Lung cancer is the most common cause of cancer death for men and women worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. Systemic chemotherapy is a cornerstone of treatment in the management of stage IV NSCLC.

First-line chemotherapy typically consists of a platinum-based treatment. The optimum approach to long-term treatment beyond 4 to 6 cycles of chemotherapy is still evolving. Second-line chemotherapy given at the time of disease progression has shown clear survival advantages when compared with best supportive care alone. With the recent increase in the number of active and more tolerable agents available to treat NSCLC, there is renewed interest in the role of continuation of antineoplastic agents (continuation maintenance) or switching to a different agent (switch maintenance) after first-line chemotherapy.

This case-based review discusses the role of maintenance chemotherapy in the long-term management of advanced NSCLC.

Systemic inflammatory profile and response to anti-tumor necrosis factor therapy in chronic obstructive pulmonary disease.

Respir Res. 2012 Feb 2;13(1):12

Authors: Loza MJ, Watt R, Baribaud F, Barnathan ES, Rennard SI

Abstract
ABSTRACT: BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by progressive worsening of airflow limitation associated with abnormally inflamed airways in older smokers. Despite correlative evidence for a role for tumor necrosis factor-alpha in the pathogenesis of COPD, the anti-tumor necrosis factor-alpha, infliximab did not show clinical efficacy in a double-blind, placebo-controlled, phase II clinical trial. This study sought to evaluate the systemic inflammatory profile associated with COPD and to assess the impact of tumor necrosis factor neutralization on systemic inflammation. METHODS: Serum samples (n=234) from the phase II trial were collected at baseline and after 24 weeks of placebo or infliximab. Additionally, baseline serum samples were obtained from an independent COPD cohort (n=160) and 2 healthy control cohorts (n=50; n=109). Serum concentrations of a broad panel of inflammation-associated analytes were measured using a 92-analyte multiplex assay. RESULTS: Twenty-five proteins were significantly elevated and 2 were decreased in COPD, including highly elevated CD40 ligand, brain-derived neurotrophic factor, epidermal growth factor, acute-phase proteins, and neutrophil-associated proteins. This profile was largely independent of smoking status, age, and clinical phenotype. The majority of these associations of serum analytes with COPD are novel findings. Increased serum creatine kinase-muscle/brain and myoglobin correlated modestly with decreased forced expiratory volume at 1 second, suggesting cardiac involvement. Infliximab did not affect this systemic inflammatory profile. CONCLUSIONS: A robust systemic inflammatory profile was associated with COPD. This profile was generally independent of disease severity. Because anti-tumor necrosis factor-alpha did not influence systemic inflammation, how to control the underlying pathology beyond symptom suppression remains unclear. Trial Registration: ClinicalTrials.gov, No.: NCT00056264.

PMID: 22300528 [PubMed - as supplied by publisher]

[Possibility to screen COPD in emergency department].

Rev Pneumol Clin. 2012 Feb;68(1):10-6

Authors: Vial M, Apelt P, Cavalli P, Guerin T, Vercherin P, Vergnon JM

Abstract
INTRODUCTION: The COPD is a stake of public health because of its prevalence in the world, its morbi-mortality and its considerable cost (2,2 billion euros/year in France). An early screening allows for a fast and effective intervention.
MATERIAL AND METHOD: The prospective study with in the emergency department of Roanne included smokers and ex-smokers, more than 10PY for the 40 years old and older, more than 20PY for the others, and/or symptomatic of COPD. Screening rested on a questionnaire filled out by the patient. Are excluded patients already diagnosed with COPD. This screening is carried out with the FEV1/FEV6. The criterion of principal judgment rests on the time taken for screening and acceptability by the patients.
RESULTS: One hundred and twenty-two patients were included, 6.5% refused screening. The average time of screening was 4,8minutes. There were 27 positive patients with the FEV1/FEV6, 14 came to make the classic spirometry. Only 10.53% have a FEV1/FEV6<0.73. On the whole, 15.86% do not have a COPD, 75,25% are at the risk of COPD, 5,94% have a COPD stage 1, 1,98% are stage 2, 0.99% stage 3 and none stage 4.
DISCUSSION: The study thus showed that a screening of the COPD in the emergency rooms is possible because of the simple and reproductible process. Its shows, however its limits since the number of inclusion decrease during days of strong attendance in emergency rooms.
CONCLUSION: The screening of the COPD as foreseen in the study is possible.

PMID: 22305132 [PubMed - in process]

Sputum matrix metalloproteinase-12 in patients with chronic obstructive pulmonary disease and asthma: Relationship to disease severity.

J Allergy Clin Immunol. 2012 Feb 1;

Authors: Chaudhuri R, McSharry C, Brady J, Donnelly I, Grierson C, McGuinness S, Jolly L, Weir CJ, Messow CM, Spears M, Miele G, Nocka K, Crowther D, Thompson J, Brannigan M, Lafferty J, Sproule M, Macnee W, Connell M, Murchison JT, Shepherd MC, Feuerstein G, Miller DK, Thomson NC

Abstract
BACKGROUND: Matrix metalloproteinase (MMP)-12 has been implicated in the pathogenesis of both chronic obstructive pulmonary disease (COPD) and asthma. The influence of disease severity on sputum MMP-12 concentrations and activity is not known. OBJECTIVES: We sought to examine the relationship between disease severity assessed by means of lung function and computed tomography (CT) and induced sputum MMP-12 concentrations and activity in patients with asthma and COPD. METHODS: In 208 subjects (109 asthmatic patients, smokers and never smokers, mild, moderate, and severe; 53 patients with COPD, smokers and exsmokers, mild, moderate, and severe; and 46 healthy control subjects, smokers and never smokers), we measured induced sputum MMP-12 concentrations (ELISA) and enzyme activity (fluorescence resonance energy transfer), sputum cell MMP12 mRNA expression (quantitative PCR [qPCR]), diffusing capacity for carbon monoxide (Dlco), and CT assessment of emphysema (percentage of low-attenuation areas at less -950 Hounsfield units). RESULTS: Sputum MMP-12 concentrations are greater in patients with COPD and smokers with asthma than in healthy nonsmokers (P = .003 and P = .035, respectively) but similar to those seen in healthy smokers. In patients with COPD, disease severity, when measured by means of CT-assessed emphysema, but not by means of spirometry or Dlco values, is directly associated with sputum MMP-12 concentrations and activity. In the asthma groups there is no significant association between disease severity and sputum MMP-12 concentrations or activity. CONCLUSIONS: Sputum MMP-12 concentrations and activity in patients with COPD are directly associated with the extent of emphysema measured by means of CT. This finding supports a role for MMP-12 in the pathogenesis of COPD and might suggest that blocking MMP-12 activity in patients with COPD could prevent the further development of emphysema.

PMID: 22305682 [PubMed - as supplied by publisher]