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What’s new in non-small cell lung cancer res...

Research into the prevention, early detection, and treatment of lung cancer is being done in many medical centers throughout the world.

Prevention

Tobacco

Prevention offers the greatest opportunity to fight lung cancer. Although decades have passed since the link between smoking and lung cancers became clear, smoking is still responsible for at least 80% of lung cancer deaths. Research is continuing on:

  • Ways to help people quit smoking and stay quit through counseling, nicotine replacement, and other medicines
  • Ways to convince young people to never start smoking
  • Inherited differences in genes that may make some people much more likely to get lung cancer if they smoke or are exposed to someone else’s smoke

Environmental causes

Researchers also continue to look into some of the other causes of lung cancer, such as exposure to radon and diesel exhaust. Finding new ways to limit these exposures could potentially save many more lives.

Diet, nutrition, and medicines

Researchers are looking for ways to use vitamins or medicines to prevent lung cancer in people at high risk, but so far none have been shown to conclusively reduce risk.

Some studies have suggested that a diet high in fruits and vegetables may offer some protection, but more research is needed to confirm this. While any protective effect of fruits and vegetables on lung cancer risk is likely to be much less than the increased risk from smoking, following the American Cancer Society dietary recommendations (such as maintaining a healthy weight and eating a diet high in fruits and vegetables, and whole grains) may still be helpful.

Early detection

As mentioned in the section ‘ Can non-small cell lung cancer be found early? ‘, a large clinical trial called the National Lung Screening Trial (NLST) recently found that spiral CT scans in people at high risk of lung cancer (due to smoking history) lowers the risk of death from lung cancer, when compared to chest x-rays. This finding has led to the development of screening guidelines for lung cancer.

Another approach now being studied uses newer, more sensitive tests to look for cancer cells in sputum samples. Researchers have found several changes often seen in the DNA of lung cancer cells. Current studies are looking at new tests that can spot these DNA changes to see if this approach is useful in finding lung cancers at an earlier stage.

Diagnosis

Fluorescence bronchoscopy

Also known as autofluorescence bronchoscopy, this technique may help doctors find some lung cancers earlier, when they may be easier to treat. For this test, the doctor inserts a bronchoscope through the mouth or nose and into the lungs. The end of the bronchoscope has a special fluorescent light on it, instead of a normal (white) light.

The fluorescent light causes abnormal areas in the airways to show up in a different color than healthy parts of the airway. Some of these areas might not be visible under white light, so the color difference may help doctors find these areas sooner. Some cancer centers now use this technique to look for early lung cancers, especially if there are no obvious tumors seen with normal bronchoscopy.

Virtual bronchoscopy

This imaging test uses CT scans to create detailed 3-dimensional pictures of the airways in the lungs. The images can be viewed as if the doctor were actually using a bronchoscope.

Virtual bronchoscopy has some possible advantages over standard bronchoscopy. First, it is non-invasive and doesn’t require anesthesia. It also helps doctors view some airways that might not be seen with standard bronchoscopy, such as those being blocked by a tumor. But it has some drawbacks as well. For example, it doesn’t show color changes in the airways that might indicate a problem. It also doesn’t let a doctor take samples of suspicious areas like bronchoscopy does. Still, it can be a useful tool in some situations, such as in people who might be too sick to get a standard bronchoscopy.

This test will likely become more available as the technology improves.

Electromagnetic navigation bronchoscopy

Lung tumors near the center of the chest can be biopsied during bronchoscopy, but bronchoscopes have trouble reaching the outer parts of the lungs, so tumors in that part of the lung often need to have a needle biopsy. This test can be a way to use a bronchoscope to biopsy a tumor in the outer part of the lung.

First, CT scans are used to create a virtual bronchoscopy. The abnormal area is identified, and a computer helps guide a bronchoscope to the area so that it can be biopsied. The bronchoscope used has some special attachments that allow it to reach further than a regular bronchoscope.

This takes extra equipment and training for the doctor, and is not widely available.

Treatment

Surgery

Doctors now use video-assisted thoracic surgery (VATS) to treat some small lung tumors. It lets doctors remove parts of the lung through smaller incisions, which can result in shorter hospital stays and less pain for patients. Doctors are now studying whether it can be used for larger lung tumors.

In a newer approach to this type of operation, the doctor sits at a specially designed control panel inside the operating room to maneuver long surgical instruments using robotic arms. This approach, known as robotic-assisted surgery, is now being tested in some larger cancer centers.

Real-time tumor imaging

Researchers are looking to use new imaging techniques, such as four-dimensional computed tomography (4DCT), to help improve treatment. In this technique, the CT machine scans the chest continuously for about 30 seconds. It shows where the tumor is in relation to other structures as a person breathes, as opposed to just giving a ‘snapshot’ of a point in time, like a standard CT does.

4DCT can be used to determine exactly where the tumor is during each part of the breathing cycle, which can help doctors deliver radiation to a tumor more precisely. This technique might also be used to help show if a tumor is attached to or invading important structures in the chest, which could help doctors determine if a patient might be eligible for surgery.

Chemotherapy

New combinations: Many clinical trials are looking at newer combinations of chemotherapy drugs to determine which are the safest and most effective. This is especially important in patients who are older and have other health problems. Doctors are also studying better ways to combine chemotherapy with radiation therapy and other treatments.

Lab tests to help predict if chemo will be helpful: Doctors know that adjuvant chemotherapy after surgery may be more helpful for some people with early (stage I or II) cancers than for others, but figuring out which patients to give it to is not easy. In early studies, newer lab tests that look at patterns of certain genes in the cancer cells have shown promise in telling which people might benefit most. Larger studies of these tests are now trying to confirm their usefulness.

Other lab tests may help predict whether a lung cancer will respond to particular chemo drugs. For example, studies have found that tumors with high levels of the ERCC1 protein are less likely to respond to chemo that includes cisplatin or carboplatin, while tumors with high levels of the RRM1 protein seem less likely to respond to chemo with gemcitabine. Doctors are now looking to see if tests for these markers can help guide the choice of treatment, so these are not a part of standard treatment.

Maintenance chemotherapy: For people with advanced lung cancers who can tolerate chemotherapy, combinations of 2 chemo drugs (sometimes along with a targeted drug) are typically given for about 4 to 6 cycles. Some recent studies have found that with cancers that have not progressed, continuing treatment beyond the 4 to 6 cycles with a single chemo drug such as pemetrexed or a targeted drug such as erlotinib may help some people live longer. This is known as maintenance therapy. A possible downside to this continued treatment is that people may not get a break from having side effects from chemotherapy. Some doctors now recommend maintenance therapy, while others await further research on this topic.

Targeted therapies

Researchers are learning more about the inner workings of lung cancer cells that control their growth and spread. This is being used to develop new targeted therapies. Some of these treatments, such as bevacizumab (Avastin), erlotinib (Tarceva), cetuximab (Erbitux), and crizotinib (Xalkori) are already being used to treat non-small cell lung cancer. Others are now being tested in clinical trials to see if they can help people with advanced lung cancer live longer or relieve their symptoms.

Other targeted drugs being studied include ganetespib, custirsen, and dacomitinib. Some targeted drugs already approved for use against other types of cancer, such as sorafenib (Nexavar) and sunitinib (Sutent), are also being tested for use against NSCLC.

Researchers are also working on lab tests to help predict which patients might be helped by which drugs. Studies have found that some patients do not benefit from certain targeted therapies, whereas others are more likely to have their tumors shrink. For example, a test can find changes in the EGFR gene that make it much more likely that a person’s lung cancer will respond to treatment with erlotinib (Tarceva), an EGFR inhibitor. Similar gene tests for other treatments are now being studied. Predicting who might benefit could save some people from trying treatments that are unlikely to work for them and would probably cause unneeded side effects.

Immune treatments

Researchers are hoping to develop drugs that can help the body’s immune system fight the cancer.

Drugs that block PD-1 and PD-L1: Cancer cells may use natural pathways in the body to help avoid detection and destruction by the immune system. For example, they often have a protein called PD-L1 on their surface that helps them evade the immune system. New drugs that block the PD-L1 protein, or the corresponding PD-1 protein on immune cells called T cells, can help the immune system recognize the cancer cells and attack them.

Nivolumab (Opdivo) and pembrolizumab (Keytruda) are anti-PD-1 drugs that have been shown to shrink or slow the growth of some tumors. They are now approved for use in advanced NSCLC, and are typically used after certain other treatments have been tried.

Other, similar drugs such as atezolizumab (MPDL3280A) and MEDI4736 might also shrink some lung cancer tumors. Larger studies of these new drugs are now being done.

Vaccines: Several types of vaccines for boosting the body’s immune response against lung cancer cells are being tested in clinical trials. Unlike vaccines against infections like measles or mumps, these vaccines are designed to help treat, not prevent, lung cancer. These types of treatments seem to have very limited side effects, so they might be useful in people who can’t tolerate other treatments.

Some vaccines are made up of lung cancer cells that have been grown in the lab, or even of cell components, such as parts of proteins commonly found on cancer cells. For example, the MUC1 protein is found on some lung cancer cells. A vaccine called TG4010 causes the immune system to react against that protein. A recent study compared combining the vaccine with chemotherapy to treatment with the same chemotherapy alone in patients with advanced lung cancer. The cancers in the group that got the vaccine were more likely to shrink or stop growing than the cancers in the group that just got chemo. More studies are planned to see if the vaccine will actually help patients live longer.

L-BLP25 (tecemotide) is another vaccine that targets the MUC1 protein. It is made up of the protein (MUC1) encased in a fat droplet (liposome) to try to make it more effective. A small study of patients with advanced NSCLC suggested it might improve survival time, although recent results from a larger study did not find it helped people live longer. This vaccine is now being studied for patients with stage III disease after treatment with chemotherapy and radiation, in efforts to improve the cure rate.

At this time, vaccines are only available in clinical trials.

Last Medical Review: 08/15/2014
Last Revised: 10/02/2015

Lung Cancer Prevention

Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.

To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.

Different ways to prevent cancer are being studied, including:

  • Changing lifestyle or eating habits.
  • Avoiding things known to cause cancer.
  • Taking medicines to treat a precancerous condition or to keep cancer from starting.

Key Points

  • Lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.
  • Lung cancer is the leading cause of cancer death in both men and women.

Lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.

The lungs are a pair of cone-shaped breathing organs in the chest. The lungs bring oxygen into the body as you breathe in. They release carbon dioxide, a waste product of the body’s cells, as you breathe out. Each lung has sections called lobes. The left lung has two lobes. The right lung is slightly larger, and has three lobes. A thin membrane called the pleura surrounds the lungs. Two tubes called bronchi lead from the trachea (windpipe) to the right and left lungs. The bronchi are sometimes also involved in lung cancer. Tiny air sacs called alveoli and small tubes called bronchioles make up the inside of the lungs.

Enlarge

There are two types of lung cancer: small cell lung cancer and non-small cell lung cancer.

See the following PDQ summaries for more information about lung cancer:

Lung cancer is the leading cause of cancer death in both men and women.

More people die from lung cancer than from any other type of cancer. Lung cancer is the second most common cancer in the United States, after skin cancer.

The number of new cases and deaths from lung cancer is highest in black men.

Key Points

  • Avoiding risk factors and increasing protective factors may help prevent lung cancer.
  • The following are risk factors for lung cancer:
    • Cigarette, cigar, and pipe smoking
    • Secondhand smoke
    • Family history
    • HIV infection
    • Environmental risk factors
    • Beta carotene supplements in heavy smokers
  • The following are protective factors for lung cancer:
    • Not smoking
    • Quitting smoking
    • Lower exposure to workplace risk factors
    • Lower exposure to radon
  • It is not clear if the following decrease the risk of lung cancer:
  • The following do not decrease the risk of lung cancer:
    • Beta carotene supplements in nonsmokers
    • Vitamin E supplements
  • Cancer prevention clinical trials are used to study ways to prevent cancer.
  • New ways to prevent lung cancer are being studied in clinical trials.

Avoiding risk factors and increasing protective factors may help prevent lung cancer.

Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking, eating a healthy diet, and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

The following are risk factors for lung cancer:

Cigarette, cigar, and pipe smoking

Tobacco smoking is the most important risk factor for lung cancer. Cigarette, cigar, and pipe smoking all increase the risk of lung cancer. Tobacco smoking causes about 9 out of 10 cases of lung cancer in men and about 8 out of 10 cases of lung cancer in women.

Studies have shown that smoking low tar or low nicotine cigarettes does not lower the risk of lung cancer.

Studies also show that the risk of lung cancer from smoking cigarettes increases with the number of cigarettes smoked per day and the number of years smoked. People who smoke have about 20 times the risk of lung cancer compared to those who do not smoke.

Secondhand smoke

Being exposed to secondhand tobacco smoke is also a risk factor for lung cancer. Secondhand smoke is the smoke that comes from a burning cigarette or other tobacco product, or that is exhaled by smokers. People who inhale secondhand smoke are exposed to the same cancer -causing agents as smokers, although in smaller amounts. Inhaling secondhand smoke is called involuntary or passive smoking.

Family history

Having a family history of lung cancer is a risk factor for lung cancer. People with a relative who has had lung cancer may be twice as likely to have lung cancer as people who do not have a relative who has had lung cancer. Because cigarette smoking tends to run in families and family members are exposed to secondhand smoke, it is hard to know whether the increased risk of lung cancer is from the family history of lung cancer or from being exposed to cigarette smoke.

HIV infection

Being infected with the human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS), is linked with a higher risk of lung cancer. People infected with HIV may have more than twice the risk of lung cancer than those who are not infected. Since smoking rates are higher in those infected with HIV than in those not infected, it is not clear whether the increased risk of lung cancer is from HIV infection or from being exposed to cigarette smoke.

Environmental risk factors

  • Radiation exposure: Being exposed to radiation is a risk factor for lung cancer. Atomic bomb radiation, radiation therapy, imaging tests, and radon are sources of radiation exposure:
    • Atomic bomb radiation: Being exposed to radiation after an atomic bomb explosion increases the risk of lung cancer.
    • Radiation therapy: Radiation therapy to the chest may be used to treat certain cancers, including breast cancer and Hodgkin lymphoma. Radiation therapy uses x-rays, gamma rays, or other types of radiation that may increase the risk of lung cancer. The higher the dose of radiation received, the higher the risk. The risk of lung cancer following radiation therapy is higher in patients who smoke than in nonsmokers.
    • Imaging tests: Imaging tests, such as CT scans, expose patients to radiation. Low-dose spiral CT scans expose patients to less radiation than higher dose CT scans. In lung cancer screening, the use of low-dose spiral CT scans can lessen the harmful effects of radiation.
    • Radon: Radon is a radioactive gas that comes from the breakdown of uranium in rocks and soil. It seeps up through the ground, and leaks into the air or water supply. Radon can enter homes through cracks in floors, walls, or the foundation, and levels of radon can build up over time.

    Studies show that high levels of radon gas inside the home or workplace increase the number of new cases of lung cancer and the number of deaths caused by lung cancer. The risk of lung cancer is higher in smokers exposed to radon than in nonsmokers who are exposed to it. In people who have never smoked, about 30% of deaths caused by lung cancer have been linked to being exposed to radon.

  • Workplace exposure: Studies show that being exposed to the following substances increases the risk of lung cancer:

    These substances can cause lung cancer in people who are exposed to them in the workplace and have never smoked. As the level of exposure to these substances increases, the risk of lung cancer also increases. The risk of lung cancer is even higher in people who are exposed and also smoke.

  • Air pollution: Studies show that living in areas with higher levels of air pollution increases the risk of lung cancer.

Beta carotene supplements in heavy smokers

Taking beta carotene supplements (pills) increases the risk of lung cancer, especially in smokers who smoke one or more packs a day. The risk is higher in smokers who have at least one alcoholic drink every day.

The following are protective factors for lung cancer:

Not smoking

The best way to prevent lung cancer is to not smoke.

Quitting smoking

Smokers can decrease their risk of lung cancer by quitting. In smokers who have been treated for lung cancer, quitting smoking lowers the risk of new lung cancers. Counseling, the use of nicotine replacement products, and antidepressant therapy have helped smokers quit for good.

In a person who has quit smoking, the chance of preventing lung cancer depends on how many years and how much the person smoked and the length of time since quitting. After a person has quit smoking for 10 years, the risk of lung cancer decreases 30% to 50%.

See the following for more information on quitting smoking:

Lower exposure to workplace risk factors

Laws that protect workers from being exposed to cancer-causing substances, such as asbestos, arsenic, nickel, and chromium, may help lower their risk of developing lung cancer. Laws that prevent smoking in the workplace help lower the risk of lung cancer caused by secondhand smoke.

Lower exposure to radon

Lowering radon levels may lower the risk of lung cancer, especially among cigarette smokers. High levels of radon in homes may be reduced by taking steps to prevent radon leakage, such as sealing basements.

It is not clear if the following decrease the risk of lung cancer:

Diet

Some studies show that people who eat high amounts of fruits or vegetables have a lower risk of lung cancer than those who eat low amounts. However, since smokers tend to have less healthy diets than nonsmokers, it is hard to know whether the decreased risk is from having a healthy diet or from not smoking.

Physical activity

Some studies show that people who are physically active have a lower risk of lung cancer than people who are not. However, since smokers tend to have different levels of physical activity than nonsmokers, it is hard to know if physical activity affects the risk of lung cancer.

The following do not decrease the risk of lung cancer:

Beta carotene supplements in nonsmokers

Studies of nonsmokers show that taking beta carotene supplements does not lower their risk of lung cancer.

Vitamin E supplements

Studies show that taking vitamin E supplements does not affect the risk of lung cancer.

Cancer prevention clinical trials are used to study ways to prevent cancer.

Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.

The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.

New ways to prevent lung cancer are being studied in clinical trials.

Clinical trials are taking place in many parts of the country. Information about clinical trials can be found in the Clinical Trials section of the NCI website. Check the list of NCI-supported cancer clinical trials for prevention trials for non-small cell lung cancer and small cell lung cancer that are now accepting patients. These include trials for quitting smoking.

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about lung cancer prevention. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (‘Date Last Modified’) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ‘standard.’ Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI’s website. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as ‘NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].’

The best way to cite this PDQ summary is:

National Cancer Institute: PDQ® Lung Cancer Prevention. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.moverfairfaxva.com/?p=276. Accessed <MM/DD/YYYY>.

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 2,000 scientific images.

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The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

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Cancer

Cancer survival rate: What it means for your prognosis

Find out what a survival rate can tell you and what it can’t. This can help you put survival statistics in perspective.

By Mayo Clinic Staff

When first diagnosed with cancer, many people ask about their prognosis. You might want to know whether your cancer is relatively easy or more difficult to cure. Your doctor can’t predict the future, but can make an estimate based on other people’s experiences with the same cancer.

It’s up to you whether you want to know the survival rates related to your cancer. The numbers can be confusing and frightening.

What is a cancer survival rate?

Cancer survival rates or survival statistics tell you the percentage of people who survive a certain type of cancer for a specific amount of time. Cancer statistics often use an overall five-year survival rate.

For instance, the overall five-year survival rate for bladder cancer is 78 percent. That means that of all people who have bladder cancer, 78 of every 100 are living five years after diagnosis. Conversely, 22 out of every 100 are dead within five years of a bladder cancer diagnosis.

Cancer survival rates are based on research from information gathered on hundreds or thousands of people with a specific cancer. An overall survival rate includes people of all ages and health conditions who have been diagnosed with your cancer, including those diagnosed very early and those diagnosed very late.

Your doctor may be able to give you more specific statistics based on your stage of cancer. For instance, 52 percent, or about half, of people diagnosed with early-stage lung cancer live for at least five years after diagnosis. The five-year survival rate for people diagnosed with late-stage lung cancer that has spread (metastasized) to other areas of the body is 4 percent.

Overall survival rates don’t specify whether cancer survivors are still undergoing treatment at five years or if they’ve become cancer-free (achieved remission). Other types of survival rates that give more specific information include:

  • Disease-free survival rate. This is the number of people with cancer who achieve remission. That means they no longer have signs of cancer in their bodies.
  • Progression-free survival rate. This is the number of people who still have cancer, but their disease isn’t progressing. This includes people who may have had some success with treatment, but the cancer hasn’t disappeared completely.

Cancer survival rates often use a five-year survival rate. That doesn’t mean cancer can’t recur beyond five years. Certain cancers can recur many years after first being found and treated. For some cancers, if it has not recurred by five years after initial diagnosis, the chance of a later recurrence is very small. Discuss your risk of a cancer recurrence with your doctor.

How are cancer survival rates used?

You and your doctor might use survival statistics to:

  • Understand your prognosis. The experience of other people in your same situation can give you and your doctor an idea of your prognosis – the chance your cancer will be cured. Other factors include age and general health. Your doctor uses these factors to help you understand the seriousness of your condition.
  • Develop a treatment plan. Statistics can also show how people with your same cancer type and stage respond to treatment. You can use this information, along with your goals for treatment, to weigh the pros and cons of each treatment option.

    For instance, if two treatments give you similar chances for remission, but one has more side effects, you might choose the option with fewer side effects.

    In another example, a treatment may offer a chance for a cure, but only for 1or 2 people out of every 100. For some, these chances are promising enough to put up with side effects. For others, the chance for a cure isn’t worth the treatment’s side effects.

    Your doctor can help you understand the benefits and risks of each treatment.

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Lung Cancer Health Center

One fourth of all people with lung cancer have no symptoms when the cancer is diagnosed. These cancers are usually identified incidentally when a chest X-ray is performed for another reason. The other three-fourths of people develop some symptoms. The symptoms are due to direct effects of the primary tumor; to effects of cancer spread to other parts of the body (metastases); or to disturbances of hormones, blood, or other systems.
Symptoms of lung cancer include cough, coughing up blood or rusty-colored phlegm, fatigue, unexplained weight loss, recurrent respiratory infections, hoarseness, new wheezing, and shortness of breath.

  • A new cough in a smoker or a former smoker should raise concern for lung cancer.
  • A cough that does not go away or gets worse over time should be evaluated by a health care provider.
  • Coughing up blood (hemoptysis) occurs in a significant number of people who have lung cancer. Any amount of coughed-up blood should be evaluated by a health care provider.
  • Pain in the chest area is a symptom in about one fourth of people with lung cancer. The pain is dull, aching, and persistent.
  • Shortness of breath usually results from a blockage in part of the lung, collection of fluid around the lung (pleural effusion), or the spread of tumor through the lungs.
  • Wheezing or hoarseness may signal blockage or inflammation in the lungs that may go along with cancer.
  • Repeated respiratory infections, such as bronchitis or pneumonia, can be a sign of lung cancer.

Lung Cancer Symptoms, Causes, Treatment – Wh...

Lung cancers, also known as bronchogenic carcinomas, are broadly classified into two types: small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). This classification is based upon the microscopic appearance of the tumor cells themselves. These two types of cancers grow and spread in different ways and may have different treatment options, so a distinction between these two types is important.

SCLC comprise about 20% of lung cancers and are the most aggressive and rapidly growing of all lung cancers. SCLC are strongly related to cigarette smoking, with only 1% of these tumors occurring in nonsmokers. SCLC metastasize rapidly to many sites within the body and are most often discovered after they have spread extensively. Referring to a specific cell appearance often seen when examining samples of SCLC under the microscope, these cancers are sometimes called oat cell carcinomas.

NSCLC are the most common lung cancers, accounting for about 80% of all lung cancers. NSCLC can be divided into three main types that are named based upon the type of cells found in the tumor:

  • Adenocarcinomas are the most commonly seen type of NSCLC in the U.S. and comprise up to 50% of NSCLC. While adenocarcinomas are associated with smoking, like other lung cancers, this type is observed as well in nonsmokers who develop lung cancer. Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs.
  • Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.
  • Squamous cell carcinomas were formerly more common than adenocarcinomas; at present, they account for about 30% of NSCLC. Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi.
  • Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC.
  • Mixtures of different types of NSCLC are also seen.

Other types of cancers can arise in the lung; these types are much less common than NSCLC and SCLC and together comprise only 5%-10% of lung cancers:

  • Bronchial carcinoids account for up to 5% of lung cancers. These tumors are generally small (3 cm-4 cm or less) when diagnosed and occur most commonly in people under 40 years of age. Unrelated to cigarette smoking, carcinoid tumors can metastasize, and a small proportion of these tumors secrete hormone-like substances that may cause specific symptoms related to the hormone being produced. Carcinoids generally grow and spread more slowly than bronchogenic cancers, and many are detected early enough to be amenable to surgical resection.
  • Cancers of supporting lung tissue such as smooth muscle, blood vessels, or cells involved in the immune response can rarely occur in the lung.

As discussed previously, metastatic cancers from other primary tumors in the body are often found in the lung. Tumors from anywhere in the body may spread to the lungs either through the bloodstream, through the lymphatic system, or directly from nearby organs. Metastatic tumors are most often multiple, scattered throughout the lung, and concentrated in the peripheral rather than central areas of the lung. Continue Reading

Lung Cancer Takes the Big Stage

By Jennifer King, Director of Science and Research at Lung Cancer Alliance

You may have seen news headlines about cancer advances last weekend. This is because it was the annual meeting of the American Society of Clinical Oncology (ASCO, a membership society for health professionals working in cancer) – a meeting of ~37,000 people that is known to be one of the best places to release high impact research results.

Some of our staff, including me, spent a few very busy days there and I’m thrilled to say that there is a lot to report. So much that I’m not sure how to fit it all into this blog – which is a great problem to have.

The Big Picture

First of all, the most important thing to say is that ASCO brought a lot of hope for those living with or at risk for lung cancer. Between the approval of screening coverage earlier this year and all the new drugs coming out, the terrible five year survival statistics for lung cancer will be changing.

At the meeting, I spoke to an oncologist who told me that in his rural community, 40% of patients who are diagnosed never go see their oncologist because they think a lung cancer diagnosis is a death sentence. We have to change this attitude. If people understood the dedication of health professionals to improving the lives of those with lung cancer and the pace of the research, everyone would see an oncologist to discuss their options.

Research just about lung cancer was so impactful that the presentations were in the big rooms that seat ~5000 people

Even if you don’t want to read the scientific re-cap, here’s the big take-home points:

  1. There will be multiple more drug approvals in lung cancer by the end of the year
  2. Don’t give up hope
  3. Go talk to your doctor(s) regularly about your options if you are diagnosed or at risk for lung cancer

If you want more details on the science presented at the meeting, keep reading…

Immuno-Oncology

2015 seemed to be the year of Immuno-Oncology at ASCO. Immuno-Oncology is using therapies that activate your own immune system to fight your cancer. Although there are many types of immunotherapies, the kind making the most news right now are drugs that block two ‘checkpoints’ called CTLA-4 and PD-1.

After I wrote my Opdivo (nivolumab) blog in March, a number of you asked me if it would work in non-squamous NSCLC. At the time I didn’t have an answer, but I do now. Sure enough, a large research study shows a significant survival advantage of Opdivo (compared to Taxotere chemotherapy) in advanced non-squamous NSCLC and generally with fewer side effects.

The key phrase at ASCO is always ‘practice-changing.’ A research study is practice-changing if it means that a doctor will actually change what he or she does or prescribes based on this new data. This is what clinical researchers aspire to…making a difference in the care of patients. This result was considered practice-changing and I’m sure we will be seeing Opdivo approved by the FDA for advanced, non-squamous NSCLC soon.

As mentioned in the Hot Topics on our website recently, there is also a competitor drug, Keytruda (pembrolizumab), that also targets PD-1 and is likely to receive FDA approval this year too. Notably, early data on both Opdivo and Keytruda in extensive small cell lung cancer was also presented. Both of the studies had promising results that indicated that some of the patients were having very favorable responses. More research needs to be done in small cell, but this early data indicates that immuno-oncology drugs may eventually also be used in this type of lung cancer that has few options.

The data on immunotherapy in lung cancer look very promising, but there were also many questions raised. In some studies, patients with higher levels of a protein called PD-L1 (which interacts with PD-1) were more likely to respond to these drugs. But this wasn’t true in all cases and it wasn’t clear how much PD-L1 needed to be present to make you more likely to respond. There was also data presented that suggested that the more DNA changes (mutations) you have in your tumor, the more likely you are to respond on a PD-1 drug. This implies that former smokers might be more likely to respond to these drugs, but the data is not clear and some non-smokers do respond.

There is also an entire pipeline of additional drugs in this space that we will see over the next few years. This includes a PD-L1 inhibitor, atezolizumab (formerly MPDL3280A) which has already been designated a breakthrough therapy by the FDA. Promising data was presented at the meeting on this agent too and there is a large clinical trial underway.

One very important advance across oncology was the presentation of combinations of immunotherapies. There was huge news in melanoma that Opdivo was significantly better than Yervoy (ipilumumab), the CTLA-4 drug that was the original poster child for cancer immunotherapy. In this study, if patients did not have high levels of the PD-L1 protein, treatment with the combination of both Opdivo and Yervoy was even better than either drug alone.

This positive effect with combinations is likely to be true in lung cancer as well and there was early data presented that the Opdivo and Yervoy given together could be better in small cell (but needs more testing) as well as research on a very small number of patients with advanced NSCLC on both Keytruda and Yervoy, that showed disease control (no progression) in ~80% of patients. So there is a lot of excitement for the future about combinations of immunotherapies along with combinations of immunotherapy and other types of agents.

All in all, there’s a huge buzz about immuno-oncology and we will see a lot more about these types of therapies in the coming year; however, there are still a number of questions to answer about how to use the drugs for the best patient results at the most reasonable cost.

Of note, pharmaceutical companies know this topic is confusing and are trying their best to educate patients and caregivers. Check out Bristol-Myers Squibb’s I-O page (where you can also raise a flag to honor someone and support LCA) and this variation of ‘Angry Birds’ from Genentech (that the science geek in me loves), where monoclonal antibodies slingshot to find the cancer cells that are ‘hiding’ from the T-cells.

Check back next week for more data from the meeting on targeted therapies.

ASCO Updates Recommendations on Lung Cancer Care

ASCO is updating its recommendations for managing care in patients with early- and late-stage lung cancer. One set of recommendations will include a large guideline update on the use of systemic treatment for patients with stage IV non-small cell lung cancer (NSCLC). A second set of recommendations, which was recently published, covers the rapidly advancing area of molecular testing for patients with either early-stage or advanced lung cancer. Forty percent of patients have stage IV NSCLC at the time of diagnosis. 1

There is also an endorsement that focuses on individuals with locally advanced NSCLC, who make up a growing proportion of diagnosed cases. 2 The guideline endorsement will provide important guidance on the use of curative-intent external-beam radiotherapy in individuals with this disease.

Endorsement of Lung Cancer Biomarker Guideline

In October 2014, ASCO endorsed a guideline from the College of American Pathologists (CAP), the International Society for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP) on molecular testing of patients with lung cancer. The guideline focuses on EGFR and ALK testing, and when and how to do the testing.

‘It is already more or less standard to test biomarkers and use them to guide treatment decisions, but the hope is that the guideline will help close the gap for the minority of patients who are not tested and help clarify among oncologists for which patients [testing] is recommended,’ said Natasha Rekhtman, MD, PhD, of Memorial Sloan Kettering Cancer Center, and co-chair of the ASCO endorsement, along with Natasha B. Leighl, MD, of Princess Margaret Cancer Centre, Toronto.

The ASCO endorsement agrees with the recommendation that patients with lung adenocarcinoma, or mixed lung cancer with a component of adenocarcinoma, should be tested for EGFR and ALK mutations at the time of diagnosis or recurrence. However the caveat, according to both documents, is that squamous or small cell lung cancer should be tested for EGFR and ALK in never-smokers because the tumors may have an unusual pathology.

The documents also bring up the issue that, although testing in the early-stage setting allows more rapid initiation of therapy in patients who experience a relapse, it should be balanced against the extra cost for patients who do not have a recurrence. As lung cancer screening becomes more widespread and more patients are diagnosed with early-stage disease, the cost versus benefit balance of screening may need to be reevaluated, Dr. Rekhtman said. 3

The guideline does not recommend testing for other biomarkers. However, it states that testing for KRAS mutations may be performed initially to eliminate the need to probe for EGFR and ALK alterations, which are mutually exclusive with KRAS.

‘The field is moving toward multigene multiplex testing, so a lot of issues of what to test first will fall by the wayside,’ Dr. Rekhtman said.

As the endorsement notes, a number of new molecular alterations have recently been associated with lung cancer, including RET and ROS1 rearrangements. The CAP/IASLC/AMP guideline will be updated to include evaluations of new biomarkers, and as it is, ASCO will consider whether to endorse the updates.

Between 10%-15% of lung cancers harbor EGFR mutations, and another 3%-5% have ALK mutations. 4 Therapies targeting EGFR include erlotinib and afatinib, whereas ALK-targeted therapies are crizotinib and ceritinib.

Guideline on Chemotherapy for Stage IV NSCLC

ASCO is in the final stages of updating its guideline on systemic therapy for patients with stage IV NSCLC. It will make recommendations for patients depending on their cancer subtype and performance status for first-, second-, and third-line treatment and will include targeted therapy for patients with molecular alterations such as EGFR and ALK. The guideline is expected to be published in 2015.

‘The guideline can help oncologists organize the information and keep them on track on the things that they really already know but would like some additional reassurance that they are doing the right thing,’ said Gregory A. Masters, MD, of Helen F. Graham Cancer Center and co-chair of the guideline along with David H. Johnson, MD, of the University of Texas Southwestern Medical Center.

It could also give patients confidence that their oncologist is staying up-to-date with new therapies. ‘If you tell a patient that you’re treating them according to a national guideline, that is reassuring for him or her,’ Dr. Masters said.

The document is an update of a 2009 ASCO guideline on the topic and a 2011 focused guideline on maintenance therapy. Since the publication of those guidelines, more targeted therapies have become available, including ALK-targeting therapies, and there are more data on maintenance therapy. The guideline panel reviewed studies published between 2007 and 2014 and used a total of 73 phase III randomized controlled trials to develop the recommendations on more than 10 different therapeutic agents.

The guideline also stresses the role of palliative care and its integration with chemotherapy, targeted therapy, or supportive care.

Endorsement of Lung Cancer Radiotherapy Guideline

ASCO has endorsed a guideline from the American Society for Radiation Oncology on external-beam radiotherapy (EBRT) for patients with locally advanced NSCLC. Both the guideline and endorsement are expected to be published in 2015.

‘This treatment is with the intent of cure, and the question is, ‘How can we maximize the chance of cure for our patients in clinical practice?’ One way is by making sure that we have the latest knowledge and guidelines,’ said Andrea Bezjak, MD, of Princess Margaret Cancer Centre, Toronto, and co-chair of the endorsement along with Christopher G. Azzoli, MD, of Massachusetts General Hospital.

The endorsement is intended for patients with stage II or III locally advanced NSCLC who have unresectable disease, as well as those who are potential candidates for surgery. The endorsement also highlights the ambiguity of defining resectability.

Although the guideline focuses on EBRT, it also considers the context of the treatment, including EBRT with or without chemotherapy and neoadjuvant or adjuvant EBRT.

The endorsement will complement a 2007 joint guideline by ASCO and Cancer Care Ontario on adjuvant chemotherapy and radiation therapy for patients with resected NSCLC. 5

‘We need an update of both old and more recent evidence, and to focus on the large group of patients with locally advanced NSCLC that is not resectable,’ Dr. Bezjak said.