I have gathered many resources for you, outlining the most
commonly used therapies for metastatic adenocarcinoma NSCLC. I?m
afraid I am uable to rate them fore effectiveness, due to the variable
involved. Your doctor and you can decide which would be the ost
effective for you ? I am not privy to your overall health, age, and
you entire medical history-your oncologist does. It does appear, that
if you do opt for a therapy, that Topotecan (Hycamtin) seems to be
well tolerated and as effective as possible. I?m afraid none of the
treatments offer a great deal of promise. I agree with the statement
from some of the sites below; you may select to opt for NO therapy
other than measures to make yourself comfortable.
As for the availability ? any of the therapies I have listed are
available to oncologists. Some may have been approved for other
cancers and not yet for NSCLC, but your oncologist will be familiar
with off-label use of these drugs, and can prescribe them if needed.
?Stage IV: This means the cancer is widespread when it is
diagnosed. Because stage IV NSCLC has spread to distant organs, a cure
is usually not possible. Treatment options depend on the site of the
distant spread and the number of tumors. Widespread recurrence or
continued growth of cancer that was more localized at the time of
diagnosis is not technically considered to be stage IV cancer.
However, the treatment options for people with a distant recurrence
are similar to those initially diagnosed as stage IV. If any
aggressive therapy is used, the goal of treatment should be clear to
you and your family. If you are in otherwise good health, surgery,
chemotherapy, and radiation therapy can help you live longer, even
though it won't cure you. In general, treatments will also help you to
feel better by relieving symptoms.
If the cancer is not squamous cell cancer, then many doctors will
add bevacizumab (Avastin) to the chemotherapy. If you have an airway
blocked by cancer you can be treated by brachytherapy (radioactive
seeds placed with a bronchoscope) or by using a laser passed through a
bronchoscope to destroy the part of the cancer in your airway.
External beam radiation therapy can also treat complications of cancer
in the lungs, as well as problems from metastatic growth, such as bone
pain and nervous system symptoms.
Patients in very poor health may have serious, life-threatening
complications of chemotherapy. If you have extensive cancer or are in
otherwise poor health, you might want to consider palliative or
supportive care, perhaps through a hospice program. Many people with
lung cancer are concerned about pain. As the cancer grows around
certain nerves it may cause severe pain. However, you can effectively
relieve this pain with medicine. Sometimes radiation therapy will
help. It is important that you talk to your doctor and take advantage
of these treatments.
Deciding on the right time to discontinue chemotherapy and focus on
palliative care is never easy. Good communication with doctors,
nurses, family, and clergy, as well as discussions with hospice staff
can help people facing this situation.?
?When deciding on the type of treatment, doctors will make the
following decisions about your lung cancer:
Is there is a chance of curing your cancer - that is, treating your
cancer so it is highly unlikely that it will ever come back (curative
If this is not possible, then the doctor will try to shrink the tumour
and stop it from re-growing for as long as possible. Hopefully by
doing this, any symptoms that your cancer is causing will be
reduced/delayed (palliative treatment).?
?Chemotherapy involves the use of anticancer drugs to treat
cancer. At one time, patients were not usually offered chemotherapy
for the treatment of stage IV lung cancer because the chemotherapy
drugs available were thought to be of little benefit. Patients with
stage IV NSCLC who do not receive any treatment live for an average of
4 months. Approximately 5 percent to 10 percent remain alive 1 year
?More recently, two-drug combination has often been used. This is
usually Platinol® (cisplatin) or Paraplatin® (carboplatin) combined
with a second chemotherapy agent. Recent research has found that a
combination of Gemzar® (gemcitabine) and Platinol may have advantages
over other standard two-drug regimens.?
?The final group includes patients with distant metastases (M1)
that were found at the time of diagnosis. This group can be treated
with radiation therapy or chemotherapy for palliation of symptoms from
the primary tumor. Patients with good performance status (PS), women,
and patients with distant metastases confined to a single site live
longer than others. Platinum-based chemotherapy has been associated
with short-term palliation of symptoms and with a survival advantage.
Currently, no single chemotherapy regimen can be recommended for
routine use. Patients previously treated with platinum combination
chemotherapy may derive symptom control and survival benefit from
docetaxel, pemetrexed, or epidermal growth factor receptor inhibitor.?
?Of these cases, about 80% will be non-small cell lung
cancer (NSCLC), whose primary histological subtypes are
adenocarcinoma, squamous cell carcinoma, and large cell carcinoma
(Lindsey & Thielvoldt, 1999; National Comprehensive Cancer Network
Unfortunately, non-small cell lung cancer is associated with a poor
prognosis.While surgical resection can produce cures in early stage
patients, over 70% of patients are diagnosed with advanced disease.
Chemotherapy regimens developed in the past decade have provided
modest survival benefits to patients with advanced or recurrent
disease, but the five-year survival rate remains only 15% (American
Cancer Society [ACS], 2003a).Thus, oncology professionals face special
challenges in identifying the most appropriate treatment decisions and
in providing acute and supportive care throughout the disease
continuum.This monograph will provide an overview of the epidemiology,
pathophysiology, prognostic factors, and available treatments for
NSCLS. In addition, it will focus on new agents recently approved or
in clinical testing for the treatment of advanced NSCLC.? Page 4
?Adenocarcinoma, by contrast, is usually peripheral in origin
and frequently metastasizes to distant sites, such as the
lymph nodes, adrenal glands, liver, bone, and brain. It is
characterized by formation of glands and papillary structures
and usually develops in the peripheral airway or
bronchoalveolar area (Ginsberg et al., 2001; Lindsey &
Thielvoldt, 1999; Houlihan, 2004). Adenocarcinoma is the
most common type of lung cancer in North America,
accounting for 40% of cases (Ginsberg et al., 2001).? Page 5
?However, since the disease is usually advanced by the time of
diagnosis, surgery is often used in combination with radiation therapy
Currently, there is no one course of treatment that has shown distinct
superiority to others.Thus, there is no standard of care, and
therapies should be chosen based upon individual patient
characteristics and preferences.
Because NSCLC is associated with poorer survival rates than many other
cancers, the goals of treatment for advanced disease are often to
provide palliation of symptoms and to extend survival rather than cure
(Table 4).? Page 7
?Third-generation combinations most often include
cisplatin or carboplatin in combination with paclitaxel
(Taxol®, Bristol-Myers Squibb, Princeton, NJ), docetaxel
(Taxotere®,Aventis, Bridgewater, NJ), vinorelbine
(Navelbine®, GlaxoSmithKline, Research Triangle Park, NC),
gemcitabine (Gemzar®, Lilly, Indianapolis, IN), or irinotecan
(Camptosar®, Pfizer [Pharmacia], New York, NY). In addition,
various non-platinum doublets have been studied (Thomas,
2003a).There are four third-generation chemotherapy
combinations (Table 6) currently approved by the FDA for
treatment of advanced NSCLC: paclitaxel plus cisplatin,
vinorelbine plus cisplatin, gemcitabine plus cisplatin (two
dosing schedules), and docetaxel plus cisplatin.? Page 8
?Advanced stages require chemotherapy usually with two drugs,
second-line chemotherapy is indicated in cases of relapse.?
?A variety of new agents and combinations have been investigated in
the treatment of NSCLC. However, to date, no clearly superior
single-agent or combination regimen has emerged. Topotecan (Hycamtin®;
GlaxoSmithKline; Philadelphia, PA), a topoisomerase I inhibitor, is
currently approved for the treatment of patients with relapsed small
cell lung cancer (SCLC) and is associated with manageable,
noncumulative, hematologic toxicities. In addition, topotecan
demonstrates a favorable nonhematologic tolerability profile compared
with agents currently used in the treatment of patients with NSCLC.
The success of topotecan in patients with SCLC has made it an
attractive option in the NSCLC setting.?
?Stage IV non-small cell lung cancer (NSCLC) denotes the presence
of metastatic disease and is largely incurable using present-day
therapies. Chemotherapy remains a therapeutic option in this patient
population, and there are many pertinent issues surrounding its use in
patients with stage IV NSCLC. Eleven questions were framed by the
American College of Chest Physicians Lung Cancer Guidelines Committee,
and these were addressed by a systematic search of the available
literature. The issues addressed included the identification of
prognostic factors in selecting patients for chemotherapy and a
critical analysis of the survival benefit provided by chemotherapy.
Given the development of several new chemotherapy agents over the
past decade, the impact that these agents have made was addressed as
well as the definition of a standard of care regarding
chemotherapeutic regimens. Given the fact that chemotherapy does not
represent a curative option, other issues addressed were the optimal
duration of treatment as well as its impact on symptom relief and
quality of life, the role of second-line therapy, and the outcomes
expectations from both first-line and second-line chemotherapy.?
?Strategies to Improve Treatment
The development of more effective cancer treatments requires that new
and innovative therapies be evaluated with cancer patients. Clinical
trials are studies that evaluate the effectiveness of new drugs or
treatment strategies. Future progress in the treatment of stage IV
NSCLC will result from the continued evaluation of new treatments in
Patients may gain access to better treatments by participating in a
clinical trial. Participation in a clinical trial also contributes to
the cancer community's understanding of optimal cancer care and may
lead to better standard treatments. Patients who are interested in
participating in a clinical trial should discuss the risks and
benefits of clinical trials with their physician. Areas of active
investigation aimed at improving the treatment of stage IV NSCLC
include the following:
? New Targeted Therapy
o Tarceva® (erlotinib)
o Avastin® (bevacizumab)
o Erbitux® (cetuximab)
o Cancer vaccines
? New Chemotherapy Drugs
o Alimta® (pemetrexed)
o New forms of paclitaxel
o Telcyta? (TLK286)
? Improving Outcomes with Taxotere and Gemzar
o Taxotere alone
o Three-drug combination: Gemzar/paclitaxel/carboplatin
o Dose-dense chemotherapy
?New Radiation Techniques
? Conformal 3-D radiation therapy is an important new technique that
allows the dose of radiation to be increased with a reduction in the
? The combination of both primary radiation therapy and chemotherapy
is being examined and shows promise.
? Fractionation: the practise of varying the dose, duration and time
between radiation treatments.
? Radiation modifiers can be used to change the cellular response to
radiation. These agents appear to inhibit cancer cells from repairing
the damage caused by a radiation treatment.
? Radiation sensitisers i.e. agents that make cells more sensitive to
the effects of radiation.
? Brachytherapy ? a technique used to deliver high doses of radiation
from very short distances and involves the placement of a small
radiation source in the airway next to a tumour.
?Recent randomized trials have suggested that the benefit of
chemotherapy for NSCLC is derived during the first several doses, and
that prolonged courses of treatment do not benefit patients any more
than do short courses (ie, 3-4 cycles).[2,3] Although the concept of
switching early to a non-cross-resistant chemotherapy regimen is
theoretically attractive, the response rate to second-line regimens is
quite low, and the chance of improving markedly the quality of
response in this patient is quite low. It is probable that reserving
further chemotherapy until tumor progression will offer equivalent
benefit, and will allow the patient some time without treatment while
he is in a partial remission.
The role of several targeted biologic agents (eg, epidermal growth
factor receptor inhibitors, anti-angiogenesis agents) in prolonging
remission and/or delaying progression in this clinical setting is
currently being evaluated, and hopefully these agents will benefit
patients like this one in the future.?
?A new therapeutic option for patients with non-small cell lung
cancer (NSCLC) in these stages with progress or relapse after
platinum-based chemotherapy exists in the inhibitors of the epidermal
growth factor receptor (EGFR) tyrosine-kinase. EGFR tyrosine-kinase
inhibitor treatment might also be an option for patients ineligible
for surgery and conventional chemotherapy. We present a case of a
53-year-old woman who was diagnosed due to pain from multiple bone
metastases of a lung adenocarcinoma. She refused cytotoxic
chemotherapy, and we administered first-line systemic treatment with
gefitinib subsequent to radiotherapy of metastatic bone disease. The
patient responded well to gefitinib treatment and achieved a partial
response after 3 weeks.
No relevant side effects occurred, and the patient experienced an
8-month remission of disease. With a follow-up of 10 months, the
patient is still alive. Retrospectively, we found a mutation of the
EGF receptor in tumor cells of the patient, which is associated with
sensitivity to gefitinib. EGFR tyrosine-kinase inhibitors (TKI) can be
an alternative first-line systemic treatment option for selected
patients with metastatic NSCLC.?
?In May 2003, FDA approved Iressa (gefitinib). Iressa is an
anticancer drug that inhibits an enzyme (tyrosine kinase) present in
lung cancer cells, as well as other cancers and normal tissues, that
appears to be important to the growth of cancer cells. Iressa has been
used as a single agent for the treatment of non-small cell lung cancer
(NSCLC) that has progressed after, or failed to respond to two other
types of chemotherapy (drugs used to kill cancer cells).?
?Gefitinib ( ge-FI-tye-nib) belongs to the group of medicines
called antineoplastics. It is used to treat non-small cell lung cancer
after the failure of other chemotherapy treatment.
Before you begin treatment with gefitinib, you and your doctor should
talk about the good this medicine will do as well as the risks of
This medicine is available only with your doctor's prescription, in
the following dosage forms:
? Tablets (U.S.)
?The epidermal growth factor receptor (EGFR) is overexpressed in
many cancers, and several targeted therapies aimed at inhibiting EGFR
signaling have been developed.Many patients with non?small cell lung
cancer (NSCLC) who show radiographic responses to gefitinib, a
small-molecule inhibitor of the tyrosine kinase domain, have somatic
mutations in the EGFR gene, but whether such mutations are associated
with responsiveness to cetuximab, a monoclonal antibody directed
against the extracellular domain, is unknown. In this issue, Mukohara
et al. (p. 1185) report on their analysis of the effects of gefitinib
and cetuximab on NSCLC cell lines carrying wild-type or mutant EGFR.
Both agents had similar, and relatively weak, effects on growth and
apoptosis of cells with wildtype EGFR. However, cells with mutant EGFR
were much more sensitive to gefitinib than to cetuximab, possibly
because only gefitinib was able to inhibit phosphorylation of the
?Tyrosine kinase inhibitors directed against the epidermal growth
factor receptor (EGFR) are the first molecular-targeted agents to be
approved in the US and other countries for the treatment of advanced
non-small-cell lung cancer after failure of chemotherapy. Some patient
characteristics, such as never-smoking, female gender, East Asian
origin, adenocarcinoma histology, and bronchioloalveolar subtype, are
associated with a greater benefit from treatment with EGFR inhibitors.
Recently, studies have identified gene mutations targeting the kinase
domain of the EGFR that are related to the response to inhibitors.
Most EGFR mutations predict a higher benefit from treatment compared
with wild-type receptors and are correlated with clinical features
related to better outcome; some EGFR mutations, however, confer drug
resistance. The analysis of material usually available from lung
cancer patients, using techniques such as direct sequencing to
determine EGFR mutational status, can be technically challenging. In
this regard, high EGFR copy number and EGFR protein detected by
immunohistochemistry can also be used to select those patients who
would benefit from treatment. Prospective validation of biological and
clinical markers of sensitivity needs to be performed?
?The 2 major classes of EGFR inhibitors in clinical use are, based
on their mechanisms of action, tyrosine kinase inhibitors (TKIs) and
monoclonal antibodies. The former group is exemplified by gefitinib
and erlotinib while the latter includes cetuximab and panitumumab.
Phase 3 trials employing the EGFR TKIs in first-line metastatic
disease yielded negative results when these agents were administered
concurrently with chemotherapy. Subsequent preclinical evidence
suggested that sequencing chemotherapy with EGFR inhibitors may be
more efficacious. Therefore, the Southwest Oncology Group performed a
randomized phase 2 trial (SWOG 0342) comparing concurrent
chemotherapy plus cetuximab vs sequential chemotherapy followed by
cetuximab in metastatic NSCLC. The plan was to select the arm with
superior overall survival and subsequently compare it with
chemotherapy alone in a phase 3 trial. However, the trial, which
enrolled 242 patients, revealed virtually identical median
progression-free (4 months in both arms) and overall (10 months in
concurrent arm, 9 months in sequential arm) survival.?
?Selection of patients for treatment with EGFR inhibitors
The association of EGFR mutations with particular patient
characteristics related to drug sensitivity, such as female gender,
adenocarcinoma histology, never-smoking status, and Asian race, is
striking. However, the selection of patients for treatment with these
agents based solely on the presence of EGFR mutations is
controversial, because not all patients who benefit from the treatment
harbor a mutation, and a few patients with mutations are resistant to
TKIs. It might seem that deletion mutants would confer sensitivity
more consistently than point mutations, which are also harder to
confirm by direct sequencing. Unlike deletion mutations, some point
mutations can affect the protein conformation in a way that prevents
optimal enzyme inhibition by EGFR TKIs.
In addition, other factors, including amplification of the EGFR gene
and the activity of molecules downstream of EGFR, such as P-Akt, and
mutations of K-ras, might play a role in the definition of sensitivity
to EGFR inhibitors. On the basis of available data, limiting treatment
only to patients harboring an EGFR mutation might not be justified,
although patients with mutations appear to have a very high chance of
responding to TKI treatment. The occurrence of secondary mutations
that alter the conformation of the ATP-binding pocket should be
investigated, and the development of second-generation EGFR inhibitors
that overcome this resistance is warranted.?
?According to results recently published in the Journal of Clinical
Oncology, the oral chemotherapy agent Hycamtin® (topotecan) may
provide an effective alternative to intravenous chemotherapy in the
treatment of recurrent non?small cell lung cancer.
Lung cancer remains the leading cause of cancer-related deaths in the
U.S. Non?small cell lung cancer (NSCLC) is the most common type of
lung cancer. ?Non?small cell? refers to the type of cell within the
lung where the cancer originated.
Recurrent NSCLC refers to cancer that has returned or progressed
following prior therapies. Effective treatment options remain limited
for these patients. Outcomes are focused on improving the duration of
survival for patients while maintaining a good quality of life.
A commonly used chemotherapy agent in the treatment of recurrent NSCLC
is Taxotere® (docetaxel). However, Taxotere is administered
intravenously (into a vein), which requires extended stays at medical
facilities for administration as well as potential for pain and
infection. Oral chemotherapy agents, such as Hycamtin, may offer
patients a more convenient alternative.?
?Patients with stage III or IV NSCLC, performance status </= 2, who
had received only one prior chemotherapy regimen, were randomly
assigned to treatment with oral topotecan 2.3 mg/m(2)/d on days 1 to 5
or IV docetaxel 75 mg/m(2) day 1 every 21 days.
CONCLUSION: Oral topotecan provides activity in the treatment of
relapsed, locally advanced, unresectable NSCLC. Both regimens were
well tolerated with differing safety profiles. Topotecan may provide
an option for patients who desire an orally available treatment after
?Study Shows Oral Hycamtin Clinically Active in Relapsed NSCLC
One open-label, phase III trial studied the risk/benefit profile of
oral Hycamtin compared with IV docetaxel. A total of 829
previously-treated patients were recruited from 140 centers worldwide.
Patients were randomized to receive either single agent oral Hycamtin
2.3 mg/m2 daily on days 1-5, every 21 days (n="414)" or IV docetaxel
75 mg/m2 on day 1, every 21 days (n="415). Results for one-year
survival rate, the study?s primary endpoint, were similar between
groups (25.1 percent for oral Hycamtin versus 28.7 percent for IV
docetaxel). With regard to differences in one-year survival between
groups, Hycamtin was shown to be non-inferior to docetaxel based on
the study?s pre-specified non-inferiority margin. Oral Hycamtin was
also similar to docetaxel in median survival (27.9 weeks versus 30.7
weeks, respectively). Nineteen patients in each group (4.6 percent)
achieved a complete or partial response, and stable disease was
observed in 111 patients (26.8 percent) in the oral Hycamtin group
versus 148 patients (35.7 percent) in the IV docetaxel group. Patients
given IV docetaxel in the study experienced significantly longer time
to progression (TTP) compared to those given oral Hycamtin (Hazards
Ratio 1.19 [95% CI 1.03, 1.37]; P = 0.0196). Median TTP was 13.1 weeks
for patients given docetaxel versus 11.3 weeks for patients given oral
"Results from this study clearly show that oral Hycamtin has activity
in NSCLC and may provide another treatment option for relapsed
patients with the convenience of oral therapy," said Roman
Perez-Solar, M.D., Chairman, Department of Me dical Oncology,
Montefiore Medical Center, and Gutman Professor of Medicine, Albert
Einstein College of Medicine.?
CAMPTOSAR® (irinotecan HCL and Cisplatin
?Results from the Phase III Four Arm Cooperative Study (FACS) of
first-line treatment regimens for advanced non-small cell lung cancer
(NSCLC) suggested that the combination of CAMPTOSAR® (irinotecan HCL
for injection, CPT-11) and cisplatin should provide the best overall
survival benefits and toxicity manageability among the four different
regimens studied, including the current standard of treatment for
NSCLC in the U.S., carboplatin plus paclitaxel.?
?"There is an increasing body of evidence that CAMPTOSAR is active in
NSCLC," said S. Hariharan, MD, Medical Director at Pfizer Oncology.
"The ability of CAMPTOSAR to be combined with platinum-based therapies
as well as other agents to provide survival benefits suggests the
flexibility and consistency of CAMPTOSAR."
?Three drugs with promising activity in NSCLC are pemetrexed
(Alimta®; Eli Lilly and Company, Indianapolis, IN,
http://www.lilly.com), bortezomib (Velcade®; Millennium
Pharmaceuticals, Inc., Cambridge, MA, http://www.mlnm.com), and
cetuximab (Erbitux®; ImClone Systems, Inc., New York, NY,
?Cetuximab has been studied in combination with chemotherapy in
previously untreated metastatic NSCLC. The response rates in
preliminary reports range from 29% to 53%. In patients with
refractory/recurrent NSCLC, the combination of docetaxel and cetuximab
resulted in a promising response rate of 28%, higher than the typical
response rates seen with docetaxel monotherapy in this setting.
Addition of cetuximab to chemotherapy is generally well tolerated.
Molecular mechanisms predicting response to cetuximab therapy are
currently not well understood. Studies are ongoing to assess the
single-agent activity of cetuximab in metastatic NSCLC.?
?Velcade should only be used in people who have already been
treated with two other types of chemotherapy (drugs used to kill
cancer cells), and whose cancer has still progressed on the most
recent therapy. Velcade is a new type of cancer drug called a
proteasome inhibitor. Proteasomes are enzymes found in cells, and play
a role in regulating cell function and growth. Velcade blocks the
activity of proteasomes. This blockade can lead to death of cancer
?Results. Treatment with bortezomib resulted in a single-agent
response rate (RR) of 8% in relapsed NSCLC, which was similar to the
RR of 9% seen with bortezomib/docetaxel. Median time to progression
was longer with bortezomib/docetaxel, and the disease control rate was
higher. Median and 1-year survival rates were similar in the
bortezomib and bortezomib/docetaxel arms.
Conclusion. Bortezomib demonstrated activity as a single agent in
previously treated NSCLC patients. Further trials will be needed to
define the optimal role of bortezomib in NSCLC.?
?CONCLUSIONS: Suberoylanilide hydroxamic acid and bortezomib
synergistically induce reactive oxygen species generation in non?small
cell lung cancer, and this plays a critical role in the induction of
apoptosis after treatment. Combined treatment with suberoylanilide
hydroxamic acid and bortezomib might be an effective treatment
strategy for non?small cell lung cancer.?
?Pemetrexed disodium (Alimta) was approved by the FDA on February
5, 2004. It is the first drug approved for mesothelioma. The
recommended dose of Alimta is 500 mg/m2 administered as an intravenous
infusion over 10 minutes on day 1 of each 21-day cycle. Patients must
take daily doses of folic acid and vitamin B12 to reduce the severity
of side effects such as low white blood cell count, nausea, vomiting,
fatigue, rash, and diarrhea.
Pemetrexed has also demonstrated clinical activity in non-small-cell
lung cancer (NSCLC). In a randomized, controlled study (n = 571),
Hanna et al (2004) compared the effectiveness and toxicity of
pemetrexed versus docetaxel in patients with advanced NSCLC previously
treated with chemotherapy. Eligible patients had a performance status
0 to 2, previous treatment with one prior chemotherapy regimen for
advanced NSCLC, and adequate organ function. Patients received
pemetrexed 500 mg/ m2 intravenously day 1 with vitamin B12, folic
acid, and dexamethasone or docetaxel 75 mg/m2 intravenously day 1 with
dexamethasone every 21 days.?
?On August 20, 2004, the FDA approved Alimta (pemetrexed for
injection) for the treatment of advanced NSCLC patients who have
undergone chemotherapy. According to available guidelines, pemetrexed
is indicated for persons who have histological or cytological
confirmation of NSCLC with stage III or IV disease not amenable to
curative therapy, and who have had prior chemotherapy for advanced
disease. According to these guidelines, candidates for pemetrexed
should have an Eastern Cooperative Oncology Group (ECOG) performance
status (PS) of 0 to 2, and have adequate bone marrow, renal and
You may also find this interesting: ?Erlotinib (Tarceva®) Plus
Chemotherapy Fails to Improve Overall Survival in Non-Small Cell Lung
I hope this has heloed you. If anything is unclear, please request
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I wish you all the best.
2006 + latest NSCLC therapies + Stage IV
?standard-of-care" options + NSCLC
?standard-of-care" options + NSCLC metastasis
Latest options + NSCLC metastasis treatment + 2006
EGFR Inhibitors + NSCLC