Cancer Treatments are Improving Constantly

For people with extensive stage disease, chemotherapy still offers the best chance for extending survival and improving quality of life. In addition, medical science is making other advances that may help you in your fight against lung cancer. Many of the new drugs and techniques mentioned here are still under investigation in clinical trials, so their use is not yet widespread. Nevertheless, there are treatment options that may hold hope for controlling the disease and improving your quality of life with lung cancer.

Clinical trials are an important part of finding new and effective treatments for lung cancer. Many of the techniques and treatments listed on this page have become available because of lung cancer patients' participation in clinical trials. Please check out the clinical trials portion of Frankly Speaking about Lung Cancer if you are interested in learning more.

The following list does not include all of the new therapies being studied. Rather, it provides a brief overview of some of the major areas of discovery. Talk with your physician about what newest cancer treatments that are being developed to determine what might be most appropriate for your medical situation.

New Surgical Techniques

While surgery remains the standard treatment for people with stage I and II non-small cell lung cancer (NSCLC), there are some patients with other health problems for whom surgery is not a viable treatment option. For people with marginal lung function who cannot tolerate major surgery, a less invasive, new surgical technique called video-assisted thoracic surgery (VATS) may be helpful. VATS allows for what is called a “keyhole” surgery so that a large incision can be avoided. Resection and lobectomy (removal of a lobe) can be performed through a small incision with the aid of a video camera and television screen so that the surgeon can see enough detail to perform the necessary surgery. VATS surgery may reduce surgical trauma and result in shorter hospital stays and quicker recovery. The disadvantage to this approach is that a surgeon cannot view the entire lung and may not be able to obtain adequate samples of the lymph nodes to check for the spread of cancer. This approach has not yet been shown to improve surgical results compared to standard techniques.

Some of the other surgical techniques being investigated include: nerve-sparing surgery, computer enhanced imaging tools, and stereotactic radiologic surgical tools that use high-energy x-rays to destroy deep-seated tumors (such as gamma knife) for brain metastases.

Innovative Radiation Techniques

Three-dimensional conformal radiation therapy is a new technique that uses computers to shape radiation beams to exactly match the size and shape of the tumor so that the dose of radiation can be directly intensified over a shorter time period without harming the surrounding tissue. The use of primary radiation in combination with chemotherapy is being examined as well as a treatment technique called interdigitation, which involves modifying or alternating dose schedules of chemotherapy and radiation therapy.

Fractionated stereotactic radiosurgery is another new technique that uses a CT scanner to target tumors with radiation with high accuracy. Another technique being studied is called accelerated hyper-fractionation, which varies the dose and duration between radiation treatments, giving smaller doses of radiation more often. It is hoped that modifying the methods in which radiation therapy is delivered may increase the effectiveness of radiation for some patients.

Radiation modifiers are drugs that are being used to change the way the cancer cells respond to radiation.

Radiation sensitizers are drugs that make cells more sensitive to the effects of radiation. Brachytherapy is a technique used to deliver high doses of radiation from very short instances. This is accomplished by placing a radioactive source, which is sealed in a container, on the surface of the body near the tumor or a short distance from the affected area.

Investigational Chemotherapy Agents

Promising new chemotherapy agents are being studied now, either alone or in a variety of combinations with surgery and/or radiation therapy. Varying the timing and dosing of various chemotherapeutic agents is also being studied. Products that can enhance the effectiveness of the drugs or products that can protect normal cells during chemotherapy are also being studied.

Epidermal Growth Factor (EGF) Receptor Inhibitors

This investigational therapy involves the use of drugs that inhibit the growth of various types of tissues around cancer cells. Specific growth factor receptors for lung cancer, which are the substances that appear to aid tumor growth, have been identified as epidermal growth factors (EGF) and vascular endothelial growth factors. Some anti-epidermal growth factor substances such as Iressa™ (ZD 1839) and Tarceva™ are currently in advanced clinical trials for lung cancer.

Thalidomide

Thalidomide is a drug that became well-known in the 1950s because of serious birth defects it caused when administered to pregnant women to treat nausea in early pregnancy. It appears that it may have some anticancer properties, working as an angiogenic inhibitor to disrupt the formation of new blood vessels that commonly accompany malignant tissue growth. Clinical trials are under way to examine the use of thalidomide in combination with radiotherapy for people with stage III NSCLC.

Antisense Therapy (Antisense Oligonucleotides)

This type of therapy attaches microscopic pieces of DNA or RNA to a tumor so that it can interfere with the cancer cell’s division and replication in a variety of ways. In other words, antisense compounds use a specific genetic code to prevent the production of disease-causing proteins. DNA (deoxyribonucleic acid) and RNA (ribonucleic acid) are the 2 nucleic acids found in all cells. DNA is the cell responsible for all the genetic information and RNA transfers that information from the DNA to proteins produced by the cells. One clinical trial for stage IIIB or IV NSCLC is evaluating the ability of one type of antisense compound, AFFINITAC™, to prolong patients’ lives in combination with carboplatin and paclitaxel.

Photodynamic Therapy for Advanced Lung Cancer

Photodynamic therapy (PDT) can be used palliatively to treat late-stage lung cancer, meaning it is used to improve quality of life by reducing symptoms. When tumors block major airways, making it increasingly difficult for the patient to breathe, PDT can be used to debulk (reduce the size of) the tumor(s). PDT for this purpose is used the same way it is used for early-stage non-small cell lung cancer. PDT has been approved by the FDA for use in advanced lung cancer to relieve bronchial obstruction. Studies are under way to determine other ways that this therapy might be helpful.

Monoclonal Antibodies

Monoclonal antibodies are antibodies (what white blood cells secrete) that are artificially reproduced in a laboratory. They are highly specific for a single antigen, that is, they only attach themselves to a certain protein that is a match for them. This means that monoclonal antibodies can be designed to attack certain tumor cells and destroy only them. There are no data yet that prove the benefit of monoclonal antibodies against lung cancer, but continued advances in this area of research are likely to emerge in the near future.

Some of the monoclonal antibodies being investigated include:

•  ABX-EGF against endothelial growth factor for non-small cell lung cancer
•  LMB-9 for non-small cell lung cancer
•  Herceptin for non-small cell lung cancer
•  Anti-VEGF

Chemoprevention

Chemoprevention is designed to prevent the development of cancer in at-risk people and to prevent a recurrence in patients apparently cured of cancer. This approach involves giving a drug before there are signs of cancer. Retinoids are known to be able to prevent some types of cancer. Inhaled retinoids have been studied in lung cancer; however, the side-effect profile of the drug was severe. Other studies will be conducted with new formulations of the drug. Selenium has also been shown to have chemopreventive capabilities and is in clinical trials for people with either small cell or non-small cell lung cancer.

Summary

The treatment of lung cancer can take a variety of forms, depending on the stage of the disease at diagnosis, your health, general preferences, and many other factors. While there is no single approach that can be used effectively to treat all cases of lung cancer, there are accepted standards of treatment that have been tested and proven to be effective in managing the disease and its symptoms.

The treatment you receive may well involve a combination of therapies that may change over time in response to the stage of lung cancer you have, your personal circumstances, and the side effects you feel are most acceptable to your lifestyle and stage of disease. Innovative therapies are being tested in clinical trials throughout the United States and many hold great promise for future treatment and management of lung cancer.

Keep in touch with new treatment discoveries by consulting with your oncologist or checking periodically with the National Cancer Institute clinical trials database by calling or 1-800-4CANCER or via the Internet at http://www.cancer.gov/clinicaltrials/

Resources for More Information

1. Johnston, L. Lung Cancer: Making Sense of Diagnosis, Treatment & Options. O’Reilly, 2001.
2. National Cancer Institute, 1-800-4CANCER, http://cnetdb.nci.nih.gov/trialsrch.shtml.