Small, early-stage lung cancers can be removed using either wedge resection (removal of a small, wedge-shaped piece of lung that contains the cancer and a margin of healthy tissue around the cancer) or lobectomy (removal of the entire subsection, or lobe, of the lung that contains the cancer). A study of patients with non-small cell lung cancer (NSCLC) that was less than 2 cm in diameter and had not spread to the lymph nodes (stage T1N0) showed that those who received lobectomy were more likely to remain cancer-free and had higher survival rates compared to those who received wedge resection. The study authors recommend lobectomy as the preferred treatment for small NSCLC tumors, with wedge resection reserved for patients whose lung function would be decreased too much by lobectomy.
- tyrosine kinase inhibitors
While new treatments for non-small cell lung cancer (NSCLC), such as tyrosine kinase inhibitors (TKIs) and Alimta (pemetrexed), are effective second-line treatments for patients whose tumors carry mutations in the EGFR gene, they are less effective for patients without such mutations. Twenty-six patients with inoperable, previously treated NSCLC received treatment with amrubicin (Calsed) and S-1 and experienced higher treatment response rates, longer periods without cancer progression, and longer overall survival than has been reported with single-agent chemotherapy. The beneficial effects were independent of cancer subtype, suggesting that combined Calsed and S-1 may be an effective second-line treatment for NSCLC without EGFR mutation.
The Lung Cancer Asbestos Victims Center has launched a national campaign emphasizing that patients diagnosed with any type of lung cancer, not just mesothelioma, may be eligible for significant financial compensation if they have been exposed to asbestos in the workplace, even if the exposure occurred decades ago. The advocacy group lists the types of workplaces with the highest risk of asbestos exposure on their website. Patients or their family members can contact the organization at 866-714-6466 to get more information and to be directed to an experienced law firm.
Cerulean Pharma Inc. is beginning a phase II clinical trial that will investigate the safety and effectiveness of a novel chemotherapy drug, CRLX101, in patients with extensive-stage small cell lung cancer (SCLC) who have responded to first-line, platinum-based chemotherapy. The study will compare CRLX101 to topotecan (Hycamtin), which is currently the only approved second-line therapy for relapsed SCLC. CRLX101 is already being assessed as a treatment for non-small cell lung cancer (NSCLC) in another phase II trial close to completion and may be safer than Hycamtin.
Medical experts at the 2012 Chemotherapy Foundation Symposium presented data on the growing number of targeted treatments for non-small cell lung cancer (NSCLC) with so-called driver mutations—specific genetic mutations that drive tumor growth. Among the drugs showing promise in adenocarcinoma are ridaforolimus for KRAS-mutant tumors, ganetespib for ALK- or KRAS-mutant tumors, and afatinib for EGFR-mutant tumors. For squamous cell carcinoma (SCC), new potential treatments include AZD4547 and BGJ398 (FGFR1-mutant), dasatinib and nilotinib (DDR2 mutant), Tarceva and Iressa (EGFRvIII-mutant), and Yervoy and Cadi-05 (all SCC), while anti–PD-1 antibodies such as BMS-936558 may be effective for both adenocarcinoma and SCC.
Concurrent chemoradiotherapy (CRT), which is radiation treatment delivered at the same time as chemotherapy, has been found to be more effective in locally advanced non-small cell lung cancer (NSCLC) than sequential treatment with chemotherapy before or after irradiation, but also has greater toxic side effects. A retrospective study of patients with stage IIIA/B NSCLC, who had large tumors and/or extensive cancer spread to the lymph nodes, found that large tumors and presence of other illnesses were associated with shorter overall survival after CRT and higher risk of early death during treatment. While NSCLC patients with extensive lymph node involvement, but smaller tumors, may benefit from CRT without excessive risk, patients with large tumors and/or additional illnesses may be better served by alternative treatment approaches.
While adjuvant chemotherapy (ACT) after surgical removal of non-small cell lung cancer (NSCLC) can help prevent cancer recurrence and improve survival, the average benefits are small and the treatment can have serious side effects. A study of patients with adenocarcinoma identified 12 genes that together predicted the likelihood of better (low-risk) or worse (high-risk) long-term outcomes in these patients. Patients with a high-risk “gene signature” benefitted significantly from ACT, while low-risk patients gained no additional benefit, suggesting that the gene set can be used to pinpoint patients for whom ACT treatment would be worth the risk of side effects.
Forty patients with non-small cell lung cancer (NSCLC) with brain metastases (cancer that had spread to the brain) were treated with the EGFR inhibitor Tarceva (erlotinib) and whole-brain radiation therapy (WBRT). Tarceva plus WBRT was relatively well tolerated and resulted in median survival rates (10.9 months) that were higher than in a previous trial of WBRT alone (3.9 months). The fact that many NSCLC patients carry mutations in the EGFR gene may contribute to the beneficial effects of adding Tarceva treatment to WBRT in NSCLC with brain metastases.