I wrote about the drug amrubicin in a prior post, after it demonstrated provocative activity in clinical trials out of Japan that were presented at ASCO 2007. Additional result on amrubicin in previously treated ED-SCLC were presented at a NYC meeting last week, and it's continued to look very encouraging in a clinical setting in which we could really use more options.

We've always been tempted to see if we can add more to standard approaches to improve our outcomes. In SCLC, people have attempted to add taxol to cisplatin and etoposide as part of the PET regimen (platinum + etoposide + taxol). Although heavily tested, it clarified that triplet therapy with standard chemo for SCLC appears to be associated with no improvement in outcomes but with a very significant improvement in side effects, including risk of dying from treatment.

We know PET scans can provide additional metabolic information that can be more sensitive and specific for cancer than chest x-rays and even CT scans in the initial staging of lung cancer (see prior post on introduction to PET scans). PET scans are now nearly universally employed in the initial workup, at least of patients who have NSCLC and aren’t already known to have stage IV disease.

Among the key issues in following patients with a history of treated lung cancer is the pattern of recurrence. We need to have a sense of when the risk is highest and where people are more likely to demonstrate new evidence of disease. Fortunately, there are several studies that can help us with these questions.

A substantial revision of the staging system was presented at the World Conference on Lung Cancer in Korea this week. This project involved multiple lung cancer experts from all over the world and from a variety of specialties over the last several years, who reviewed the data on approximately 100,000 lung cancer cases, both NSCLC and SCLC. They looked at various ways to break down this large database of cases in order to provide a more accurate prognosis for patients.

The fact is that lung cancer, like many others, is a disease disproportionately affecting older populations, with the median age now in the 69-70 range.

(Click to enlarge)

I recently received a question on the Q&A Forum about the use of cisplatin vs. carboplatin in SCLC. In contrast to the smoldering debate about cisplatin vs. carboplatin in NSCLC that I described in a recent post, there's been very little study and not as much debate about SCLC.

After Avastin was found to produce a survival benefit when combined with chemo in advanced NSCLC, it became increasingly appealing to try to see if adding Avastin in earlier stages of lung cancer, both SCLC and NSCLC, where it might increase the cure rate.

In a talk at ASCO 2007, I was asked to present some commentary on a couple of phase II, single arm trials of patients with ED-SCLC that were reported by two different cancer cooperative groups in the US, each adding the anti-angiogenic agent Avastin (bevacizumab) to standard chemotherapy options in this setting.

As I described in prior post, prophylactic cranial irradiation (PCI) is established as a treatment approach for patients with LD-SCLC who have had a complete or "good partial" response to chemo and radiation. Some physicians also recommend PCI for patients with ED-SCLC who have experienced a very good response, since about 10% of the patients on the PCI trials that led to our current recommendations had ED-SCLC.