Navigation Links
The current state of lung cancer treatment

A review in the December issue of the journal Archives of Pathology & Laboratory Medicine by Paul Bunn Jr, MD, University of Colorado Cancer Center investigator and past president of ASCO, IASLC and AACI describes the current state of lung cancer care.

"We're in a new paradigm in which we realize this top cause of cancer deaths is actually a number of related diseases, each potentially with its own cause and cure," Bunn says.

The review describes the shift from blanketing lung cancer with radiation and chemotherapy, to targeting the specific genetic mutations that cause lung cancer's many varieties. The first of these oncogenic lung cancer mutations to be exploited by a drug was the epidermal growth factor receptor (EGFR), described in 2004 and targeted by the drugs erlotinib and gefitinib. Then in 2007 the oncogenic ALK/EML4 fusion protein was described, and is now targeted by the drug crizotinib, which earned FDA approval in 2011. Drugs in the development pipeline target a handful of additional lung-cancer-causing mutations including KRAS, HER2/neu, BRAF, NRAF, and ROS.

"Pathologists used to define lung cancer as one of four types, based on its appearance," Bunn says, "but it's much more heterogenous than that. Some of these driver mutations may only be present in 1 or 2 percent of the lung cancer population, and mutations in combination may make for hundreds of species of the disease, each with its own response characteristics to targeted drugs and drug combinations."

"Whole exome sequencing shows there are about 300 mutations in the average lung cancer," Bunn says. "You may have an EGFR mutation driving the cancer, but then the other 299 mutations may help define who will do well on an EGFR inhibitor."

Bunn points out that in the lung cancer varieties whose driver oncogenes can be matched with targeted therapy, we tend to see 70-80 percent patient response as opposed to 20-30 percent response to traditional chemotherapies, and with much reduced side effects.

But with this great promise of picking off cancer varieties one-by-one according to their oncogenes comes the challenge of testing drugs that are effective in perhaps only one of every 100 lung cancer patients. The challenge is twofold: enrolling enough patients on a clinical trial to make the results meaningful, and securing funding for a trial in which the drug will only be marketable to a small slice of the lung cancer population.

"How do you get drug approvals for what we'd normally call orphan diseases?" Bunn asks.

Then, Bunn points to the major challenge of staying ahead of lung cancer as it mutates in response to these targeted first-line drugs. "Targeted therapies don't cure patients yet," Bunn says. Instead, lung cancer eventually mutates around the drug's effectiveness. "And so we have to discover the most rational combinations and see if these combinations allow complete response," Bunn says.

In addition to therapies targeting oncogenes, Bunn describes completely new approaches to treating the disease, including Phase III clinical trials of lung cancer vaccines that aid the body's immune response against the cancer, and the search for ways to promote the function of tumor-suppressor genes that are commonly turned off in cancers.

What is clear is that after many years of chemotherapy and radiation, we're in the midst of an explosion in novel lung cancer treatment options.

"In the coming few years it is likely that we will identify additional 'actionable' molecular drivers treated with specific oral inhibitors," Bunn says. "We're already up to 30 or 40 percent of lung cancers that are susceptible to targeted therapies. I don't know if we'll reach 100 percent but the number is certain to grow."


Contact: Garth Sundem
University of Colorado Denver

Related medicine news :

1. Range of diagnostic spinal fluid tests needed to differentiate concurrent brain diseases
2. Triple negative breast cancer symposium highlights current advances
3. Why current strategies for fighting obesity are not working
4. Current and former smokers at risk for recurrent hepatitis post-liver transplantation
5. DMP module on heart failure: Current guidelines indicate some need for revision
6. Study suggests new way to prevent recurrent ear infections
7. Daily Aspirin May Help Those at Risk for Recurrent Blood Clots
8. Mayo Clinic gets FDA approval for new imaging agent for recurrent prostate cancer
9. Benefit of PET or PET/CT in recurrent bowel cancer is not proven
10. Study reveals how cancer drug causes diabetic-like state
11. New drug prevents spread of human prostate cancer cells
Post Your Comments:
(Date:11/27/2015)... , ... November 27, 2015 , ... ... the toilets were," said an inventor from Hillside, N.J. "Many people catch diseases ... cover so that individuals will always be protected from germs." , He developed ...
(Date:11/27/2015)... ... November 27, 2015 , ... Consistent with the ... 2016 Building Better Radiology Marketing Programs meeting will showcase some of the ... 2016, at Caesars Palace in Las Vegas with a pre-conference session on a ...
(Date:11/27/2015)... Los Angeles, CA (PRWEB) , ... November 27, 2015 , ... ... the Commission on Accreditation of Allied Health Education Programs (CAAHEP) awarded accreditation to its ... exclusive list of CAAHEP accredited colleges, as only one of twelve colleges and universities ...
(Date:11/26/2015)... Marne, MI (PRWEB) , ... November 26, 2015 ... ... center for substance abuse located in central Michigan, have come together on Thanksgiving ... a specially produced video, available for viewing on the Serenity Point YouTube channel, ...
(Date:11/26/2015)... ... November 26, 2015 , ... Jobs in hospital medical laboratories and ... offered by healthcare staffing agency Aureus Medical Group . These fields, ... 2015 among those searching for healthcare jobs through the company’s website, ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... PUNE, India , November ... --> ... / personal emergency response system ... grow steadily for 5 years ... growing region expected to see ...
(Date:11/26/2015)... November 26, 2015 --> ... combination approach blends immunotherapy with Bremachlorin-photodynamic therapy for advanced ... approach blends immunotherapy with Bremachlorin-photodynamic therapy for advanced cancer. ... approach blends immunotherapy with Bremachlorin-photodynamic therapy for advanced cancer. ... has found that immunotherapy can be efficiently combined with ...
(Date:11/26/2015)... DUBLIN , Nov. 26, 2015 Research and ... "Asia Pacific Cardiac Pacemaker Market Outlook to 2019 - ... Drive the Demand " report to their offering. ... --> Boston scientific and others. ... global players including Medtronic, Biotronik, Boston ...
Breaking Medicine Technology: