Promising Advancements in Lung Cancer Management

By Michael Kosty, M.D., Scripps Health

Lung cancer is still the most common cause of cancer death among both men and women, in the United States. According to the American Cancer Society, about 224,210 new cases of lung cancer will be diagnosed in 2014. However, thanks to advancements in screening and treatment, many patients may now be diagnosed sooner and live longer than in the past.

Spiral CT Scan Improves Detection
As with most types of cancer, the earlier lung cancer is diagnosed, the more options you have for successful treatment. Regular X-rays and even CT scans have not been very effective screening tools for lung cancer; people who had these screening tests on a fairly regular basis had no better survival rates than those who already had symptoms or were diagnosed for other reasons.

Now, a new screening technique uses a spiral CT scan that can detect lung abnormalities at a very early stage. Because the test is fast and uses a low dose of radiation, there is a lower risk of radiation exposure than with traditional CT scans. In addition, the target population for screening has been refined to include only current smokers or people who have quit smoking within last 15 years.

A couple of large studies have demonstrated that this approach does detect lung cancer at an earlier stage, and that earlier detection does result in improved survival. Though the spiral CT scan is more expensive than other cancer screening tests such as a mammogram or a prostate blood test, Medicare and insurance companies are expected to begin covering the cost of the screening within the next year or so.

Multispecialty Treatment Improves Outcomes
Lung cancer has truly become a multispecialty disease that requires an integrated team of specialists working together to care for the patient. Often, treatment involves different combinations of surgery, chemotherapy and radiation therapy. This multi-modality approach has significantly improved the survival of people with lung cancer, particularly in the advanced stages. A decade ago, people with stage 4 disease that had metastasized, or spread to other areas of the body, had a life expectancy of about nine months. Today, their life expectancy is three or four years.

Additionally, there are now more treatment options available. In the past, surgery was the only option for someone who had very early-stage lung cancer. These days, for patients who are not candidates for surgery, advanced radiation therapies offer alternatives. Scripps offers both conventional and proton radiation therapy that can target lung tumors without harming the surrounding lung tissue. We have been using this radiation-only approach for more than five years, and survival rates appear to be equivalent to using radiation and surgery. Surgery still remains the standard of care, but that may change in the near future.

When cancer metastasizes, it often travels first to the lymph nodes in the center of the chest, called the mediastinum. Again, surgery has traditionally been the standard of care, but the cure rate from surgery alone was at best 25 to 30 percent. Today, using low dose chemotherapy in these patients to make the cancer cells more sensitive to radiation, along with radiation therapy, has improved the cure rate to 40 to 50 percent.

Targeted Therapies Attack Tumors
Specific DNA mutations have been identified in many lung tumors, and these mutations enable cancer cells to grow and proliferate more easily. Therapies that directly target these mutations can be very effective in shutting off the signal that tells tumor cells to grow, and many patients with these mutated tumors have had a profound and prolonged shrinkage of the tumor with very minimal side effects.

Right now, therapies have been developed to target at least four different mutations. Many additional mutations have been identified as well, and researchers around the world are working on drugs to target them. Unlike invasive treatments like chemotherapy, these are oral medications that are generally very well-tolerated and more convenient for patients.

Finally, a very exciting treatment on the horizon is immune therapy. Tumor cells develop proteins on their surface that allow them to evade detection by the body’s immune system. A number of drugs have been developed that disguise these proteins or render them inactive, enabling the immune system to recognize these tumor cells as invaders and fight them off. Using these immune therapies, either alone or in conjunction with traditional chemotherapy, has significantly boosted survivability. While immune therapy will not completely eradicate the tumors, it may be able to keep them in check, making lung cancer more of a manageable chronic disease, like diabetes, than a fatal one.

Michael Kosty, M.D., is an oncologist with Scripps Health and medical director of Scripps Cancer Center at Scripps Green Hospital. “To Your Health” is brought to you by the physicians and staff of Scripps Health. For a referral to a Scripps physician, please call 1-800-SCRIPPS.