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Strides made in lung cancer therapy and survival rates


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http://www.sptimes.com/2005/12/12/Citru ... ung_.shtml


Published December 12, 2005

I was recently asked to see a patient in consultation for stage II nonsmall-cell lung cancer. She was not given much hope. My evaluation revealed that her cancer was potentially curable by surgery and possible chemotherapy subsequently. Because of her family support in New York, I referred her to Memorial Sloan Kettering Cancer Center in that state.

She was evaluated by thoracic surgeons and medical oncologists, who agreed that a cure was possible. They, however, felt that chemotherapy given before surgery would be better so the tumor could be shrunken, makingsurgical removal easier.

The patient preferred to come back to the Cancer and Blood Disease Center in Lecanto for chemotherapy. After just two of a planned four cycles of chemotherapy, a PET scan showed major shrinkage of the tumor. She will undergo surgical resection of the residual disease after two additional cycles of chemotherapy.

This brief case summary is given to illustrate the progress in lung cancer treatment. The good news is that after 20 odd years of clinical trials, researchers have figured out that the best way to increase survival is to administer platinum containing chemotherapy after surgical removal of what appears to be cancers limited to the lung only.

Long-term survival of patients with nonsmall-cell lung cancer after surgery is only 60 percent. This is significantly less than what is expected for patients with other solid tumors such as breast, colon and prostate cancers. Nonsmall-cell lung cancer patients, like patients with other solid tumors, have microscopic disease at distant sites at the time of initial diagnosis. These develop into metastases over time, even after removal what appears to be a localized mass.

Chemotherapy treatment after surgery addresses these distant cancers and improves survival and cure rates. Survival of breast and colon cancers is better because adjuvant chemotherapy is routine and is the standard of care. Even for prostate cancer, adjuvant chemotherapy after surgery is intuitively necessary and is under active investigation.

Until 2003, adjuvant chemotherapy trials for nonsmall-cell lung cancer showed only modest benefits in terms of survival. Since 2003, seven randomized control trials for resected stage I to stage III lung cancer showed an overall five-year survival, ranging from 33 to 71 months.

The benefit noted in these trials was not a mere month or two more of life in a terminal situation; rather, it was a statistically significant increase in recurrence-free survival and cure rates.

Many in the oncology community believe that this a significant stride in lung cancer management. If this type of adjuvant chemotherapy was given to all eligible patients, about 5,000 lives could be saved annually in the United States alone. Since these trials were conducted, newer modalities of treatment such as the Epidermal Growth Factor Receptor (EGFR) inhibitors and the antiangeogenesis agents that are active against nonsmall-cell lung cancer have been tested and approved by the FDA. Clinical trials show benefit in advanced disease and incorporation of these into the treatment armamentarium may yield even better results.

The bad news is that, although cigarette smoking is a well-known carcinogen, there are still 54.9-million active and 50-million ex-smokers in the United States. A recent survey reported that 30 percent of high school senior girls smoked. This is a very large reservoir of potential lung cancer victims. It is estimated that there will be 172,570 new cases and 163,510 deaths from lung cancer in 2005. Currently lung cancer accounts for more deaths than colon, breast, pancreatic and prostate cancers combined.

Although the therapeutic advances in the treatment of nonsmall-cell lung cancer have made major strides, they do not meet everyone's expectations. The general medical community and the public would like to see a major leap forward. The ground reality is, however, that progress in cancer treatment is incremental and cumulative rather than a home run.

As long as there is a large pool of smokers, new cases will continue to be diagnosed. Unless therapeutic advances reported with adjuvant chemotherapy for early stage lung cancer in this article and for advanced disease elsewhere are widely applied, the progress made by research will not reach the patients.

--V. Upender Rao MD, FACP, practices at the Cancer and Blood Disease Center in Lecanto.

[Last modified December 12, 2005, 01:10:15]

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