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Marquez-Medina D.,University of Lleida | Popat S.,Lung Unit
Lung Cancer | Year: 2015

Between 25 and 33% of neuroendocrine tumours arise in the lung as low-grade typical pulmonary carcinoids (TPC), intermediate-grade atypical pulmonary carcinoids (APC), and high-grade large cell neuroendocrine or small cell carcinomas. The relatively uncommon incidence and prevalence of PCs are progressively increasing. However, data regarding systemic treatment for PCs are limited, controversial and based on old reports with few randomized or placebo-controlled trials, small sample sizes, or including tumours with very different behaviours. Moreover, conclusions are generally extrapolated from the outcome of extra-pulmonary carcinoids, treatment arms are not well defined or mix different therapies, and the indolent nature of some PCs is not adequately considered in designing control arms. Here, we reviewed and discuss current recommendations regarding systemic treatments for PCs. © 2015 Elsevier Ireland Ltd.

Scagliotti G.V.,University of Turin | Bondarenko I.,Dnepropetrovsk Medical Academy | Blackhall F.,University of Manchester | Barlesi F.,Aix - Marseille University | And 11 more authors.
Annals of Oncology | Year: 2015

Background: Figitumumab (CP-751,871) is a fully human IgG2 monoclonal antibody that inhibits the insulin-like growth factor 1 receptor. This multicenter, randomized, phase III study investigated the efficacy of figitumumab plus erlotinib compared with erlotinib alone in patients with pretreated, nonsmall-cell lung cancer (NSCLC). Patients and methods: Patients (stage IIIB/IV or recurrent disease with nonadenocarcinoma histology) who had previously received at least one platinum-based regimen were randomized to receive open-label figitumumab (20 mg/kg) plus erlotinib 150 mg/day or erlotinib alone every 3 weeks. The primary end point was overall survival (OS). Results: Of 583 patients randomized, 579 received treatment. The study was closed early by an independent data safety monitoring committee due to results crossing the prespecified futility boundary. At the final analysis, median OS was 5.7 months for figitumumab plus erlotinib and 6.2 months for erlotinib alone [hazard ratio (HR) 1.09; 95% confidence interval (CI) 0.91-1.31; P = 0.35]. Median progression-free survival was 2.1 months for figitumumab plus erlotinib and 2.6 months for erlotinib alone (HR 1.08; 95% CI 0.90-1.29; P = 0.43). Treatment-related nonfatal serious adverse events occurred in 18% and 5% of patients in the figitumumab arm or erlotinib alone arm, respectively. There were nine treatmentrelated deaths (three related to both drugs, four related to erlotinib alone and two related to figitumumab). Conclusions: The addition of figitumumab to erlotinib did not improve OS in patients with advanced, pretreated, nonadenocarcinoma NSCLC. Clinical development of figitumumab has been discontinued. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology.

Marquez-Medina D.,University of Lleida | Martin-Marco A.,University of Lleida | Popat S.,Lung Unit
Clinical and Translational Oncology | Year: 2016

Introduction: Induction treatment is becoming the gold standard for locally advanced non-small cell lung cancers (LA-NSCLC). In contrast to baseline positron emission/computed tomography scan (PET/CT scan), re-staging PET/CT scan has been poorly studied in LA-NSCLC. Materials and methods: We retrospectively explored the efficacy of re-staging PET/CT scan to diagnose response and to predict disease-free survival (DFS) in 55 induction-treated LA-NSCLC further treated with curative surgery or radiation but not with adjuvant therapy. Results: Re-staging N status by PET/CT scan significantly correlated with pathological N status. Radiological or metabolic response in the re-staging PET/CT scan was associated with a significantly better DFS, which decreased from 25.8 to 19.3, to 11.2, and to 9.4 months in cN0, cN1, cN2, and cN3 patients, respectively. Conclusion: Re-staging PET/CT scan helps to define response and consolidation treatment in induction-treated LA-NSCLC and predicts DFS. Further extended studies should confirm our results. © 2015, Federación de Sociedades Españolas de Oncología (FESEO).

Marquez-Medina D.,University of Lleida | Popat S.,Lung Unit
Future Oncology | Year: 2015

First-generation reversible EGF receptor (EGFR) tyrosine kinase inhibitors (TKIs) changed our understanding of advanced non-small-cell lung cancer biology and behavior. The presence of sensitizing EGFR mutations in advanced non-small-cell lung cancer defines a subset of patients with a better prognosis and sensitivity to EGFR-TKIs with a better response rate, progression-free survival, quality of life and symptom control than with chemotherapy in the first-line therapy setting. However, current EGFR-TKIs show minimal responses in EGFR wild-type patients or with acquired TKI resistance mediated through the EGFR T790M allele. Afatinib is an irreversible pan-ErbB-TKI, active against wild-type EGFR, sensitizing and T970M-mutant EGFR, ErbB2 and ErbB4 receptors, and represents a step change between reversible first-generation and future irreversible highly specific third-generation EGFR-TKIs. Here, we review the clinical development of afatinib through the LUX-Lung trials portfolio highlighting benefits and toxicities. © 2015 Future Medicine Ltd.

Gasparini S.,Pulmonary Diseases Unit | Zuccatosta L.,Pulmonary Diseases Unit | Bonifazi M.,Lung Unit | Bolliger C.T.,SOD Pneumologia
Respiration | Year: 2012

In recent years, different bronchoscopic techniques have been proposed for the treatment of emphysema, with the aim of obtaining the same clinical and functional advantages of lung volume reduction surgical techniques while reducing risks and costs. Such techniques can be classified into: methods employing devices that block the airways (e.g. spigots and unidirectional valves), methods that have a direct effect on the lung parenchyma (polymeric lung volume reduction, coils and thermal vapor ablation) and procedures that facilitate the expiration of trapped air from the emphysematous lung (airway bypass). This review aimed to evaluate the indications, outcomes and safety of the different techniques, based on the evidence from the available literature. Results obtained by these methods are encouraging, but they are still based mainly on studies with small groups of patients. However, several trials are ongoing and in the near future we will acquire more knowledge which should lead to a better optimization of these procedures. Meanwhile, the bronchoscopic treatment of emphysema cannot yet be considered a standard of care and patients should be treated in the context of clinical trials or controlled registries, with well-defined programs of evaluation and follow-up. Copyright © 2012 S. Karger AG, Basel.

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