Alternatives to chemotherapy and radiotherapy in the treatment of small cell lung cancer.
Despite high initial response rates, most patients with small cell lung cancer (SCLC) relapse shortly after discontinuing therapy, and cure remains an elusive goal, even for patients with limited-stage disease. For this reason, investigators have turned to the evaluation of alternative treatment strategies for patients with this malignancy. Interferon has been evaluated in four trials of adjuvant therapy after response to chemotherapy for SCLC. Different interferon preparations were used, but none of the trials showed a significant prolongation of survival. Tumor vaccines against gangliosides that are expressed on almost all human SCLC cells have been recently developed. An anti-idiotypic monoclonal antibody against the GD3 ganglioside, BEC-2, is being evaluated after chemotherapy in SCLC patients in a European study. In North America, a bivalent ganglioside vaccine, BMS-248967, is under study at the phase II level. If results are promising, a phase III trial will be undertaken. Trials of anticoagulant therapy using heparin, warfarin, and aspirin were undertaken in the 1980s and early 1990s. Although one study of warfarin and another of heparin showed trends in favor of anticoagulant therapy, there has been little research over the past decade evaluating this form of treatment of SCLC. The matrix metalloproteinase inhibitors marimastat and BMS-275291 are under evaluation in SCLC. In all trials, the matrix metalloproteinase inhibitor is administered after chemotherapy and radiotherapy as adjuvant treatment. These trials are not yet mature and survival results are not available. Miscellaneous treatments, including monoclonal antibody therapy, tamoxifen, and growth factor inhibition have not yet been shown to have a role in the treatment of SCLC. Semin Oncol 28 (suppl 4):30-37.
Shepherd
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FA
Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario.
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D019496:Cancer Vaccines / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000628:therapy*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy; D007372:Interferons / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000628:therapy*; D061965:Matrix Metalloproteinase Inhibitors
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D000970:Antineoplastic Agents; D019496:Cancer Vaccines; D004791:Enzyme Inhibitors; D061965:Matrix Metalloproteinase Inhibitors; D007372:Interferons