Researchers have constructed a model to assess the cost-effectiveness of different treatments for stage I non-small cell lung cancer (NSCLC) based on treatment costs, predicted life expectancy, and expected quality of life. Model simulations indicate that lobectomy (removal of an entire subsection of the lungs) is the most cost-effective treatment for patients whose cancer is clearly operable. For patients who are only borderline eligible for surgery due to poor health (‘marginally operable’), who often cannot withstand lobectomy, a type of radiotherapy called stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), was found to be more cost-effective than wedge resection (removal of a small piece of lung containing the cancer).
- Wedge resection
Bevacizumab (Avastin), which is approved for treatment of a number of advanced-stage cancer types, is commonly avoided in patients with brain metastases (cancer that has spread to the brain) because of fear of brain hemorrhages (bleeding in the brain). A retrospective study of 52 patients with advanced non-small cell lung cancer (NSCLC) who had received chemotherapy containing Avastin found no cases of serious bleeding events and no significant differences in survival or treatment side effects between patients with or without brain metastases. Avastin may therefore be a safe treatment option in NSCLC with brain metastases.
Research paper: https://www.jstage.jst.go.jp/article/acrt/20/2/20_47/_pdf
The roles of the genes IGF1R and EGFR in lung cancer were examined in patients with non-small cell lung cancer (NSCLC) who had their primary tumor surgically removed. Patients whose tumors had increased expression of both IGFR1R and EGFR were more likely to experience recurrence of the cancer after a shorter amount of time and had shorter survival times after surgery. This finding suggests that concurrent overexpression of IGF1R and EGFR is a negative prognosis factor in NSCLC and may indicate patients who are more likely to benefit from novel treatments with IGF1R inhibitors.
A retrospective study in Japan examined 55 patients aged 75 years or over with inoperable non-small cell lung cancer (NSCLC) who had a mutation in the EGFR gene and received gefitinib (Iressa) as first-line therapy. The treatment was generally well tolerated and patients experienced longer periods without cancer progression (median: 13.8 months) and longer overall survival (median: 29.1 months) than commonly reported for similar patients. While studies using control groups will need to confirm that Iressa is indeed more effective than standard chemotherapy or a placebo, these findings suggest that Iressa may be a preferable first-line treatment in elderly patients with advanced EGFR-mutant NSCLC.
A study of individuals with and without lung cancer in North India found that those carrying a particular version (or “polymorphism”) of a gene for the protein p53 were more likely to have lung cancer, independent of their age or smoking rate. P53 belongs to a class of proteins called “tumor suppressor proteins,” and is involved in DNA repair, regulating cell growth, and inducing cell death in damaged or abnormal cells. The findings suggest that this version of the p53 gene, called Arg72Pro, may contribute to higher susceptibility for lung cancer, at least in the North Indian population.
Research paper: http://online.liebertpub.com/doi/full/10.1089/dna.2012.1792
A recent study examined first-line treatment with the chemotherapy agent carboplatin (Paraplatin), combined with either albumin-bound paclitaxel (Abraxane) or standard solvent-based paclitaxel (Taxol), in both elderly and younger patients with advanced non-small cell lung cancer (NSCLC). Patients treated with Abraxane/Paraplatin exhibited higher treatment response rates and fewer toxic side effects in both age groups; elderly patients (age 70+ years) experienced longer periods without cancer progression and longer overall survival with Abraxane/Paraplatin compared to Taxol/Paraplatin treatment. Abraxane plus Paraplatin may constitute a safe, effective first-line treatment for elderly patients with advanced NSCLC, a group that has been traditionally undertreated.
Research paper: http://annonc.oxfordjournals.org/content/24/2/314.long
Variations in genes for a family of proteins called matrix metalloproteases (MMPs) have been suggested to play a role in lung cancer risk. A meta-analysis of several studies on MMP genes found that a particular version (or “polymorphism”) of the MMP1 gene, called MMP1-1607 1G/2G, is associated with higher susceptibility for lung cancer in Asian patients. In contrast, the MMP2-1306 C/T version of the MMP2 gene decreases lung cancer risk in Asian patients and the MMP9-1562 C/T version of the MMP9 gene decreases lung cancer risk in white patients.
National Jewish Health is performing a clinical trial to examine the benefits of lung cancer screening that combines a computed tomography (CT) chest scan with a blood test. The blood test detects anticancer antibodies created by the immune system. The trial seeks to find out whether adding the blood test, called EarlyCDT-Lung, will further improve the ability of CT chest scans to prevent lung cancer deaths in high-risk populations and avoid invasive follow-up testing in the case of CT scan “false alarms.” Participants can enroll if they are between ages 50 to 75 years, have a smoking history of at least 20 pack-years (meaning 1 pack a day for 20 years, or 2 packs a day for 10 years, etc.), are current smokers or quit fewer than 10 years ago, and have no serious illness or history of cancer other than skin cancer. Call 303-398-1911 to find out more.
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.