Survival rates for lung cancer are poor, which is why developing new ways to treat the disease -- or prevent it altogether -- is so important.
Lung cancer is the most dangerous type of cancer, killing 85% of people within five years of diagnosis. "Lung cancer causes more deaths in women than breast and ovarian cancer combined, and more than three times more deaths in men than prostate cancer,” emphasizes Julie Brahmer, M.D., an assistant professor at Hopkins’s Sidney Kimmel Comprehensive Care Center.
But effective treatments for lung cancer do exist, with those that can extend survival by even a few months representing a significant advance in treatment. Treating lung cancer also can improve quality of life.
The three options for treating lung cancer -- surgery, chemotherapy, and radiation therapy -- may be used alone or in combination. The choice of treatment depends on a number of factors, including the size and location of the tumor, whether the cancer is small cell or non-small cell, the physical condition of the patient, and whether the cancer has spread to lymph nodes or further. Because of the complexity of treatment, people with lung cancer should discuss their options with a multidisciplinary team of experts, which includes a pulmonologist, a thoracic surgeon, medical and radiation oncologists, and other health professionals.
Treating lung cancer with surgery.
All people with lung cancer should be evaluated for possible surgery because surgery is the most effective treatment for non-small cell lung cancer. Resectability and operability are major considerations in deciding whether a person with lung cancer is a good candidate for surgery. A resectable tumor is one that can be removed in its entirety. If the tumor has spread extensively or is too close to vital structures, such as the heart or major blood vessels, it is no longer resectable.
The decision that a tumor is not resectable is usually based on information from both the biopsy and scans. A tumor is considered operable if the patient is able to undergo the surgical procedure safely and can tolerate the extent of resection necessary for a cure. The patient's lung function and the presence of other diseases are key factors in determining operability.
A minimally invasive surgical procedure, known as video-assisted thorascopic surgery, or VATS, is being used for some patients with early-stage lung cancer that hasn't spread. VATS allows patients to avoid traditional surgery that requires opening the chest wall. During the VATS procedure, the surgeon makes 2 to 4 small incisions in the chest and inserts a tiny telescope (thorascope) and surgical tools through them. The thorascope is connected to a video camera that allows the surgeon to view the inside of the lungs. The surgeon can then remove the small pieces of lung tissue through the incisions.
Treating lung cancer with chemotherapy.
Chemotherapy is individualized for each patient and may involve administration of a combination of several drugs given in four to six cycles. The drug Platinol (cisplatin) used to be the standard treatment for non-small cell lung cancer. Now a second drug, such as Gemzar (gemcitabine), Navelbine (vinorelbine), Taxol (paclitaxel), or Taxotere (docetaxel) is added to boost Platinol's effectiveness. Sometimes a less toxic drug called Paraplatin (carboplatin) is substituted for Platinol.
In May 2003, the FDA approved a new drug -- Iressa (gefitinib) -- for the treatment of patients with non-small cell lung cancer who had failed two or more courses of chemotherapy. In December 2004, however, the FDA announced that a large clinical trial comparing Iressa with a placebo (a "dummy" pill) in patients with non-small cell lung cancer who had failed other courses of cancer therapy showed no survival benefit from taking Iressa.
More recently, the FDA approved bevacizumab (Avastin) -- a type of drug known as a monoclonal antibody to be used in combination with chemotherapy as an initial treatment against non-small cell lung cancer. Approval was based on a study showing that adding Avastin to standard chemotherapy improved survival by 25% compared with chemotherapy alone.
Platinol or Paraplaten plus etoposide (VePesid, Etopophos, Toposar) is usually considered the optimal chemotherapy regimen for small cell lung cancer, but researchers are studying many other possible approaches as well. Cetuximab (Erbitux) is used in addition to standard chemotherapy in some patients with advanced lung cancer.
Treating lung cancer with radiation.
External radiation may be the main form of treatment for lung cancer patients who are unable to tolerate surgery and for those whose lung cancer has spread beyond the reach of surgical removal. Radiation is administered five days a week for four to eight weeks. It may be directed to areas of cancer in the lung that cannot be removed with surgery, or it may be used to treat cancer that has spread to the brain or bones or cancer that compresses the spinal cord.
Novel approach in the treatment of lung cancer.
One innovative approach being tested for lung cancer treatment is vaccination.
- Treating lung cancer with vaccination. Researchers are studying a vaccine, called MAGE-A3 Antigen-Specific Cancer Immunotherapeutic, that appears to trigger the patient's immune system to identify and attack cancer cells without harming normal cells. Results from an ongoing clinical trial of this vaccine, called MAGRIT (MAGE-A3 as Adjuvant, Non-Small Cell Lung Cancer Immunotherapy), may be available in 2009.
