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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.

Lung cancer – Integrative Cancer Treatments

Lung cancer and how we can help

Whatever phase of treatment, or Stage you are at, Verita Life can help treat and defeat your Lung Cancer.

Our expertise, clinical experience and personalised protocols are delivered in 5 separate Programmes, one of which is best for you or your loved one.

1. Optimising your conventional treatments – Verita Oncoboost™

If you are already having Chemo or Radio therapy we can reduce painful side effects, increase therapy effectiveness, and increase your chance of remission.

Treatments are personalised, safe, and targeted to strengthen organ and immune system function.

2. Complete protocols using targeted cancer treatments – Verita 360™

We offer a complete and comprehensive Lung cancer treatment programme if you don’t want to, or can’t, undergo conventional treatment. Our clinics only use effective, proven and safe complementary and alternative therapies.

Undecided patients willing to wait a few weeks before committing to conventional treatments may want to ‘try Verita Life first’. Results are easily measurable and you can switch at any time.

3. Verita BodyBoost™ – essential pre-treatment strengthening

If Lung cancer treatment has not begun yet, we can prepare your immune system and organs with our unique combination of protocols. This will help withstand the damage that can occur from conventional treatment, and also improve treatment outcomes.

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If you are unable to travel to us you can start home care immediately by using our clinical expertise and 15 years of research by our scientific team.

Verita Life will review your condition and send you powerful pharmaceutical grade combination packs customised to target Lung cancer, and support your other therapies.

5. All Clear Aftercare™ – Recover from cancer side effects and stay cancer free

It is a sad fact that so many cancers return within 5 years or less, especially if contributing factors are not addressed.

Rebuilding your weakened immune system, and also any damaged organs, is an essential and immediate need to regain full health and keep you cancer free.

Verita Life clinics offer unique, customised, after-care programmes with measurable results.
The treatments available at Verita Life >
Whichever of the 5 Medical Programmes you follow, there are 15 separate core treatments. Your doctor will recommend which are best for your condition.

The exact combination and frequency of treatments is planned according to your specific needs.

List Of Treatments Offered

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Lung cancer in Australia – Australian Institute of Health and …

Lung cancer: what you need to know –

Drug therapy of lung cancer – Australian Prescriber

Lung cancer | Healthdirect

Lung cancer treatment | Cancer Council NSW

Lung cancer | Cancer Council NSW

Lung Cancer – Cancer Australia

New clinical guidelines for lung cancer treatment | Cancer … treatment and supportive care. … Foreword. Lung cancer in Australia: an overview is the first tumour-specific report including cancer.

Clinical practice guidelines for the treatment of lung cancer … Cancer Australia and Cancer Council Australia. New clinical practice guidelines for the treatment of lung cancer have been published in an …

Lung cancer – Cancer Council Australia In 2011, 10,511 new cases of lung cancer (including small cell and non-small cell lung cancers) were diagnosed in Australia. … The five year survival rate for people diagnosed with lung cancer is less than 14%.Lung cancer – non small cell.


ASCO Institute For Quality

Clinical practice guidelines serve as a guide for doctors and outline appropriate methods of treatment and care. Guidelines can address specific clinical situations (disease-oriented) or use of approved medical products, procedures, or tests (modality-oriented). Using the best available evidence, ASCO expert panels identify and develop practice recommendations for specific areas of cancer care that would benefit from the availability of practice guidelines. Topics for guidelines are selected on the basis of significant clinical or economic importance; presence of variations in patterns of, or access to, care; availability of suitable data; and ethical considerations.

To raise awareness of its evidence-based recommendations on cancer care, ASCO has created the Practice Guidelines Implementation Network (PGIN) network of representative members of oncology practice teams including oncologists, oncology nurses (members of ONS), hematology/oncology pharmacists (members of HOPA), and oncology practice managers. The network members accomplish this through participation in development and dissemination of ASCO Clinical Practice Guidelines and associated Clinical Tools and Resources, with the goal of assisting practices to increase the quality of oncology care, including facilitating shared decision-making with people with cancer and their caregivers.

To comment on published guidelines or provide new evidence, visit the ASCO Guidelines Wiki. Visit our Recently Published Guidelines page to view our new and updated guidelines from 2014 and 2015.

The Clinical Practice Guidelines Committee (CPGC) is charged with the responsibility of approving topics on behalf of the ASCO Board of Directors. Guideline Advisory Groups (AGs) make recommendations to the Clinical Practice Guidelines Committee (CPGC) on identifying and prioritizing topics for guideline development. This is with the goal of ASCO offering a more comprehensive portfolio of authoritative practice guidelines. Annually, ASCO will review guideline topic proposals from ASCO members. Each spring, a survey will be launched to provide members with an opportunity to submit topics for guideline development. After the survey closes, member-suggested topics will be provided to the appropriate Guideline Advisory Group (GAG) for review during their annual priority setting process. Please submit a topic.

Guidelines containing this symbol indicate an associated QOPI® Measure.

Non-small cell lung cancer survival rates by stage

Survival rates are often used by doctors as a standard way of discussing a person’s prognosis (outlook). Some patients may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them. If you do not want to read about survival rates for non-small cell lung cancer, stop reading here and skip to the next section.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many of these people live much longer than 5 years.

To get 5-year survival rates, doctors look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with non-small cell lung cancer.

The rates below are based on the stage of the cancer at the time of diagnosis. When looking at survival rates, it’s important to understand that the stage of a cancer does not change over time, even if the cancer progresses. A cancer that spreads or comes back is still referred to by the stage it was given when it was first found, but more information is added to explain the current extent of the cancer. (And of course, the treatment plan is adjusted based on the change in cancer status.)

The numbers below are survival rates published in 2007. They are calculated from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, based on people who were diagnosed with non-small cell lung cancer between 1998 and 2000. Although they are based on patients diagnosed several years ago, they are the most recent published for survival by the current AJCC staging system.

These survival rates are for observed survival. Patients with cancer can die of other things, and these don’t take that into account.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen to any person. Knowing the type and the stage of a person’s cancer helps estimate their outlook. But many other factors can also affect outlook, such as the genetic changes in the cancer cells, the treatment received, how well the cancer responds to treatment, and a person’s overall health. Even when taking these other factors into account, survival rates are at best rough estimates. Your doctor can tell you how the numbers above may apply to you.

Last Medical Review: 08/15/2014
Last Revised: 03/04/2015

Lung cancer

Lung cancer causes more than one million deaths globally each year, including 6000 deaths in Australia – more than any other type of cancer.
There have been only slight improvements in lung cancer survival in the past 25 years. Our research into lung cancer is focused on developing new ways to detect and treat lung cancer through a better understanding of its biology.

Our lung cancer researchers are focused on:

  • Understanding how normal lung cells develop, to determine what goes wrong when lung cancer develops.
  • Establishing new systems in which to study lung cancer biology and therapy.
  • Developing new approaches to treating lung cancer.

What is lung cancer?

Lung cancer is the abnormal, uncontrolled growth of lung cells. This is caused by changes to their genetic material. Different types of lung cancers arise from different cell types within the lung. The process by which this occurs is poorly understood.

Most lung cancer types are classified by their microscopic appearance. These include:

  • Small cell lung cancer
  • Non-small cell lung cancer: squamous cell carcinoma, adenocarcinoma and large cell carcinoma.

Other types of cancer can also occur in the lung. Some of these are rare types of cancer that arise from lung tissue.

Of lung cancers in Australia,

  • Around 10 per cent are small cell lung cancers.
  • Around 60 per cent are non-small cell lung cancer.
  • The remainder are rare types of lung cancer or cannot be definitively classified.

Cancer cells from other organs can also spread (metastasise) to the lung.

Mesothelioma is a type of cancer that starts in the lining of the chest and spreads into the lungs. Exposure to asbestos is strongly linked to mesothelioma. For more information about mesothelioma, please visit Cancer Council Victoria.

The treatment and outlook for lung cancer depends on the type of cancer, and how far the cancer cells have spread. Lung cancers may be:

  • Contained within one part of a lung.
  • Spread to several sites across the lungs.
  • Spread (metastasised) to other parts of the body.

Most cases of lung cancer in Australia are detected at later, harder-to-treat stages.

What causes lung cancer?

Lung cancer occurs because of genetic changes in lung cells. These occur more frequently in people exposed to DNA-damaging agents such as tobacco smoke.

People who have smoked are 10 times more likely to develop lung cancer than non-smokers. People who have never smoked tend to develop adenocarcinoma.

Specific cancer-promoting genetic changes have been discovered in adenocarcinomas in non-smokers. Understanding the genes that drive lung cancer growth and spread is allowing new treatments to be designed that can be matched to the genetic changes found in a patient’s lung cancer cells.

Risk factors for developing lung cancer

  • Exposure to tobacco smoke or other forms of smoke, including smog or traffic fumes.
  • Exposure to radiation such as the radioactive gas radon, or chest radiation to treat another cancer.
  • Exposure to other cancer-causing (‘carcinogenic’) substances.
  • Gender: amongst non-smokers, females are at higher risk of developing non-small cell lung cancer.
  • Age: lung cancer rates increase with age.
  • Lung inflammation and scarring, from other lung diseases.
  • Family history: close relatives of a non-smoker with lung cancer are more likely to get the same disease.

How is lung cancer treated?

Treatment for lung cancer depends on the type of lung cancer and how far the cancer cells have spread. Currently, most lung cancers are only discovered when they have spread beyond the lungs, which reduces the likelihood of treatment curing the disease.

Lung cancers that are small and confined to one section of a lung can often be successfully removed by surgery.

Lung cancers are often treated with:

  • Chemotherapy and radiotherapy to kill rapidly growing cells
  • Targeted therapies that match medicines to the proteins that are driving the cancer’s growth. For example, lung cancers with high levels of the EGFR protein can be successfully treated with medications that block EGFR function

Support for people with lung cancer

For more information about how lung cancer is treated and patient support, please visit Cancer Council Victoria or the Lung Foundation Australia.

Institute researchers are not able to provide specific medical advice specific to individuals. If you have lung cancer and wish to find out more information about clinical trials, please visit the Australian Cancer Trials or the Australian New Zealand Clinical Trials Registry, or consult your medical specialist.

Lung Cancer-Prevention

Quitting smoking

Most lung cancers are caused by smoking. If you use tobacco, you can help prevent lung cancer by quitting. For more information, see the topic Quitting Smoking.

Other prevention tips

You may be able to make other changes in your life that can help prevent lung cancer:

  • Avoid working in jobs where you are exposed to asbestos, arsenic, or secondhand smoke.
  • Check the radon level in your home. If your radon level is high, lowering it can reduce your risk.
  • Don’t have unnecessary chest X-rays.
  • Eat a healthy diet. Consider including a variety of foods, such as:
    • Foods high in antioxidants, like beans, berries, prunes, and artichokes.
    • Foods high in phytoestrogens, like soy foods (tofu, soy milk, and edamame), whole grains, sprouts (alfalfa and clover), seeds (flaxseed, sesame, sunflower, and pumpkin), and nuts.
    • Cruciferous vegetables, like broccoli, cabbage, cauliflower, brussels sprouts, bok choy, kale, and collard greens.

Studies show that taking supplements of beta carotene or vitamin E does not affect the risk of lung cancer for non-smokers. But for smokers, especially those who smoke one or more packs a day, taking beta carotene supplements can actually increase their risk for lung cancer.