New research presented at the 2009 World Conference on Lung Cancer from July 31 to August 4 in San Francisco addressed the science and advances in the treatment of lung cancer. The features below highlight just some of the studies that emerged from the conference.

Maintenance Therapy Benefits NSCLC Patients

The Particulars: Current guidelines for non-small-cell lung cancer (NSCLC) call for first-line therapy, followed by a watchful waiting period for disease progression before starting second-line and third-line treatment.

Data Breakdown: A study of chemotherapy-naïve patients with advanced NSCLC who were given four cycles of a first-line, platinum-based doublet therapy was conducted. Of those showing no progression of disease after the fourth cycle, patients were then randomized to erlotinib 150 mg daily or placebo. Patients continued maintenance therapy until their disease progressed. More than half (53%) of patients receiving erlotinib had not experienced disease progression at 12 weeks; 31% showed no progression at 24 weeks. For the placebo group, corresponding rates were 40% and 17% at 12 and 24 weeks, respectively.

Take Home Pearl: Maintenance therapy with erlotinib appears to be safe and effective for treating NSCLC, and current protocols for treatment may change to first-line therapy followed by maintenance therapy, and second-line treatment only after patients progress on maintenance therapy.

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A Combination First-Line Approach for Advanced Disease

The Particulars: Some studies have demonstrated that combining cetuximab with standard first-line chemotherapy regimens (eg, cisplatin plus vinorelbine and carboplatin plus paclitaxel or docetaxel) may improve survival and overall response rates in patients with advanced non-small-cell lung cancer (NSCLC).

Data Breakdown: A phase II study was conducted in which 48 patients with metastatic NSCLC received an initial dose of cetuximab 400 mg/m² followed by 250 mg/m² weekly in combination with both cisplatin 40 mg/m² and gemcitabine 1,200 mg/m² on days 1 and 8 every 21 days for up to six cycles. The overall response rate utilizing this combination approach was 35.4% in an intent-to-treat analysis and 38.1% in those who actually received the treatment. In the intent-to-treat group, median time to progression was 5 months and median overall survival was 12 months.

Take Home Pearl: Combining cetuximab with cisplatin and gemcitabine appears to be effective and tolerable as a first-line treatment of advanced NSCLC.

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New Concepts in Third-Line Chemotherapy

The Particulars: Currently, there are no specific criteria to assist clinicians in selecting non-small-cell lung cancer (NSCLC) patients who are most likely to benefit from third-line chemotherapy.

Data Breakdown: Investigators reviewed medical files on NSCLC patients with stage IIIB or stage IV disease who received systemic antineoplastic agents and/or EGFR tyrosine kinase inhibitors and at least one third-line course of treatment. At the beginning of third-line therapy, 76% of NSCLC patients had cancer-related symptoms, but 92% of these patients reported partial or complete symptom relief during treatment. Disease progression status improved by at least 1 point in 52% of patients during third-line treatment; 40% maintained stable performance status. Disease control following first- and second-line therapy was the strongest predictor of longer survival following third-line treatment.

Take Home Pearl: Response to earlier lines of chemotherapy appears to be the most appropriate prognostic markers for third-line treatment in patients with NSCLC.

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