A major study released in the Journal of Clinical Oncology has shown that doctors could increase the survival of patients with a specific type of lung cancer to over 12 months, if they match choice of chemotherapy with the type of tissue in a patient's tumour.

Mick Peake, Lung Cancer Specialist and Chair of the Clinical Reference Group for the UK Lung Cancer Coalition (UKLCC) commented, "This is a very important opportunity to re-assess how we treat people with NSCLC. It is particularly exciting since it is the first time we have seen the average survival time increase beyond one year in this group of patients with advanced disease. It can be a very difficult disease to treat and a treatment which offers significantly better survival together with improved quality of life during those extra months is a valuable contribution to the level of care we are able to provide for people with NSCLC." [1]

"While non-small cell lung cancer has typically been treated as one disease, this study confirms that histology, or tumour type, can provide a clue as to which treatment regimen works best for a particular tumour type." said the study's lead author, Giorgio Scagliotti, M.D., University of Torino, Italy. [2]

Currently in the UK, guidelines issued by NICE do not differentiate between chemotherapy treatments for different types of NSCLC [3]. Eighty percent of all lung cancers are classified as non-small cell lung cancer (NSCLC), of which there are three main subtypes: adenocarcinoma (27%), large cell (10%) and squamous cell carcinoma (35%).5

The Phase III study showed that patients with the adenocarcinoma type of NSCLC who were treated with the chemotherapy Alimta® (pemetrexed) plus cisplatin survived on average 12.6 months, compared to an average survival of 10.9 months for those receiving the current standard treatment, Gemzar® (gemcitabine) plus cisplatin. [4] Similarly, patients in the study with the large-cell carcinoma subtype of NSCLC who were treated with pemetrexed plus cisplatin also had a significantly better rate of survival than those treated with gemcitabine plus cisplatin (10.4 months vs. 6.7 months, respectively).

Adenocarcinoma is rising in incidence in Europe; however, squamous cell carcinoma is still the most common type of NSCLC, accounting for 35% in Europe. [5]

Further study details

The patients (n=1725) in the study4 had previously untreated advanced NSCLC and were recruited from 177 sites in 26 countries. In all participants, survival was non-inferior for the group treated with pemetrexed plus cisplatin, compared with the group treated with gemcitabine plus cisplatin (10.3 months vs. 10.3 months for overall survival and 4.8 months vs. 5.1 months for progression free survival in pemetrexed plus cisplatin vs. gemcitabine plus cisplatin, respectively).

In addition, treatment with pemetrexed plus cisplatin had significantly lower levels of side effects associated with chemotherapy. Neutropenia (which results in a decreased number of white blood cells) occurred in 15% of the pemetrexed plus cisplatin group versus 27% of the gemcitabine plus cisplatin group. The incidence of hair loss was nearly halved in the pemetrexed plus cisplatin group (12%), when compared with the gemcitabine plus cisplatin group (21%).

In the UK in 2004, more than 100 people were diagnosed daily with lung cancer, which was equivalent to approximately 38,000 a year. [6] The disease accounts for one in six of all cancer cases and one in four of all cancer deaths. [7]

References

[1] Personal communication from Mick Peake

[2] Personal communication from Giorgio Scagliotti

[3] National Institute for Health and Clinical Excellence. The Diagnosis and Treatment of Lung Cancer. February 2005.(Accessed 22nd May 2008)

[4] Scagliotti G, Purvish P, et al. Phase III study of pemetrexed plus cisplatin versus gemcitabine plus cisplatin in chemonaive patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). Abstract PRS-3, 12th World Conference on Lung Cancer (WCLC) 2007. Journal of Thoracic Oncology, Vol 2 No 8, Supplement 4, Page S306, August 2007

[5] Cancer Research UK infoncerresearchuk/cancerstats/types/lung/incidence/ (Accessed 22nd May 2008)

[6] Cancer Research UK - UK Cancer Incidence Statistics (Accessed 22nd May 2008)

[7] UKLCC Lung Cancer Facts (Accessed 22nd May 2008)

Eli Lilly and Company Limited
Lilly House
Priestley Road
Basingstoke
Hampshire. RG24 9NL
lilly

View drug information on Alimta; Gemzar.