Current Modalities in the Treatment of Lung Cancer

Hackensack University Medical CenterJohn Theurer Cancer Center

New Frontiers in the Management of Solid and Liquid Tumors

Lung Cancer Update2011

Harry Harper, M.D.Christopher Azzoli, M.D.

November 4, 2011

Lung Cancer Update, 2011OVERVIEW

• Lung cancer facts and figures• Screening smokers for lung cancer• NSCLC:

– Surgery– Chemotherapy + XRT– Chemotherapy

• SCLC:– Chemotherapy– Chemotherapy + XRT– Prophylactic cranial irradiation

Cancer in the United States, 2011

New Cases Deaths

Prostate 240,890 Lung 156,940

Breast 230,480 Colorectal 49,380

Lung 221,130 Breast 39,520

Colorectal 141,210 Prostate 33,720

Jemal, Cancer Facts & Figures 2011, CA, 2011

1522

55

1522

55

1222

59

0102030405060708090

100

Localized Regional Distant

Stage at Diagnosis: Females

60

33

5

61

32

4

51

39

8

0102030405060708090

100

Localized Regional Distant

All RacesWhiteAfrican American

Breast Cancer Lung Cancer

Perc

ent (

%)

Jemal A et al. CA Cancer J Clin. 2010;60:227-300.

Current, orformer heavy

cigarette smoker(>1ppd x 30 years)

Age 55-74Randomized

Low-dose fast spiral CT

CXR

Years0 1 2

September, 2002 – February, 200450,000 participants randomized

Monitor through 2009

Primary endpoint:Mortality due to lung cancer

0 1 2

National Lung Screening Trial

Lung cancers detectedScan 1

Lung cancers detected Scan 2

Lung cancers detected Scan 3

Lung cancer deaths

Total deaths

Lung Cancer Deaths Avoided

CT 270 168 211Total: 649

427 1877 1 for every 320 screened

Mammogram:1 for every

570 from age 50

CXR 136 65 78Total:279

503

HR 0.80

1998

HR 0.93

24% CT scans “abnormal” (>4mm solid nodule or enlarged nodes)7% of CXR were “abnormal”

NLST, NEJM 2011

Criteria Total Smokers Current Former

55-74, ≥30 pack years 7,425,000 4,027,000 3,398,000

50-79, ≥20 pack years 13,500,000 9,114,000 4,386,000

55-74, any smoking history 26,627,000 7,738,000 18,889,000

≥50, any smoking history 46,481,000 14,729,000 31,752,000

≥21, ≥10 years of smoking any amount

77,005,000 39,883,000 37,122,000

CDC sponsored National Health and Nutrition Examination Survey (NHANES)9,762 Americans polled in 2007-08

Data Courtesy of Peter Bach

Estimated American Smokers at Risk

“We’re gonna need a bigger boat.”

“Don’t smoke cigarettes.”

IIIALYMPHNODES

NSCLCStaging

I

II

IIIB

Major change:7th-Edition TNM StagingJuly, 2009

IIA

Node-negative tumors>5cm are now stage II

Best Treatment for NSCLC: SURGERYO

vera

ll Su

rviv

al

Goldstraw, et al. J Thorac Oncol. 2007;2:706-714

51 3 7 9

8988 / 15952 : TOTAL

Surgically resected patients, 1990 – 2000Overall Survival with Surgery

Benefit of Adjuvant Cisplatin+Vinorelbine

HR 0.925Y risk 36%

HR 0.835Y risk 61%

HR 0.835Y risk 74%

LACE, N=4584Pignon , JCO 2008;26

N=1371

N=1616

N=1247

HR 0.925Y risk 36%

HR 0.835Y risk 61%

HR 0.835Y risk 74%

LACE, N=4584Pignon , JCO 2008;26

Stage IB

Stage II

Stage III

Number Needed to Treatto Save 1 Life

1 / absolute risk reduction

1 / 3% = 33 patients

1 / 10% = 10 patients

1 / 13% = 8 patients

Benefit of Adjuvant Cisplatin+Vinorelbine

N=1371

N=1616

N=1247

Best Treatment for Unresectable/Inoperable NSCLC:RADIATION THERAPY

REFERENCES:1. Dillman, NEJM 19902. RTOG 94-10, Curran, JNCI, 20113. Chemo before chemo+RT (induction) is toxic, does not improve overall survival (CALGB 39801)4. Docetaxel after chemo+RT (consolidation) is toxic, does not improve overall survival (HOG 01-24)

Unresectable Stage III (N2-N3) NSCLC:MST(mos)

3YS(%)

FebrileIllness

G3-4Esophagitis

XRT only (>6000 rads) 11 m < 10% 3% 3%

Cisplatin-based chemo, then XRT“SEQUENTIAL”

15 m 10-20 8% 5%

Cisplatin-based chemo plus XRT“CONCURRENT”

17 m 20-30 15% 30%

Important clinical trials in unresectable stage IIIB NSCLC

RANDOM I ZE

Cisplatin + Pemetrexed x 3Concurrent XRT to 6600cGy

Cisplatin + Etoposide x 3Concurrent XRT to 6600cGy

N=600

US NIH, 2011.

Pemetrexed x 4

Dealer’s choice x 4:EtoposideVinorelbinePaclitaxel

Presenter

Presentation Notes

Key Point: Bevacizumab development is moving into the adjuvant setting in this ECOG trial. Are these plans adequate for adjuvant NSCLC?

Best treatment for stage IV NSCLC:DRUG THERAPY

Survival NoChemo

Cytotoxic chemo

Chemo + anti-angio

genesis

TargetEGFR

mutation

MST (mo) 4 8 12 301-year (%) 10 20 50 90

2-year (%) 0 3 10 30

• Improving length of life• Improving quality of life

R

Results Pem/Cis Gem/Cis HRNo. patients 862 863Median survival (mos) 10.3 10.3 0.94Adenocarcinoma (847) 12.6 10.9Large cell (153) 10.4 6.7SqCC (473) 9.4 10.8 1.23

Scagliotti et al, 2008.

n=1725Stage IV NSCLCRecord histology

One cycle = 3 weeks, stop at 6 cycles

Cisplatin 75 mg/m2 Day 1 plus Pemetrexed 500 mg/m2 Day 1

Cisplatin 75 mg/m2 Day 1 plus Gemcitabine 1,250 mg/m2 Days 1, 8

“Cytotoxic” Chemotherapyfor Stage IV NSCLC

Presenter

Presentation Notes

Scagliotti GV, Parikh P, von Pawel J, Biesma B, et al. Phase III Study Comparing Cisplatin Plus Gemcitabine With Cisplatin Plus Pemetrexed in Chemotherapy-Naive Patients With Advanced-Stage Non–Small-Cell Lung Cancer. J Clin Oncol. 2008;26(21): 3543–3551. histology type, the differences, where cis/gem versus pem/gem versus pem rather, cis shows good numbers of patients, phase III, median survival was the same but when you broke it down the adenocarcinomas did better, they had the large cells, smaller in number, better than the squamous cell and the hazard ratio was 0.81. So I think this shows that histology makes a difference.

Four cycles of pemetrexed (500 mg/m2, Day 1) + cisplatin (75 mg/m2, Day 1)* n=900

Pemetrexed 500 mg/m2

+ BSC* (D1, q21d) until disease progressionN=372 pts

Placebo + BSC* (D1, q21d)

until disease progressionN=186 pts

CR, PR, or SD and ECOG PS of 0 or 1

2:1 randomization

“Continuation Maintenance” Chemotherapy

Paz-Ares et al, 2011.

Paz-Ares et al, 2011PFS HR=.62, OS results pending

Presenter

Presentation Notes

The study will have 4 periods: a baseline period, an unblinded induction treatment period, a blinded maintenance treatment period, and a postdiscontinuation period. In the induction treatment period, eligible patients will receive 4 cycles of induction chemotherapy with pemetrexed and cisplatin. Patients who have a documented (confirmed or unconfirmed) response of CR, PR, or SD after completion of induction chemotherapy and ECOG PS of 0 or 1 will be considered eligible for randomization to maintenance treatment. Immediately following the induction treatment period, a minimum of 558 eligible patients will be randomized in a 2:1 ratio to pemetrexed plus BSC maintenance treatment (experimental Arm A, approximately 372 patients) or to placebo plus BSC maintenance treatment (control Arm B, approximately 186 patients). To randomize at least 558 eligible patients, it is expected that approximately 900 patients must be enrolled to this study. Primary Objective To compare maintenance therapy with pemetrexed plus BSC vs placebo plus BSC, in terms of objective PFS time in patients with stage IIIB (with pleural effusion and/or positive supraclavicular lymph nodes) or IV nonsquamous NSCLC whose disease has not progressed during 4 cycles of pemetrexed and cisplatin induction chemotherapy. Secondary Objectives To compare the following between randomized treatment arms: • Time-to-event efficacy endpoint: OS • Objective tumor response rate • Patient-reported outcomes using the EuroQol 5-dimensional scale (EQ-5D) • Resource utilization • Toxicity Complete Reference for Citation: H3E-EW-S124(a). A Phase 3, Double-Blind, Placebo-Controlled Study of Maintenance Pemetrexed plus Best Supportive Care versus Best Supportive Care Immediately Following Induction Treatment with Pemetrexed + Cisplatin for Advanced Nonsquamous Non-Small Cell Lung Cancer. 19 March 2009: pages 8-15.

Biologic/Molecular Targets for New Drugs

IGFR

P P

Gene Transcription

Angiogenesis Proliferation Metastasis Adhesion

Gene Transcription

Angiogenesis Survival

P P P PP P

PDGFVEGF

VEGFRPDGFR

VEGF

EGFR

Tumor cell Endothelial cell

EML4-ALK

bevacizumab

Gefitinib Erlotinib

Vandetanib

figitumumabcetuximab

Crizotinib

Raf

mTOR

Akt

Pi3K

MEK

ERK

P

MET

P

CC CC

PP

Sorafenib Sunitinib Axitinib

Pazopanib Motesanib

Raf

mTOR

Akt

Pi3K

MEK

ERK

Sorafenib Sunitinib Axitinib

Pazopanib MotesanibVandetanib

XL-184

ARQ197 XL-184

Crizotinib

MetMab

Sandler et al, NEJM 2006.

Target Angiogenesis: BevacizumabSQUAMOUS HISTOLOGY EXCLUDED

(for squamous histology, rate of hemoptysis 30% in phase 2 testing

0 6 12 18 24 30 36

0

20

40

60

80

100

Time (mos)

p = .003; HR = 0.79 Median OS: 12.3 mos vs.

10.3 mos1-Yr OS: 51% vs. 44%2-Yr OS: 23% vs. 15%

Patie

nts

Surv

ivin

g (%

)

OS

0

20

40

60

80

100

Patie

nts

With

PFS

(%)

0 6 12 18 24 30 36Time (mos)

p < .001; HR = 0.66 Median PFS: 6.2 mos vs.

4.5 mos6-Mos PFS: 55% vs. 33%1-Yr PFS: 15% vs. 6%

PFSCbPCbP + Bevacizumab

CbPCbP + Bevacizumab

RR: 15% for CbP Vs. 35% for CbP + Bevacizumab

Presenter

Presentation Notes

Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. New Engl J Med. 2006;355(24):2542-2550.

Bevacizumab with other Drugs

End Point CG + Placebo CG + Bev (7.5 mg/kg) CG + Bev (15 mg/kg)

PFS, HR (95% CI) NA 0.75 (0.62–0.91); p = .0026

0.82 (0.68–0.98); p = .0301

Median PFS (mos) 6.1 6.7 6.5RR (%) 20 34 (p < .0001) 30 (p < .017)Median Survival (mos)HR, p value 13.1 13.6

(0.92, p = .3664)13.4

(1.02, p = .8420)

1.0

0.8

0.6

0.4

0.2

Time (mos)0 6 12 183 9 15

PFS

0.0

CG + Bevacizumab 15 mg/kg

CG + Placebo

Time (mos)

1.0

0.8

0.6

0.4

0.2

0.0

1.0

0.8

0.6

0.4

0.2

0.00 6 12 183 9 15

1.0

0.8

0.6

0.4

0.2

0.0

1.0

0.8

0.6

0.4

0.2

0.00 6 12 183 9 15

1.0

0.8

0.6

0.4

0.2

0.0

1.0

0.8

0.4

0.2

0.00 12 183 9 15

CG + Bevacizumab 7.5 mg/kg

CG + Placebo

PFS

Poss

ibili

ty o

f PFS

(%)

Reck et al, 2010, 2009.

SQUAMOUS HISTOLOGY EXCLUDED

Presenter

Presentation Notes

Reck M, von Pawel J, Zatloukal P, et al. Phase III Trial of Cisplatin Plus Gemcitabine With Either Placebo or Bevacizumab As First-Line Therapy for Nonsquamous Non–Small-Cell Lung Cancer: AVAiL. J Clin Oncol. 2009;27(8):1227-1234.

Pemetrexed500 mg/m2 iv q21d

CarboplatinAUC 6 iv q21d

Bevacizumab15 mg/kg iv q21d

Arm A - 450 Patients Arm B - 450 Patients

Paclitaxel200 mg/m2 iv q21d

CarboplatinAUC 6 iv q21d


Pemetrexed500 mg/m2 iv q21d



Post discontinuation follow up

Induction Therapy:up to four 21-day cycles

Maintenance Therapy:until PD or treatment discontinuation

Patients with PD:follow up q90d until death

Patients without PD:follow up q6w until PD;

thereafter, follow up q90d until death

Patients with CR, PR, or SDAfter induction therapy

Continue on to maintenance therapy

Determination of Eligibility

Ongoing BevacizumabTrials

Primary Endpoint: OS

Patel et al, 2009.

Testing Bevacizumab forEarly-stage NSCLC: ECOG 1505

• Cisplatin and vinorelbine• Cisplatin and docetaxel• Cisplatin and gemcitabine• Cisplatin and pemetrexed

Primary endpoint: overall survival

Secondary endpoints: disease-free survival, safety[bleeding and arterial thromboembolic events]

Eligibility• Resected IB (>4cm) – IIIA• ≥ lobectomy• Adequate MLND sampling

• All pts: level 7• Left: level 5 or 6 • Right: level 4

• No previous chemotherapy• No planned XRT• No CVA / TIA / ATEN = 1500

RANDOM I ZE

Chemotherapy* x 4 cycles

Chemotherapy* x 4 cycles +bevacizumab x 1 year

No molecular markers being studied prospectivelyAccrual has been slow. Results anticipated in 2016.

Presenter

Presentation Notes

Key Point: Bevacizumab development is moving into the adjuvant setting in this ECOG trial. Are these plans adequate for adjuvant NSCLC?

Agent Description Reference

Sorafenib Multi-kinase inhibitor including VEGFR Spigel et al, 2010

Sunitinib Multi-kinase inhibitor including VEGFR Govindan et al, 2010

Axitinib Multi-kinase inhibitor including VEGFR Kelly et al, 2010

BIBF 1120 (intedanib)

Multi-kinase inhibitor including VEGFR, PDGFR, FGFR Reck, 2010

Cediranib Multi-kinase inhibitor including VEGFR Mitchell et al, 2010

Vandetanib Multi-kinase inhibitor including EGFR and VEGFR Morabito et al, 2010

HuMV833 Antibody to VEGF-A Jayson et al, 2002

IMCL 1121b (ramucirumab)

Antibody to VEGFR2 Spratlin et al, 2010

IMC-18F1 Antibody to VEGFR1 Schwartz et al, 2010

VEGF Trap (aflibercept)

Antibody to VEGF-A Leighl et al, 2010

Angiogenesis: Targeted Agents on the Horizon

VEGFR = vascular endothelial growth factor receptor; PDGFR = platelet-derived growth factor receptor; FGFR = fibroblast growth factor receptor.

Ove

rall

surv

ival

(%)

Months

Pirker et al, 2009, and 2011

Target EGFR: Cetuximab

RETROSPECTIVE SUBGROUP ANALYSIS:

• HR = 0.80 in the 354 patients with the highest EGFR IHC score

• HR = 1.05 in patients with lower EGFR IHC score

CT

cetuximabuntil PD

Stage IV NSCLC

EGFR expression by IHC

N=1,688

CT + cetuximab

RANDOMIZE ITT (n=1125) Median

OS1-year

survival

▬ CT + cetuximab(n=557)

11.3 mo 47%

▬ CT(n=568)

10.1 mo 42%

HR=0.871, p=0.044

Presenter

Presentation Notes

Pirker R, Pereira JR, Szczesna A, von Pawel J, et al. Lancet. Cetuximab plus chemotherapy in patient with advanced non-small cell lung care (FLEX): an open-label phase III trial. Lancet. 2009;373(9674):1525-1531.

The Biggest Discovery:EGFR Activating Mutations

Pao, Nature Reviews Cancer 10, 760-774

5 days on gefitinib

Stage IV 1st-line EGFR TKI for EGFR mutationStudy Drugs ORR PFS OS

IPASSYang, ESMO 2010

gefitinibvs.carbo + paclitaxel

71%

47%

N=261HR 0.48P<.0001

HR 1.00P=0.990

First-SIGNALLee, IASLC 2009

gefitinibvs.cis + gemcitabine

85%

37%

N=42HR 0.62P=.084

HR 0.82 P=.648

WJTOG 3405 TsurutaniESMO 2009

gefitinibvs.cis + docetaxel

62%

32%

N=172HR 0.49 P<.001

Not reported

NEJ 002MaemondoNEJM 2010

gefitinibvs. carbo + paclitaxel

74%

31%

N=228HR 0.30P<.001

HR NSP=0.31

OPTIMALZhou, ESMO 2010

erlotinibvs.carbo + gemcitabine

83%

36%

N=154HR 0.16 P<.0001

Not reported

0.0

0.2

0.4

0.6

0.8

1.0

Prob

abili

ty o

f OS

No EGFR mutationEGFR mutation

0 1 2 3 4 5 6 7 8Years After Surgery

No. At RiskNo EGFR mutation896 778 517 293 160 104 65 26 10EGFR mutation222 204 133 91 55 33 18 7 4

No EGFR mutation: Median OS = 6.3yr (95%CI: 5.6 - 7.8)EGFR mutation: Median OS = 6.9yr (95%CI: 6.3 - NA)p (adj for stage) < 0.001

EGFR mutation is Prognostic of Survival in Early-stage NSCLC

DatacourtesySandraD’AngeloMSKCC

Testing erlotinib for early-stage NSCLC with EGFR mutation

NCI Personalized Adjuvant Trial “PAT”

Resected NSCLCTested positive forEGFR activating/sensitizing mutationN=400

RANDOM I ZE

Erlotinib for 2 years

Placebo for 2 years

US NIH, 2011.

ALK gene translocation drives 3% of NSCLC

Vysis LSI ALK dual color break apart probe

Kwak et al, 2010.

Break-apart FISH assay of tumor cells from a patient with

rearrangement of the gene encoding ALK

Presenter

Presentation Notes

Figure 1. Diagnosis of an EML4-ALK-Positive Non-Small-Cell Lung Cancer in a Single Representative Patient. Panel A shows the results of a break-apart fluorescence in situ hybridization assay of tumor cells from a patient with rearrangement of the gene encoding anaplastic lymphoma kinase (ALK). The green probe hybridizes to the region immediately 5[variant prime] to ALK, and the red probe to the 3[variant prime] region. The separation of red and green probe signals (arrows) indicates a chromosomal rearrangement involving ALK. Close apposition of red and green probe signals indicates an intact wild-type copy of ALK. The probe that was used was the Vysis LSI ALK Dual Color, Break Apart Rearrangement Probe (Abbott Molecular). (Kwak et al, 2010)

• Study A (N = 136 patients), ORR 50%, median duration 10 months

• Study B (N = 119 patients), ORR 61%, median duration 12 months

• 94% had received prior systemic treatment for NSCLC

• No differences in ORR by performance status, the number of prior chemotherapeutic regimens, or the percentage of cells found to have the ALK gene rearrangement were noted.

Phase II studies of crizotinib for patients with stage IV NSCLC and ALK translocation

FDA Approval Announcement, 8/26/2011

First-line crizotinib for patients with ALK Translocation

Crizotinib 250 mg PO BID

Pemetrexed 500 mg/m2 + cisplatin 75 mg/m2 or carboplatin AUC 5, q 21 days

1º endpoint: To demonstrate that crizotinib is superiorto first-line chemotherapy

2º endpoint: ORR, OS, Duration of Response Safety

US NIH, 2011.

Randomized Study of Crizotinib vs Pem/Cis or Pem/Carbo in Untreated Patients with Non-squamous Carcinoma of the Lung With EML4-ALK Mutation

Novel Agents Under Phase III Investigation: Currently Recruiting Trials

Agent Mechanism of Action Study ID Primary Completion Date

Tivantinib (ARQ 197)

c-Met inhibitor NCT01244191 May 2013

Tivantinib (ARQ 197)

c-Met inhibitor NCT01395758 June 2012

Iniparib PARP inhibitor NCT01082549 (ECLIPSE) March 2013

PF-02341066 ALK inhibitor NCT00932893 June 2012

Afatinib EGFR/HER2 inhibitor NCT01121393 (LUX-Lung 6) May 2012

Afatinib EGFR/HER2 inhibitor NCT01085136 (LUX-Lung 5) March 2012

Talactoferrin Immunostimulant NCT00706862 (FORTIS-C) March 2013

Ipilimumab Anti-CTLA4 Antibody NCT01285609 August 2014

Ramucirumab VEGFR-2 inhibitor NCT01168973 June 2014

Necitumumab EGFR inhibitor NCT00981058 (SQUIRE) May 2013

Vargatef Multikinase inhibitor NCT00806819 (LUME-Lung 2) May 2013

MetMab Met inhibitor Recruitment will begin later this year (2011)

US NIH, 2011.

Problem: With so many new drugs, and targets, how do we know we are giving the right drug to the right patient?

Solution: Test! Don’t guess!

Lung Cancer Mutation ConsortiumIncidence of Single Driver Mutations

At least 1 mutation was found in 54% (280/516) of tumors completely tested (CI 50%–59%)

Kris et al, ASCO 2011.97% of Mutations Mutually Exclusive

Lung Cancer Mutation Consortium Targeted Clinical Trials

Target Agent(s)EGFR Erlotinib + OSI 906

Erlotinib + MM 121KRAS Tivantinib + Erlotinib

GSK1120212MET Amplification MetMAB

EML4-ALK CrizotinibNRAS GSK1120212

Kris et al, ASCO 2011.

MEK1 GSK1120212BRAF (V600E) GSK2118434

BRAF (not V600E) GSK1120212HER2 Afatinib

PIK3CA BKM120

Real progress for patients with stage IV NSCLC

Survival NoChemo

Cytotoxic chemo

Chemo+bev

EGFRTKI for EGFR

mutant

MST (mo) 4 8 12 301-year (%) 10 20 50 90

2-year (%) 0 3 10 30

• Improving length of life• Improving quality of life

SMALL CELLLUNG CANCER

LimitedStage

ExtensiveStage

Surgery rarely an option.No molecular markers discovered yet.No new drugs for 20 years!

Twice Daily Thoracic Radiotherapy for Limited Stage SCLC

Turrisi et al, NEJM, 1999

• 417 patients with limited stage SCLC• 4 cycles etoposide + cisplatin with concurrent once vs.

twice daily RT to 45 Gy starting with first cycle

2-year survival41 vs. 47%

5-year survival16 vs. 26%p = 0.04

Prophylactic Cranial IrradiationAuperin et al, NEJM, 1999

• 7 randomized trials, 987 pts with CR

• 5% increase in survival at 3 yrs• Higher dose improved local

recurrence but no effect on survival

Death Brain Mets

54% ↓ risk16% ↓ risk

PCI in Extensive SCLC286 patients with extensive SCLC and response after 4-6 cycles of chemotherapy were randomized to PCI or no PCI

Median survival: 6.7 vs 5.4 mo1 yr survival: 27% vs 13%

Slotman et al, NEJM 2007

IP: median 9.3 mo (0.1-32.6) 1yr 35.4%, 2yr 8.0%EP: median 10.2 mo (0.3-44.6) 1yr 36.7%, 2yr 7.9%

Etoposide + cis (n = 110)Irinotecan + cis (n = 221)

P = 0.6226

Months

Prob

abili

ty

1.00.9

0.8

0.70.6

0.50.4

0.30.2

0.10

0 10 20 30 40

Hanna, J Clin Oncol 24:2038, 2006

For Extensive Stage: Cisplatin + Etoposide

Greater proportion had improved dyspnea, anorexia, hoarseness and fatigue with topotecan

von Pawel, JCO, 17:658, 1999

Topotecan CAV

Response Rate 24% 18%

Med Survival 6 mo 6 mo

Grade 4 (% pts)NeutropeniaAnemiaPlatelets

70%3%

29%

72%2%5%

TransfusionsRBCsPlts

52%20%

27%2%

“2nd-line” Chemo for Extensive SCLC

• Rechallenge with 1st regimen if time to relapse > 6 months

• Topotecan• CAV • Irinotecan• Paclitaxel• Docetaxel• Gemcitabine• Vinorelbine• Amrubicin: active, but failed to

significantly improve survival vs. topotecan in phase 3 study

“2nd-line” Chemo for Extensive SCLC:

n=637amrubicin 40 mg/m2 IV on days 1-3

vs.topotecan 1.5 mg/m2 IV on days 1-5

HR 0.82, p=NSprimary refractory subgroup, HR 0.77, p=.047

Jotte R, J Clin Oncol 29: 2011;29(15s):(abstract 7000),453s

Presenter

Presentation Notes

10.DeVore. Presented at ASCO 1998. ((10/Slide 8/as marked))

Lung Cancer Update, 2011REVIEW

• Lung cancer facts and figures• Screening smokers for lung cancer• NSCLC:

– Surgery– Chemotherapy + XRT– Chemotherapy

• SCLC:– Chemotherapy– Chemotherapy + XRT– Prophylactic cranial irradiation

The era of personalized medicine has arrived !

EGFR, ALK …

Screening saves lives !

Newest stories:

OLDEST STORY:“Don’t smoke cigarettes.”

Current Modalities in the Treatment of Lung Cancer

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