Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life

BACKGROUND: In 1995 a meta-analysis of randomised trials investigating the value of adding chemotherapy to primary treatment for non-small cell lung cancer (NSCLC) suggested a small survival benefit for cisplatin-based chemotherapy in each of the primary treatment settings. However, the metaanalysis included many small trials and trials with differing eligibility criteria and chemotherapy regimens. METHODS: The aim of the Big Lung Trial was to confirm the survival benefits seen in the meta-analysis and to assess quality of life and cost in the supportive care setting. A total of 725 patients were randomised to receive supportive care alone (n = 361) or supportive care plus cisplatin-based chemotherapy (n = 364). RESULTS: 65% of patients allocated chemotherapy (C) received all three cycles of treatment and a further 27% received one or two cycles. 74% of patients allocated no chemotherapy (NoC) received thoracic radiotherapy compared with 47% of the C group. Patients allocated C had a significantly better survival than those allocated NoC: HR 0.77 (95% CI 0.66 to 0.89, p = 0.0006), median survival 8.0 months for the C group v 5.7 months for the NoC group, a difference of 9 weeks. There were 19 (5%) treatment related deaths in the C group. There was no evidence that any subgroup benefited more or less fromchemotherapy. No significant differences were observed between the two groups in terms of the pre-defined primary and secondary quality of life end points, although large negative effects of chemotherapy were ruled out. The regimens used proved to be cost effective, the extra cost of chemotherapy being offset by longer survival. CONCLUSIONS: The survival benefit seen in this trial was entirely consistent with the NSCLC meta-analysis and subsequent similarly designed large trials. The information on quality of life and cost should enablepatients and their clinicians to make more informed treatment choices

Luminous Red Novae: Stellar Mergers or Giant Eruptions?

We present extensive datasets for a class of intermediate-luminosity optical transients known as luminous red novae. They show double-peaked light curves, with an initial rapid luminosity rise to a blue peak (at -13 to -15 mag), which is followed by a longer-duration red peak that sometimes is attenuated, resembling a plateau. The progenitors of three of them (NGC 4490-2011OT1, M 101-2015OT1, and SNhunt248), likely relatively massive blue to yellow stars, were also observed in a pre-eruptive stage when their luminosity was slowly increasing. Early spectra obtained during the first peak show a blue continuum with superposed prominent narrow Balmer lines, with P Cygni profiles. Lines of Fe II are also clearly observed, mostly in emission. During the second peak, the spectral continuum becomes much redder, H alpha is barely detected, and a forest of narrow metal lines is observed in absorption. Very late-time spectra (similar to 6 months after blue peak) show an extremely red spectral continuum, peaking in the infrared (IR) domain. H alpha is detected in pure emission at such late phases, along with broad absorption bands due to molecular overtones (such as TiO, VO). We discuss a few alternative scenarios for luminous red novae. Although major instabilities of single massive stars cannot be definitely ruled out, we favour a common envelope ejection in a close binary system, with possibly a final coalescence of the two stars. The similarity between luminous red novae and the outburst observed a few months before the explosion of the Type IIn SN 2011ht is also discussed