Health Report: A look at new approaches to lung cancer
November is National Lung Cancer Awareness Month, a time to assess the progress and challenges of dealing with one of the nation’s major public health issues. After nonmelanoma skin cancers, lung cancer is the second-most prevalent form of cancer – and it’s the most deadly.
According to the American Cancer Society, more than 221,000 new cases of lung cancer will be diagnosed in the United States this year, with more than 158,000 estimated deaths from the disease. For perspective, consider that lung cancer kills more people each year than breast, prostate and colon cancer combined.
The five-year survival rate for lung cancer is approximately 18 percent. Compare that to breast cancer, which is around 91 percent.
While it’s true that the most important risk factor for lung cancer is cigarette smoking, many nonsmokers develop the disease, including some who have never smoked. Now that smoking in the U.S. has declined, as many as 15 percent of lung cancer patients are now nonsmokers. Even if everyone stopped smoking, lung cancer would still be with us.
Fortunately, researchers and clinicians are making many efforts to improve the numbers against lung cancer. Advanced surgical techniques are increasing the number of patients who can benefit from surgery. New approaches to screening may open the door for earlier detection. And revolutionary new treatments are harnessing the immune system to attack cancer. The hope is that these combined approaches will make a significant dent in lung cancer mortality.
Minimally invasive surgery
One of the most significant advances in lung cancer treatments has been the adoption of minimally invasive surgery, including robotically assisted and thoracosopic procedures. Ten years ago, surgeons would have to perform a traditional open surgery, which required them to spread the patient’s ribs.
“We had to detach muscle from the ribs and cut chest wall muscles to get enough space to get hands and instruments inside the chest,” said James Hemp, M.D., a Scripps Health cardiothoracic surgeon. “Now we can make small incisions and not spread the ribs. We use a tiny camera to get inside the chest and perform the surgery through smaller openings. We also use a device that remotely staples and cuts blood vessels without bleeding, rather than directly stitching them. Together these advances make the surgery much less painful, and it takes a lot less time for the patient to heal.”
Recently, the National Lung Screening Trial (NLST) published some startling results. NLST had studied more than 53,000 former smokers and found that using low-dose CT scans to screen this high-risk group reduced their risk of dying from lung cancer by 15 to 20 percent.
In February, Medicare finalized its decision to start covering these annual CT screening tests for high-risk patients. To qualify, a person must be between 55 and 80 and be a current smoker, have quit in the past 15 years or have a history of smoking at least one pack a day for 30 years. Today, health care providers across the U.S. are in the process of making these screenings available for patients.
Targeted treatments and immunotherapy
In the past, chemotherapy was often a one-size-fits-all option. Oncologists simply did not have the tools to personalize care. However, decades of research has led to newer therapies that target several genes known to drive cancer. One of these genes is called EGFR, which is often mutated in lung cancer. There are a number of EGFR inhibitors, such as Tarceva, that are being used to treat non-small cell lung cancer. More targeted therapies are in the pipeline.
Another key development is new diagnostics that help physicians individualize care. These tests look for markers in a tumor that can determine whether a drug will be useful against that specific cancer. For example, they can show whether a mutated EGFR gene is driving the cancer. If not, an EGFR inhibitor may not be a good option.
Immunotherapy is another promising advance. One of the most disturbing aspects of many cancers is their ability to evade the immune system. For some patients, immunotherapy treatments take away that evasiveness by essentially taking the brakes off the patient’s immune cells to attack cancer.
Better surgical techniques, more aggressive screening and targeted treatments have great potential to save lives and improve quality of life. However, it’s too early to say whether these changes are making a significant difference against lung cancer mortality. New research will provide a better picture of that. Still, new therapies are moving through clinical trials, and hopefully, we can make further progress in fighting this deadly disease.
For more information, visit scripps.org/KUSI or call 858-240-5075.