Advances in Screening and Surgery Improve Lung Cancer Survival

New U.S. guidelines recommending low-dose computed tomography (CT) scans to screen for lung cancer in high-risk individuals are leading to earlier detection and better survival for lung cancer patients. Screening is available without a prescription for people who have smoked the equivalent of at least a pack of cigarettes per day for 30 years. The scans can uncover lung cancer in early stages, when the chances for successful treatment are the highest. Recent medical advances have also made lung cancer surgery less invasive. Robotic surgeries can often be performed through small incisions in the chest, without the need to crack open ribs. These developments mean more lung cancer patients can undergo surgery and those who do have an easier recovery.

Long or Ultralong Cigarettes Increase Lung Cancer Risk

Smokers of long or ultralong cigarettes are at greater risk for lung and oral cancer than smokers of regular and king-size cigarettes, a recent study determined. Researchers analyzed urine tests from over 3,500 smokers and found that those who smoked long or ultralong cigarettes had higher levels of tobacco-related carcinogens (cancer-causing substances). Female, black, and older smokers were more likely to smoke long or ultralong cigarettes.

Immune-Based Drug Shows Promise Against Lung Cancer, Especially in Smokers

Results from an early clinical trial suggest that the drug MPDL3280A is effective against non-small cell lung cancer (NSCLC). The phase I study found that tumors shrank in 23% of patients with advanced NSCLC treated with MPDL3280A. The effect was more pronounced in smokers (who had a 26% response rate) than in nonsmokers (a 10% rate), making it the first treatment with stronger activity in smokers. MPDL3280A inhibits PD-L1, a protein expressed on cancer cells that suppresses the immune response. Blocking PD-L1 allows the immune system to keep attacking the cancer. The tumor cells in smokers may carry more mutations, provoking a stronger attack from the unleashed immune system, which could explain the stronger effects in smokers.

Lung Cancer Drug Retaspimycin Fails Clinical Trial

A phase II clinical trial found no survival benefit for the lung cancer drug retaspimycin in non-small cell lung cancer (NSCLC). The trial examined NSCLC patients with a history of smoking who were given the chemotherapy agent docetaxel (Taxotere) either with or without retaspimycin. Adding retaspimycin did not improve overall survival in NSCLC patients in general or in the subset of patients with squamous cell carcinoma (a type of NSCLC closely linked to smoking). The company will complete enrollment in a separate study investigating retaspimycin in combination with everolimus (Afinitor) by the end of 2013, but will begin no further clinical trials with retaspimycin.

New Tool Helps to Tell Cancerous Lung Spots from Benign Ones

Researchers have developed a ‘risk calculator‘ that can identify with 90% accuracy whether spots or bumps (so-called ‘nodules’) detected by a CT (computed tomography) scan in high-risk individuals are indeed lung cancer or not. Prevention experts recommend annual low-dose lung CT scans for heavy smokers. However, these scans also detect many nodules that are not cancer and follow-up interventions can be costly and dangerous. The new risk calculation software uses several different factors, including the size of the nodule and its location in the lung; the patient’s age, sex, and family history; and more, to predict whether a given nodule is cancerous. Experts hope that this tool will reduce unnecessary follow-up procedures, while increasing early detection of lung cancer.

Genetic Characteristics of Women With Lung Cancer Differ Depending on Smoking History

Few studies so far have focused specifically on lung cancer in women, despite increasing evidence of differences in lung cancer features between women and men. A striking example is the higher rate among women of nonsmokers who develop lung cancer. A recent study of women with lung adenocarcinoma, a type of non-squamous non-small cell lung cancer (NSCLC), found that those who had never smoked were much more likely to have mutations in the EGFR gene and/or abnormally high levels of estrogen receptors, while smokers were more likely to have mutations in the KRAS gene. Based on these findings, a new phase II clinical trial will explore the effectiveness of treating postmenopausal, nonsmoking women who have advanced non-squamous lung cancer with EGFR inhibitors and anti-estrogen drugs.

Blood Levels of Bilirubin Predict Lung Cancer Risk in Smokers

Smokers with low blood levels of a molecule called bilirubin are at greater risk of developing lung cancer and dying from it, researchers have found. Among 400,000 people, they found that smokers with the lowest levels of bilirubin had a 69% higher rate of lung cancer and were 76% more likely to die from the disease compared to those with the highest bilirubin levels. Among nonsmokers, differences in bilirubin levels did not affect lung cancer risk. It is not clear whether bilirubin has a protective effect against lung cancer or whether low bilirubin is simply a byproduct of other processes involved in lung cancer development. Either way, low bilirubin levels could identify smokers at high risk of lung cancer who are particularly in need of anti-smoking interventions and cancer screening.

Smoking Sooner after Waking Is Associated with Higher Lung Cancer Risk

Smokers who have their first cigarette sooner after waking are at higher risk for lung cancer, researchers have found. Those who smoke immediately after waking have higher blood levels of NNAL, a sign of carcinogens absorbed from tobacco, compared to those who smoke their first cigarette later in the day. The results hold even for those who do not smoke more cigarettes overall. The researchers suggest that smoking upon waking may reflect greater tobacco dependence, leading smokers to inhale more deeply and absorb more carcinogens.

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