isoenzyme pattern for non-small cell lung cancer, and to determine the relationship between the response to chemotherapy and the changes in serum LDH levels following chemotherapy MATERIALS AND METHODS: Patients with pathologically confirmed non-small cell lung cancer were entered onto this study. Their serum LDH levels were assessed prior to chemotherapy, with the LDH isoenzyme being assessed in patients with high initial serum LDH levels. The serum LDH levels were re-assessed following 2 cycles of chemotherapy. The relationship between the response to chemotherapy, pre-treatment serum LDH levels and LDH isoenzyme pattern and the changes in serum LDH levels, following chemotherapy, were evaluated. RESULTS: 49 patients were entered onto this study. The pre-treatment serum LDH levels were normal in 26 patients, and elevated in 23. The LDH isoenzyme was evaluated in 15 patients, with LDH2 being elevated the most frequently. The response rate to chemotherapy was 42.9% in all 42 patients able to be evaluated, 45.8% in patients with normal serum LDH levels and 41.2% in patients with elevated serum LDH levels. This difference was not statistically significant (p=0.767). The median survival was 37 weeks in all patients able to be evaluated, 38 weeks in those with normal serum LDH levels and 31 weeks in those with elevated serum LDH levels. These differences were not statistically significant (p=0.202). The patients with normal serum LDH levels following chemotherapy were more responsive to chemotherapy than those with elevated serum LDH levels following chemotherapy (response rate 51.4% vs. 0%, p=0.027). CONCLUSION: The LDH2 are most commonly elevated in non small cell lung cancer patients. The pre-treatment serum LDH levels do not reflect the prognosis accurately. The serum LDH levels following chemotherapy are associated with the response to chemotherapy.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Humans ; Oxidoreductases* ; Prognosis ; Small Cell Lung Carcinoma

Immunotherapy has significantly improved clinical outcomes of non-small cell lung cancer (NSCLC), however, along with the popularization of immunotherapy, immune resistance has become an unavoidable problem. Immunotherapy can induce extensive cellular and molecular alterations in the tumor microenvironment. Considering the mechanisms of immune resistance are not yet fully understood and the efficacy of standard chemotherapy regimens is limited, more effective coping strategies based on resistance mechanisms are urgently needed. In this review, we intend to summarize the known mechanisms of immune resistance and feasible strategies, so as to provide a foundation for clinicians to develop more individualized and precise regimens and finally improve patients' prognosis.
.
Humans ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Lung Neoplasms/drug therapy* ; Prognosis ; Immunotherapy ; Tumor Microenvironment

Immune escape mechanisms in non-small cell lung cancer (NSCLC) can disrupt every step of the anti-cancer immune response. In recent years, an increased understanding of the specific mechanisms fueling immune escape has allowed for the development of numerous immunotherapeutic treatments that have been introduced into the clinical practice. The advent of immunotherapy has dramatically changed the current treatment landscape of advanced or metastatic NSCLC because of its durable efficacy and manageable toxicity. In this review, we will first present a brief overview of recent evidence on immune escape mechanisms in NSCLC. We will then discuss the current promising immunotherapeutic strategies in advanced or metastatic NSCLC tumors.
Humans ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Lung Neoplasms/drug therapy* ; Immunotherapy

PURPOSE: To evaluate the efficacy and toxicity of the combination therapy of paclitaxel and cisplatin in advanced, non-small cell, lung cancer patients MATERIALS AND METHODS: Between December 1997 and September 2001, 37 patients with advanced, non-small cell, lung cancer were enrolled in this study. Patients were treated with paclitaxel (135 mg/m2, 24 hr infusion) and cisplatin (75 mg/m2). The treatments were repeated every 4 weeks. RESULTS: Among the 37 patients enrolled, 21 were treated with paclitaxel and cisplatin as a first-line and 16 patients as a second-line. The median age of the patients was 59. In the first-line group, 10 had stage IIIB and 11 had stage IV, non small cell lung cancer. Of 21 patients in first-line treatment group that could be evaluated, objective responses were observed in 6 patients (response rate: 28.6%, CR: 4.8%, PR: 23.8%). The mediansurvival duration for patients was 48 weeks. With the second-line group, 3 patients showed a partial response (response rate: 18.7%) to treatment, with median survival duration of 44 weeks. Grade 3-4 leukopenia was observed in 27.1% of the first-line, and 23.6% in second- line, treatment groups. CONCLUSION: Combination chemotherapy, with paclitaxel and cisplatin, in non-small cell lung cancer has acceptable toxicities in both first and second-line treatment groups. In terms of efficacy, no superior response was shown for either group. More randomized studies, with a larger group of patients, are required to prove the true efficacy.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy, Combination* ; Humans ; Leukopenia ; Lung Neoplasms ; Paclitaxel* ; Small Cell Lung Carcinoma

BACKGROUND: Surgical therapy remains the only curative treatment of localized non-small cell lung cancer(NSCLC). But the efficacy of surgery for patients with NSCLC is limited, although recent studies suggest that neoadjuvant chemotherapy may improve survival. Many studies also demonstrated benefit for neoadjuvant therapy. However very few studies about neoadjuvant chemotherapy were reported in Korea. We conducted this study to examine the possible benefit of neoadjuvant chemotherapy in patients with operable stage IIIA NSCLC. METHODS: Twenty seven patients(25 men and 2 women) with clinical stage IIIA NSCLC were analyzed. The patients received 2 to 4 courses of cisplatin based chemotherapy and followed by surgery. To compare the resection rate and survival, 12 patients(10 men, 2 women) with clinical stage IIIA and initially treated operation were also anayzed. RESULTS: The radiologically assessed response rate to the neoadjuvant therapy was 59.3%. Twelve seven patients underwent gross tumor resection with 24(88.9%) having complete resection and 21(77.8%) having postaperative stage I ar II. Pathologically defined response in nodal staging was more higher(85.2%). There was no difference of relapse free interval in recurred patients between two groups. But in patients treated with neoadjuvant therapy, distant recurrence is less higher than local recurrence. The median period of survival was 42 months in the patients treated with neoadjuvant therapy, and 27 months in the patients initially treated with surgery(p=0.287). CONCLUSION: The neoadjuvant chemotherapy improves local tumor control and lowers the distant recurrence. There was a possible trend improving median survival. So neoadjuvant chemotherapy might be considered as a standard therapy in stage IIIA NSCLC.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Drug Therapy* ; Humans ; Korea ; Lung ; Male ; Neoadjuvant Therapy ; Recurrence

PURPOSE: With the increased use of chemotherapy for non small cell lung cancer (NSCLC), a growing group of patients can now be considered for second-line chemotherapy. However, guidelines for the second line treatment remain to be developed. The objective of this study was to evaluate the efficacy and safety of the gemcitabine and vinorelbine combination therapy in patients with advanced NSCLC, pretreated with taxane and platinum based regimens. Gemcitabine has already demonstrated activity in this patient group, with the combination therapy having been reported to be well tolerated in previous phase I/II studies. MATERIALS AND METHODS: Forty two patients with advanced NSCLC (stages III/IV), having received prior taxane and platinum based chemotherapy, with an ECOG performance status (PS) 0~2, and unimpaired hematopoietic and organ function, were treated with vinorelbine, 20 mg/m2, followed by gemcitabine, 1, 000 mg/m2, both administered on days 1, 8 and 15, every 4 weeks. RESULTS: Out of the 42 patients enrolled, 41 were evaluable for their response, and all 42 for their toxicity. The patient's characteristics were as follows; median age=60 years (42~73), median PS=1 (range 0~2), a gender ratio 31: 11 males/females, with stages IIIA, IIIB and IV in 3, 14 and 25 cases. The objective responses included a partial response (PR) 8/41 (19.5%), a stable disease 15/41 (36.6%) and a progressive disease 18/41 (43.9%). The median time-to progression (TTP) and survival were 4 months, ranging from 2 to 14 months, and 8 months, ranging from 2 to 17+ months, respectively. Grade 3 neutropenia was seen in 19% of the patient, and there was no grade 4 neutropenia or episodes of febrile neutropenia. No grade 4 thrombocytopenia or other grade 3/4 non-hematological toxicities were observed. CONCLUSION: The combination of gemcitabine/vinorelbine is active and well tolerated in patients with advanced NSCLC having failed prior taxane/platinum therapy.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Febrile Neutropenia ; Humans ; Neutropenia ; Platinum ; Small Cell Lung Carcinoma ; Thrombocytopenia

PURPOSE: A prolonged administration of etoposide increases its effectiveness on the suggestion that pralonged maintenance of low levels is an important factor in determining its activity. Many studies have been tried to define the efficacy of combination of oral etoposide with other chemotherapeutic drugs such as cisplatin, 5-FU, and ifosfamide in patients with advanced non-small cell lung cancer (NSCLC). In this study, we evaluated the effectiveness and toxicities of combination chemotherapy of oral etoposide with intravenous cisplatin and ifosfamide in advanced NSCLC patients. MATERIALS AND METHODS: Thirty-three patients with inoperable NSCLC who had measurable diseases and had not been treated with chemotherapeutic drug, were enrolled in this study (from May 1995 to April 1998). Treatment consisted of intravenous cisplatin (20 mg/m(2)/day, Day 1-3) and ifosfamide (1,800 mg/m(2)/day, Days 1-3) with Mesna (1,100 mg/m(2)/day, Days 1-3), and oral etoposide (50 mg/m(2)/day, Days 4-17). This treatment was repeated every 4 weeks. Patients showing stable disease or a better response were continued on treatment with the range of one to nine cycles (medium: 3 cycles). All patients were evaluated for the response, survival, and toxicity of this combination chemotherapy. RESULTS: Eleven patients showed either complete responses [CR, 3 (9%)] or partial responses [PR, 8 (24%)]. The median number of treatment cycles were 5 (range, 3-9) for responders and 2 (range, 1-7) for non-responders. The responders had median response duration of 10 months and the overall survival of 12 months. The overall survival of responders were longer than that of non-responders (median 19 vs 5 months, p 0.0232). The toxicities of this treatment were tolerable without treatment related death. Limiting toxicities were myelosuppression and oral mucbsities, Grade 3 or 4 leukopenia and oral mucosities were observed in 34% and 9%, respectively. CONCLUSION: The combination of cisplatin, ifosfamide, and oral etoposide produced encouraging response rates and median survival duration in patients with response. Further study of this combination is warranted in comparison with standard cisplatin+etoposide regimen or intravenous etoposide, cisplatin and ifosfamide regimen.
Carcinoma, Non-Small-Cell Lung ; Cisplatin* ; Drug Therapy, Combination* ; Etoposide* ; Fluorouracil ; Humans ; Ifosfamide* ; Leukopenia ; Mesna ; Small Cell Lung Carcinoma*