Strategies to enhance the already established doublet
chemotherapy regimen for
lung cancer have been investigated for more than 20 years. Initially, the concept was to administer
chemotherapy drugs locally to the
tumor site for efficient diffusion through passive transport within the
tumor. Recent advances have enhanced the diffusion of pharmaceuticals through active transport by using pharmaceuticals designed to target the genome of
tumors. In the present study, five patients with
non-small cell lung cancer epidermal growth factor receptor (EGFR) negative stage IIIa-IV International Union Against
Cancer 7 (UICC-7), and with Eastern Cooperative Oncology Group (ECOG) 2 scores were administered
platinum-based doublet
chemotherapy using combined intratumoral-regional and intravenous route of administration.
Cisplatin analogues were injected at 0.5%-1% concentration within the
tumor lesion and proven malignant lymph nodes according to pretreatment histological/cytological results and the concentration of systemic infusion was decreased to 70% of a standard protocol. This combined intravenous plus intratumoral-regional
chemotherapy is used as a first line
therapy on this short series of patients. To the best of our knowledge this is the first report of direct treatment of involved lymph nodes with
cisplatin by endobronchial ultrasound drug delivery with a needle without any adverse effects. The initial overall survival and local response are suggestive of a better efficacy compared to established doublet
cisplatin-based systemic
chemotherapy in (higher) standard concentrations alone according to the UICC 7 database expected survival. An extensive search of the literature was performed to gather information of previously published literature of intratumoral chemo-drug administration and formulation for this treatment modality. Our study shows a favorable local response, more than a 50% reduction, for a massive
tumor mass after administration of five sessions of intratumoral
chemotherapy plus two cycles of low-dose intravenous
chemotherapy according to our protocol. These encouraging results (even in very sick ECOG 2 patients with central obstructive
non-small cell lung cancer having a worse prognosis and quality of life than a
non-small cell lung cancer in ECOG 0 of the same
tumor node
metastasis [TNM]-stage without central obstruction) for a
chemotherapy-only protocol that differs from conventional
cisplatin-based doublet
chemotherapy by the route, target site, and dose paves the way for broader applications of this technique. Finally, future perspectives of this treatment and pharmaceutical design for intratumoral administration are presented.