Alain Depierre

Third-Line Chemotherapy in Advanced Non-small Cell Lung Cancer: Identifying the Candidates for Routine Practice

Background: The interest of first- and second-line treatments in non-small cell lung cancer (NSCLC) has been demonstrated by successive randomized trials. Improvements in lung cancer care have routinely allowed a significant proportion of patients to be considered for third-line treatment. Methods: A retrospective analysis was performed, including all consecutive patients with advanced NSCLC, who received at least three lines of systemic antineoplastic treatment at our institution. Results: From a population of 613 patients treated with first-line treatment, a total of 173 patients received third-line treatment (cytotoxic chemotherapy in 131 patients; epidermal growth factor (EGFR) tyrosine kinase inhibitors in 42 patients). Only 13 patients (8%) received less than 75% of the theoretical dose intensity; 22 patients (13%) presented with severe toxicities. Symptom relief and performance status (PS) improvement were observed in 121 (92% of the 131 patients with symptoms) and 90 patients (52%), respectively. Using multivariate analysis, survival after third-line treatment was significantly increased in patients younger than 70 years-old (hazard ratio [HR] = 0.73, 95% confidence interval [CI]: 0.53–0.99, p = 0.047), who smoked less than 10 pack-years (HR = 0.82, 95% CI: 0.57–0.93, p = 0.036), with no cancer-related symptoms (HR = 0.75, 95% CI: 0.61–0.92, p = 0.007), a weight loss inferior to 5 kg since the beginning of second-line (HR = 0.63, 95% CI: 0.52–0.75, p = 0.013), a PS 0 to 1 (HR = 0.81, 95% CI: 0.76–0.86, p = 0.008), and no extrathoracic tumor spread at initiation of third-line treatment (HR = 0.67, 95% CI: 0.47–0.94, p = 0.042). Disease control after both first- and second-line treatments was the strongest predictor of prolonged survival after third-line treatment (HR = 0.47, 95% CI: 0.33–0.67, p = 0.001). Conclusions: Patients with advanced NSCLC may benefit from third-line treatment. The best candidates can be identified using standard prognostic factors, such as PS, and disease control after first- and second-line treatments.

Negative impact of rurality on lung cancer survival in a population-based study.

Introduction: Several studies have suggested that rurality is a risk factor for worse prognosis in cancer. Methods: The study population included the 2268 lung cancer cases collected between 1981 and 1996 in the Doubs Cancer Registry (France). Results: The numbers of patients were 849 (31.8%) in rural areas and 89 (3.3%) in very rural areas. The relative 5-year survival was 15.2% in rural areas and 13.4% in urban areas (p = 0.5), and 2.7% in very rural areas and 14.4% in extended urban areas (p = 0.02). Multivariate analyses of observed and relative survival showed that patients living in very rural areas (p < 0.0001), 65 years of age and older and having small cell carcinoma had a significantly shorter survival. Conclusions: This study showed that the multidimensional definition of rurality identified a population with unfavorable prognoses.

Infection pulmonaire à Mycobacterium malmoense compliquée d'un aspergillome

Summary A 49 year old man was medically treated, first in 1986 and then in 1988, for atypical primary pulmonary infection caused by Mycobacterium malmoense. Since no clinical or bacteriological improvement of both smear and culture was observed, upper right bilobectomy was performed in december 1988. Oral treatment with rifabutin, clofazimine, ethambutol and isoniazid was clinically and bacteriologically successful in May 1989. In 1990, Aspergillus flavus infection developed in a sequeleae cavity located in the posterior segment of the upper left lobe. To our knowledge the Mycobacterium malmoense-Aspergillus flavus association has not yet been described.

C3-04: Phase III study comparing a preoperative (PRE) and a perioperative (PERI) chemotherapy (CT) with two different CT regimens in resectable stage I-II non-small cell lung cancer (NSCLC): the IFCT 0002 protocol

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