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