A. Sixty-two of 578 patients treated for small cell lung cancer at the National Cancer Institute (11%) were cancer-free two years after initiation of therapy for small cell lung cancer. The risk of a NSCLC and aerodigestive cancer in these patients increased more than 6-fold, from 2% per patient per year during years 2-4 to 12.6% and 14.4% respectively, after more than 10 years had passed. The cumulative actuarial risk of a second primary NSCLC or aerodigestive cancer at 16 years is 69% and 72% respectively. B. Investigators from nine different institutions submitted their data on 611 patients with small cell lung cancer surviving cancer-free for two or more years. The risk of a second lung cancer in these patients increased with time to more than 24-fold ten years or more from diagnosis. Chest irradiation and continued smoking each increased the risk approximately 2- fold. The cumulative actuarial risk of a second cancer reaches 30% at ten years and 60% at 15 years. These patients are candidates for chemoprevention trials. C. Twenty-eight tumor cell lines from patients with lung cancer have been studied to determine the cytotoxicity of increasing durations (3, 24, and 120 hours) of exposure to paclitaxel. The median concentration required to inhibit 50% (IC5O) of the growth of 14 non-small cell lung cancer cell lines at three hours was > 32 micromolar compared to 0.023 micromolar when exposed for 120 hours. A clinical trial using 96 hour infusion of paclitaxel combined with cisplatin has been initiated for patients with stage IV non-small cell lung cancer and extensive stage small cell lung cancer.
