November 6, 2012 3 Comments
With November designated as Lung Cancer awareness month we have the opportunity to focus national attention on this disease, the leading cause of cancer death in America.
It may come as a surprise to many that lung cancer causes more deaths than prostate, breast and colorectal cancer combined. Lung cancer is the big kahuna. And up until the last several years, no one seemed to be paying much attention. It may be that people considered lung cancer a disease associated with cigarette smoking and therefore, in some way, the individual victim’s fault. However, we are now witness to a changing biology wherein the predominant histology of lung cancer, previously squamous cell, has transitioned to adenocarcinoma.
While the incidence in males has fallen, the incidence in females has risen. Strikingly, the incidence of lung cancer in non-smokers is rapidly climbing. Indeed, up to 20 percent of lung cancers today do not appear to be directly related to cigarettes or known exposures at all.
Our recent publication of a clinical trial in lung cancer patients was highly instructive. First, we were able to double the response rate and nearly double the survival through functional profiling (EVA-PCD®).
Second, there was no “right” treatment for patients. Different treatment combinations worked best for each patient with no single combination working for all.
Third, many patients did well with first line targeted agents. In fact, several long-term survivors have never received any form of cytotoxic chemotherapy, despite widely metastatic disease at presentation.
Several questions remain. Among them, the role of the repeat biopsies in patients with recurrent disease. Several patients under my care have undergone additional biopsies each time a recurrence was documented with the new assay findings guiding us to a different treatment regimen. It is not impossible to imagine a day when cancer treatments will be modified and changed the way contemporary internists switch antihypertensives or cholesterol lowering drugs. That is, lung cancer like these maladies is becoming a chronic disease.
With several patients out over five years this strategy has served us well in select cases. A second issue surrounds the early introduction of experimental agents. Should we not have the opportunity to utilize drugs that have succeeded in Phase I trials, (and are thereby known to be safe for human administration), for patients whose cancer tissue reveals a favorable profile ex-vivo? I, for one, would relish the opportunity to administer second-generation EGFr-TKIs to c-MET inhibitors, to appropriately selected candidates. Smart drugs need smart mechanisms to get to market.
With the advent of lung cancer awareness month we have the opportunity to educate the public and expand awareness of the desperate need for advances in this disease. The disparity in funding for lung cancer patients compared with ovarian or breast cancer patients is disturbing. For every lung cancer death, there are five to 10 times more dollars expended on research to prevent breast and ovarian cancer deaths. While we applaud the successes in breast and ovarian cancer treatment we encourage lung cancer patients to call your congressperson to make lung cancer a front burner issue.
One of our most gratifying success stories is Pat Merwin, now four years since diagnosis. Pat has organized a local (Long Beach, CA) observance of the national lung cancer awareness vigil to be held on Tuesday, November 13. I could not be happier than to be the invited speaker for this important occasion and to be with many of my patients.