New and Emerging Treatments in Lung Cancer

Lung cancer treatment continues to evolve. It is important to remember that all treatments have risks and potential benefits and that only a doctor can decide which treatments are right for an individual patient. Therefore, it is important that you talk with your treatment team to learn which options might work for your situation.

Targeted therapies

An important advancement in lung cancer treatment has been the discovery of targeted therapies. Because traditional chemotherapies go throughout the entire body to target fast growing cells, health cells and tissues are affected along with the cancerous cells. Targeted treatments attack cancer in more specific ways, usually by interrupting the ways that cancer cells grow or divide such as:

• Epidermal growth factor receptor Inhibitors – Iressa (gefitinib), Tarceva (erlotinib), and Erbitux (cetuximab). Epidermal growth factor receptors (EGFR) are proteins found on the surface of some cells. The epidermal growth factor attaches to these proteins and causes the cells to divide. Some lung cancer cells have abnormally high EGFR levels, which makes those cells divide very quickly. Drugs that reduce or prevent this action are called EGFR inhibitors because they interrupt the process that leads to an abnormal growth of cells.

• Anti-angiogenesis drugs – Avastin (bevacizumab). Angiogenesis is the formation of blood vessels. To continue to grow, cancer tumors must develop new blood vessels. Drugs that cut off the flow of blood to the tumor with the goal of starving it are called angiogenesis inhibitors, or anti-angiogenesis medications. These drugs also seem to make traditional chemotherapies more effective. Among the anti-angiogenesis drugs that are currently in late stage clinical trials for NSCLC are Zactima (vandetanib), Sutent (sunitinib), and Nexavar (sorafenib).

• Monoclonal antibodies –Avastin, Erbitux. Monoclonal antibodies are proteins that are made in the lab and, in the case of cancer, locate and attach to tumor cells. Each one is made to find a particular substance. They can be used alone to target defects in the cancer cells, to make the cancer cells more receptive to the body’s immune system, or to block the signals that cancer cells receive which cause them to grow. Monoclonal antibodies can also carry other drugs or substances directly to a tumor.

Progress in the treatment of non-small cell lung cancer

Tarceva
Approved in November 2004 as an oral treatment for advanced non-small cell lung cancer that failed to respond to other therapy.

Alimta
Approved in September 2008 for use (with the chemotherapy drug cisplatin) as first line treatment for patients with locally advanced and metastatic non-small cell lung cancer that is not squamous cell carcinoma. With this action, the 2004 approval was also amended to exclude use in patients with squamous cell carcinoma.

Approved in August 2004 for use alone in patients with advanced non-small cell lung cancer who have previously received chemotherapy.

Avastin
Approved in October 2006 for use with chemotherapy (carboplatin and paclitaxel) for patients with non-small cell lung cancer that is not surgically removable and is locally advanced, recurrent, or metastatic Avastin is not appropriate for use in patients with squamous cell carcinoma.

Erbitux (in clinical trials, not yet approved)
Erbitux is an approved treatment for colorectal and some head and neck cancers. Data released in June 2008 showed survival advantage in non-small cell lung cancer patients. In January 2009, the FDA application submitted to approve Erbitux as a treatment for advanced non-small cell lung cancer was withdrawn but resubmission is expected.

Zactima (in clinical trials, not yet approved)
Submitted for FDA approval for use in combination with chemotherapy for patients with advanced non-small cell lung cancer in June 2009. The application was withdrawn in October 2009 pending the completion of further clinical trials.

Iressa (not currently available to new US patients outside the clinical trial setting)
US Approval removed in June 2005 after studies showed it did not help the majority of people to live longer. Iressa is available to those patients who received benefit from the drug at the time the US approval was removed. It remains an approved treatment for lung cancer in over 30 countries and continues to be studied in clinical trials in the US.

Approved in May 2003 as an oral treatment for advanced non-small cell lung cancer.

Progress in the treatment of small cell lung cancer

Hycamtin
In October 2007, the pill form of Hycamtin was approved for the treatment of relapsed small cell lung cancer patients with a prior complete or partial response who are at least 45 days from the end of first line chemotherapy.

Injectable Hycamtin (topotecan) has been an approved treatment for small cell lung cancer since 1998.

Amrubicin (in clinical trials, not yet approved)
Granted fast-track designation in September 2008 for the treatment of small cell lung cancer after first line chemotherapy.

Other treatments

Photodynamic Therapy (PDT)
PDT has been an approved treatment for small tumors and for the relief of symptoms (breathing problems, bleeding) in non-small cell lung cancer since 1998.