Progress of Non Small Cell Lung Cancer
Isabella Martire, M.D.
First of all, most lung cancers can be prevented by NOT smoking or smoking cessation. This is a well-known fact. The reality is that people still smoke.
After years of research, we were finally able to demonstrate decreased mortality from lung cancer; with screening spiral CT scans, in the “high risk” population.
Surgery is still the “gold standard” for curing lung cancer; if the patient has limited disease stage I, II and III a. Adjuvant chemotherapy is the standard of care for Stage II disease and combined modality chemotherapy plus radiation is commonly used for stage III disease. For small tumors in patients who are NOT surgical candidates, stereotactic radiation has been very effective; with very low toxicity.
What is really new, in lung cancer, is targeted therapy in metastatic disease based on the biology of the tumor. If the tumor tests positive for the KRAS mutation, we know that the patient will respond well to chemotherapy. If the tumor tests positive for EGFR, we know it will have a good response to the tyrosine kinase inhibitors or to the monoclonal antibody Erbitux. And, if the tumor tests positive for the ALK mutation, then the response to ALK inhibitors will be very high. This means that even in lung cancer we are moving toward personalized treatments.
Antiangiogenic therapy, combined with chemotherapy, was also approved as a first line; in metastatic disease. And two drugs, Tarceva and Alimta have been approved for maintenance therapy.
Progress has and will continue to be made; but your best bet is still smoking cessation.