Our research activities are focused on four areas: 1) detection, diagnosis and treatment of peripheral-type minute lung cancers not visible in plain chest X-rays; 2) development of new and effective diagnosis and treatment modalities; 3) performance of basic collaborative studies with the Research Center for Innovative Oncology; correlation between gene abnormalities and clinical characteristics; studies of precancerous lesions; atypical adenomatous hyperplasia; and 4) the mental status of patients with lung cancer and communications skills training for physicians who care for cancer patients.
To establish a standard for the management of minute pulmonary nodules detected by chest computed tomography, a protocol for prospective observational studies is ongoing. A limited resection trial for small ground-glass opacity lung lesions is also currently under way. A multi-institutional phase III study comparing UFT versus TS-1 in patients with completely resected stage I tumor was started this year. Although surgical resection is the standard treatment for patients with stage II non-small cell lung cancer (NSCLC), the diagnosis of clinical N1 is unsatisfactory and there was a high rate of unexpected pN2 disease (91). A Phase II study of preoperative chemoradiotherapy followed by surgical resection in patients with superior sulcus NSCLC demonstrated encouraging long-term survival, and the trimodality approach is currently considered as the standard treatment for patients (68). Concurrent chemoradiotherapy is the standard care provided to patients with inoperable stage III NSCLC (69); however, local and systemic control is still problematic (70, 71). To develop a more effective treatment strategy for advanced NSCLC, we conducted a randomized phase III trial comparing non-platinum sequential three-drug combination (vinorelbine plus gemcitabine followed by docetaxel) with carboplatin plus paclitaxel (72). Although the trial failed to demonstrate a significant survival advantage of the experimental regimen over the standard platinum doublet, several important findings regarding ethnic differences have been shown (73). Importantly, understanding tumor biology and medical system differences is critically important for improving patient care (28, 63, 74, 75, 76, 77). On the other hand, epidermal growth factor receptor antagonists are active against NSCLC (78). However, a randomized trial of gefitinib versus docetaxel failed to demonstrate the non-inferiority of gefitinib in previously treated NSCLC patients (79). Patient selection is needed to improve outcomes and reduce risk of pulmonary toxicities (80). Several new agents are currently under investigation (81, 82). In particular, pemetrexed plus cisplatin is the standard regimen for malignant pleural mesothelioma (83). A randomized phase II study of pemetrexed using different doses demonstrated no dose-response above 500 mg/m2 (84). Thus, 500 mg/m2 of pemetrexed together with vitamin supplementation should be used for further investigations.
● K. Kubota ●
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