Chest
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The disappointing results obtained with currently available chemotherapy for lung cancer has led to the development of several new agents over the past 5 years. These include paclitaxel, docetaxel, vinorelbine, gemcitabine, and the camptothecins, irinotecan and topotecan. To date, phase I and II clinical trials with paclitaxel, docetaxel, gemcitabine, and combinations containing these drugs have been performed in patients with non-small cell lung cancer in Australia. ⋯ In general, the agents have been well tolerated. However, these studies cannot be compared with previous studies employing conventional chemotherapeutic agents, primarily because the results of the former studies may have been skewed due to enrollment of younger, healthier patients and a variable proportion of patients with locally advanced rather than metastatic disease. Randomized controlled trials will be needed to determine whether use of these newer agents is associated with improvements in survival, palliation, and/or toxic reactions when compared with currently used regimens.
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To critically appraise and summarize the studies examining the cost-effectiveness of noncardiac transitional care units (TCUs). ⋯ To date, the evidence in the literature is insufficient to determine under which circumstances, if any, TCUs are a cost-effective alternative technology to the traditional institution with only ICU and general ward beds.
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Lung cancer, which is the leading cause of cancer mortality, remains a significant health-care problem among men and women in the United States, despite an overall 20-year decline in the incidence of cigarette smoking. Non-small cell lung cancer (NSCLC) comprises 75 to 80% of all lung cancer cases. The metastatic nature of this disease has been responsible for the poor survival statistics reported to date and emphasizes the need for effective systemic treatment. ⋯ Recently, however, several new compounds and classes of compounds have offered some hope for at least small improvements in response and survival while being relatively well tolerated in patients with this disease. This article presents current findings for some of these agents, including the taxanes paclitaxel and docetaxel, the topoisomerase inhibitors irinotecan and topotecan, and the novel pyrimidine analogue gemcitabine. In addition, the University of Southern California/Norris Cancer Center experience with the combination of carboplatin and paclitaxel is presented.
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The treatment of small cell lung cancer (SCLC) has evolved significantly over the past 3 decades. Single-agent and combination chemotherapies given with radiotherapy have greatly improved response rates and median survival. Combination regimens such as cisplatin/etoposide, carboplatin/etoposide, ifosfamide/carboplatin/etoposide, cyclophosphamide/doxorubicin/vincristine, and etoposide/ifosfamide/cisplatin have all achieved good response rates. ⋯ New agents showing good preliminary single-agent activity in untreated SCLC include paclitaxel, vinorelbine, gemcitabine, topotecan, and teniposide. Results obtained with single-agent docetaxel and CPT-11 are thus far inconclusive. Studies evaluating response and survival rates of these new agents in combination with agents of known activity are underway.