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Causes & Risk Factors

Detection & Diagnosis

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Early detection and diagnosis is crucial to patient survival. If lung cancer is diagnosed and treated at the localized stage, the average 5-year relative survival rate is about 49%. However, only about 16% will be diagnosed this early. [27] This is partially due to the limited effectiveness of current screening tools.

Chest X-ray and sputum cytology

The most common screening tests for lung cancer are the chest X-ray and sputum cytology. [30] Previous clinical studies have not resulted in any good evidence that these screening methods can reduce lung cancer mortality. [30] The National Cancer Institute (NCI) is conducting the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial in order to demonstrate whether an important benefit exists with chest X-ray screening. [30]

Long-term randomized controlled trial
37,000 men are screened for prostate, lung, and colorectal cancers and 37,000 women are screened for lung, colorectal, and ovarian cancers
Chest X-ray (annual posteroanterior) as screening modality in the
lung component
Equal numbers of men and women are followed with routine medical care as controls
In the baseline screen, 9% of participants had a positive screen, with significant increases in prevalence of positive screens with older age and more extensive smoking histories
Total of 126 participants were subsequently diagnosed with lung cancer, and approximately one half of these were stage I

Spiral computed tomography (CT)

A few newer methods are being analyzed to help improve early detection of lung cancer, including low-dose helical computed tomography (LDCT) and molecular techniques. LDCT is more sensitive than chest radiography. In one screening study, LDCT detected almost 6 times as many stage I lung cancers as chest radiography. And most of the tumors detected were no larger than 1 cm in diameter. [30] A controlled clinical trial is needed to prove the effectiveness of LDCT. The harm of false-positives, which can lead to anxiety and invasive diagnostic procedures, must be considered against the potential benefits.

To learn more about these screening techniques and associated studies, please visit the National Cancer Institute’s Web site.

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Important Safety Information

Contraindications

Hycamtin is contraindicated in patients who have a history of hypersensitivity reactions to topotecan or to any of its ingredients. Hycamtin should not be used in patients who are pregnant or breast-feeding, or those with severe bone marrow depression.

Warnings

Hycamtin should be used only in patients with adequate bone marrow reserves, including baseline neutrophil counts of at least 1,500 cells/mm³ and platelet counts of at least 100,000/mm³. Frequent monitoring of blood counts should be instituted during treatment with Hycamtin.

Patients should not be treated with subsequent courses of Hycamtin until neutrophils recover to >1,000 cells/mm³, platelets recover to >100,000 cells/mm³, and hemoglobin levels recover to 9.0 g/dL (with transfusion if necessary).

Hycamtin may cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised to avoid becoming pregnant during therapy with Hycamtin.

Drug Interactions

Concomitant administration of G-CSF can prolong the duration of neutropenia, so if G-CSF is to be used, it should not be initiated until day 6 of the course of therapy, 24 hours after completion of treatment with Hycamtin.

Myelosuppression was more severe when Hycamtin was given in combination with cisplatin in phase I studies. In a reported study on concomitant administration of cisplatin 50 mg/m² and Hycamtin at a dose of 1.25 mg/m²/day x 5 days, 1 of 3 patients had severe neutropenia for 12 days, and a second patient died with neutropenic sepsis. There are no adequate data to define a safe and effective regimen for Hycamtin and cisplatin in combination.

Adverse Events

Frequently reported nonhematologic adverse events associated with use of Hycamtin included nausea (64%), vomiting (45%), diarrhea (32%), alopecia (49%), fatigue (29%), and dyspnea (22%). Most nonhematologic toxicities were grade 1 or 2.

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