Lung Cancer Review

The leading cancer killer in both men and women in the U.S., lung cancer was estimated to kill 158,040 Americans in 2015, according to the American Lung Association (http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/learn-about-lung-cancer/lung-cancer-fact-sheet.html?referrer=https://www.google.com/).

However, as science and technology continue to advance, major medical innovations hope to see this number decline as the New Year progresses.

Key to saving lives, much of the past year’s progress can be attributed to developments in areas of new targeted therapies and early detection methods. This push toward early discovery of malignance has additionally led to a greater awareness about lung cancer screening options.

Increased Screening Availability

Helping to find lung cancer at earlier stages when it is easier to treat, annual low-dose CT screenings can largely benefit those at risk. Although these scans are reserved for individuals who meet certain guidelines, the National Cancer Institute affirms through its “Evidence of Benefit Associated With Screening” study that screening persons aged 55 to 74 years who have cigarette smoking histories of 30 or more pack-years and who, if they are former smokers, have quit within the last 15 years reduces lung cancer mortality by 20% and all-cause mortality by 6.7% (http://www.cancer.gov/types/lung/hp/lung-screening-pdq).

“This study demonstrated a significant reduction in both lung cancer death and all-cause mortality in the screened population,” expressed David M. Waterhouse, MD, MPH, chair of the Department of Clinical Research for Oncology Hematology Care (OHC). “The US Preventative Task Force now recommends lung cancer screening. In 2016 we anticipate more institutions adopting and executing screening protocols for their at risk populations.”

Adding to this notion, the Centers for Medicare & Medicaid Services (CMS) announced in February of 2015 that it would additionally bring the benefit of screening for lung cancer with Low Dose Computed Tomography (LDCT) to approximately five million American seniors at no cost. This coverage includes a visit for counseling and shared decision-making on the benefits and risks of lung cancer screening (https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274).

This increased coverage, in combination with most private insurance plans required to cover high-risk screenings, can truly work to progress early detection competency leading to more lives saved. While this coverage is a huge step in the right direction, in months and years to come, preventative measures for those not considered high risk, but who also suffer as a result of secondhand smoke, air pollution or natural causes, should also be implemented to ensure that the number of people dying of the disease is further reduced.

New Immunotherapy Drugs

The development of seven new lung cancer drugs approved by the U.S. Food and Drug Administration (FDA) in combination with new available immunotherapy drugs has further led to the advancement of cancer detection and treatment in 2015. Immunotherapy drugs work through treating the disease by inducing, enhancing, or suppressing an immune response to fight the cancer.

According to the Bonnie J. Addario Lung Cancer Foundation (https://www.lungcancerfoundation.org/patients/news/breakthrough-medicines-usher-in-hopeful-era-for-lung-cancer-patients/?loggedin), drugs approved by the FDA in 2015 include:

  • Gefitinib (Iressa), to treat patients with metastatic NSCLC whose tumors had mutations in EGFR
  • Pembrolizumab (Keytruda), for patients with advanced, metastatic NSCLC whose disease has progressed after other treatments (chemotherapy or targeted therapy) and whose tumors express the protein PDL1
  • Necitumumab (Portrazza), for the treatment of advanced, metastatic squamous NSCLC patients who have not been previously treated for their advanced lung cancer
  • Alectinib (Alecensa), for patients with ALK (Anaplastic Lymphoma Kinase)-rearranged metastatic NSCLC who have progressed on or are intolerant to crizotinib (Xalkori)

“Targeted therapies are part of the standard of treatment for Non-small cell lung cancer (NSCLC), the most common lung cancer type in the US,” explained Rabih Bechara MD, FCCP, division director of Pulmonary, Interventional and Critical Care Medicine at Cancer Treatment Centers of America at Southeastern Regional Medical Center in Atlanta, Georgia. “There are several types of treatments such as vaccines, antibodies and cell-based immunotherapies that work in different ways with the immune system against cancer cells. In lung cancer PD-L1 (programmed cell death ligand) and PD-1 (programmed cell death) pathways have emerged as promising treatment options for patients with advanced Non-small cell lung cancer.”

Proton Therapy

Another new, revolutionary method of treatment for lung cancer is proton therapy, a particularly beneficial measure for patients who need concurrent chemotherapy, have had prior radiation or have limited or poor pulmonary function. This advanced form of radiation therapy destroys cancer cells by preventing them from dividing and growing, but unlike standard X-ray radiation, it uses protons – positively charged, sub-atomic particles.

The proton beam then delivers its radiation to the site of the tumor and stops there – incurring no “exit dose.” This reduces damage to the healthy tissues and organs near the tumor, and potentially allows patients to receive higher, more effective doses of radiation but with low risk of side effects from treatment.

“In most lung cancer cases, the cancer can be close to the patient’s heart, spinal cord, healthy lung, and other vital organs. The unique properties of proton therapy allow it to precisely target lung tumors while avoiding those healthy, functioning organs,” explained Henry Tsai, MD, board certified radiation oncologist ProCure Proton Therapy Center in Somerset, NJ. “With proton radiation we’re seeing patients that are experiencing less side effects and a better quality of life through treatment – being able to work and participate in normal day-to-day activities.”

Although lung cancer has been in decline since its peak in 1991, the American Cancer Society still predicts an additional 224,390 new cases and 158,080 related deaths to occur in 2016, according to their Cancer statistics, 2016 (http://onlinelibrary.wiley.com/doi/10.3322/caac.21332/full). While researchers have come a long way over the years, more investment and research is needed to continue to strive to find better ways to diagnose, treat and ultimately cure lung cancer.

Lindsey Nolen is a staff writer. Contact: lnolen@advanceweb.com.

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