Taking Chemo Drug Continuously Delayed Lung Cancer's Return
SUNDAY June 5, 2011 -- While most patients with advanced lung cancer only take four courses of two chemotherapy drugs and then stop until recurrence occurs, continuing treatment with one of those drugs may delay return of the deadly disease, new research suggests.
The results are preliminary, but Spanish scientists report that staying on Alimta (pemextrexed) delayed recurrence of the disease.
"This is the first trial with what looks like a positive outcome where you continue the same treatment," said Dr. Neal Ready, a professor of medicine at the Duke Cancer Institute in Durham, N.C. "All the other positive trials in the past switched chemotherapy regimens, so this is a true 'maintenance' approach" in that doctors maintained the patients on the same drug.
Although overall survival data is not yet in, "if it all bears out and that looks good, this would influence medical oncologists to continue treatment after the standard combination of two chemotherapies at the same time," Ready said.
The findings, which were presented Sunday at the annual meeting of the American Society of Clinical Oncology in Chicago, was funded by Lilly, which makes Alimta.
In this study, almost 1,000 patients with advanced nonsquamous non-small cell lung cancer were given a typical four courses of Alimta and cisplatin. The 539 patients who saw their disease stabilize were then randomly chosen to receive Alimta or a placebo.
Participants taking Alimta lived an average of 4.1 months without a disease recurrence compared to 2.8 months in the placebo group.
"There was a decrease of 38 percent in the risk of progression, which we believe is clinically significant and may support the use of this in a clinical context," said study author Dr. Luis Paz-Ares, chair of oncology at Seville University Hospital in Seville, Spain, who spoke at a Sunday news conference.
Side effects were about the same as those seen in previous trials of Alimta, with the only significant increases in problems being fatigue, anemia and low white blood cell count.
But in all those cases, the incidence was lower than 5 percent, Paz-Ares said.
According to Lilly, the cost of Alimta varies depending up on the patient's size but is about $4,000 per cycle wholesale.
When asked if oncologists would be likely to prescribe this medication given the possibly prohibitive cost, Dr. Mark G. Kris, moderator of the press conference and chief of the Thoracic Oncology Service at Memorial Sloan-Kettering Cancer Center in New York City, said that he thought they would, at least for patients in which the drug worked and was tolerable.
"The benefit would be worth the spending for people who get a benefit," he said.
Ready believes that doctors' willingness to use the drug will ultimately depend on seeing the overall survival results which, said Paz-Ares, "may be available in the near future."
The American Cancer Society reports that lung cancer is the leading cause of cancer death among both men and women, killing more people than colon, breast, and prostate cancers combined. The chance that a man will develop lung cancer is about one in 13; for a woman, about one in 16. While the estimates include both smokers and non-smokers, for smokers the risk is much higher.
Research presented at medical meetings should be considered preliminary until it is published in a peer-reviewed journal.
The U.S. National Cancer Institute has more on lung cancer.
Posted: June 2011