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Lung cancer no longer a death sentence

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Treatment gains helping patients to live longer

http://www.theithacajournal.com/apps/pb ... 70311/1025


Gannett News Service

Lung cancer is the No. 1 form of cancer that kills both men and women, but new drugs that target tumors and advances in radiation and chemotherapy are helping patients live longer.

When Connie DeWitt was first told that she had lung cancer, two words popped into her head: death sentence.

“My mother was perfectly active at 72, and they told her she had lung cancer and she lived six months,” DeWitt says.

DeWitt was diagnosed three years ago. But looking at her now, you wouldn't know she was undergoing treatment for cancer unless you asked.

“They said, ‘We've come a long way in 10 years,”' DeWitt recalls. “‘You're not your mother.”'

DeWitt, of LaVergne, Tenn., was one of the fortunate few who was diagnosed with lung cancer early. She had an unrelated cyst on her neck that doctors X-rayed, and they happened to find a 2-centimeter tumor.

A study of nearly 50,000 current and former smokers is under way to better understand how — or if —X-rays and more detailed spiral CT scans are useful for detecting lung cancer.

Results from the National Lung Cancer Screening Trial won't be available for several years, but already some people are asking their doctors for a CT scan.

There are risks. Anywhere from 25 percent to 60 percent of current or former smokers have some kind of abnormality that a CT scan would find. These abnormalities could be scar tissue, areas of inflammation or other conditions that aren't lung cancer but can look like it. The test might also find small tumors that would never be life threatening.

To examine these abnormalities, doctors remove a small piece of lung tissue. With this procedure, patients risk infection or other complications. Doctors might have to perform open lung surgery, which carries even more risk.

“The main risk in my view of screening is you can hurt the patient by trying to find out what's wrong when they really don't have cancer,” says Dr. F. Anthony Greco, medical director of the Sarah Cannon Research Institute. “And this is not rare.”

He and others generally don't recommend it for former or current smokers.

Targeted drugs

In addition to early detection, DeWitt had another advantage that her mother didn't. Doctors treated her with chemotherapy and an experimental drug called Avastin.

It's one of two main types of so-called targeted therapies that attack cancer cells while sparing noncancerous cells. Avastin prevents the growth of blood vessels that feed tumors, so tumors essentially starve to death.

Dr. Alan Sandler, associate professor of medicine at the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., is leading a study of nearly 900 patients that compares combined treatment with the drug and chemotherapy versus chemotherapy alone.

Sandler presented preliminary results of his study at a meeting of the American Society of Clinical Oncology in Orlando, Fla. The study found that patients with the most common type of lung cancer lived an average of 12.5 months with the drug compared to an average of 10.2 months without it.

“This the first time that an agent that targets new blood vessel development has shown a survival benefit in lung cancer,” Sandler says.

Patients enrolled in the study had relatively advanced lung cancer, and Sandler expects the drug might be used with earlier stage disease with better results.

DeWitt credits the drug with holding her cancer at bay for a year, but her cancer has “outsmarted the drug,” she says, and is growing again.

She now is being treated with Iressa, another therapy that has shown mixed results. While Avastin targets blood vessel growth, Iressa and a similar drug called Tarceva target a protein that's mutated in some cancer patients. The U.S. Food and Drug Administration approved Iressa in 2003 based on preliminary data for use in lung cancer patients who have tried two chemotherapy treatments without success.

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