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1、2Frankly Speaking About Lung Cancer“What You Need to Know About Lung Cancer & Its Treatment”3Frankly Speaking About Lung CancerPowerful facts:177,000 cases annually Lung cancer is the #1 cause of cancer-related deaths by far in the U.S.more than breast, prostate, and colon cancer combined.4Frankly S
2、peaking About Lung CancerRisk Factors:Smoking (90% of all cases)Second-hand smoke (25% of non-smoker cases)Occupational/environmental5Frankly Speaking About Lung CancerNon-Small Cell Lung Cancer (NSCLC)Comprises 85% of all lung cancersTypes of NSCLC:Adenocarcinoma (most common)Squamous cellBronchoal
3、veolar CarcinomaLarge Cell CarcinomaAdenosquamous 6Frankly Speaking About Lung CancerSmall Cell Lung Cancer (SCLC)Comprises 15-20% of all lung cancersSpreads more aggressively than NSCLCIs more responsive to chemotherapyFrequently found in smokers or former smokers7Frankly Speaking About Lung Cancer
4、 Stages of Non-Small Cell Lung CancerStage Iconfined to lung tissue aloneStage IIlung tissue and lymph nodes in lungStage IIIlung tissue and lymph nodes outside of the lungStage IVdistant spread (liver, adrenal glands, bone, brain, other sites)8Frankly Speaking About Lung Cancer LUNG CANCER STAGING
5、(TNM)T= Primary tumor size (T1-T4)N= Lymph node involvement (N1-N3)M= Distant metastasis (M0-M1)9Frankly Speaking About Lung CancerTreatment of Stage I NSCLCEvaluate for surgerySurgery alone is the standard of carePathologic stage I: 67% cureClinical trials are evaluating the value of adjuvant (afte
6、r surgery) therapy10Frankly Speaking About Lung CancerTreatment of Stage II NSCLCEvaluate for type of surgerySurgery alone is the standard of carePathologic stage II: 40-50% cureClinical trials are evaluating the value of adjuvant (after surgery) therapy11Frankly Speaking About Lung CancerTheoretica
7、l Advantages of Combining Different Types of Cancer TherapiesChemotherapy:Controls micro-metastases that may be responsible for systemic recurrence after “successful” surgeryActs synergistically with XRT to downstage NSCLC and make tumor-free margin surgery more likelyRadiation Therapy “Sterilizes”
8、surgical margins making local recurrence less likely 12Frankly Speaking About Lung CancerSummary: Treatment Stage I & II NSCLCSurgery is the standard of careNeoadjuvant (given before surgery) therapy is promisingAdjuvant (given after surgery) chemotherapy or radiation therapy show no improvement13Fr
9、ankly Speaking About Lung CancerStage III Non-Small Cell Lung Cancer2 types: Stage IIIA and Stage IIIBRadiation alone was the standard care until 1990sChemotherapy + radiation is the new standard based on results of clinical trialsNewer radiation techniques minimize side effects of treatment 14Frank
10、ly Speaking About Lung CancerTreatment of Stage III NSCLC Chemo + radiation = standard of care Role of surgery is undefined Unanswered questions:-Which chemo is best? How does one decide?-When & how should chemotherapy be given?-When & how should radiation be given?15Frankly Speaking About Lung Canc
11、erStage III A Non-Small Cell Lung CancerBulky vs. minimal diseaseChemotherapy + radiationCommonly used chemotherapy drugs:Platinum-basedNon-platinum basedRole of surgery undefined16Frankly Speaking About Lung CancerStage III B Non-Small Cell Lung CancerPleural effusion affects treatment planChemothe
12、rapy + radiation or radiation aloneCommonly used chemotherapy drugs:Platinum-basedNon-platinum based17Frankly Speaking About Lung CancerTreatment of Stage IIIB-IV NSCLCReduce Chemotherapy ToxicityRecent study: Combination of 2 drugs provide same benefit as 3, but with fewer side effects:Less nausea/
13、vomitingLess hair lossLess nerve damageLower risk of infectionGemcitabine + vinorelbine slightly less toxicity but equivalent response (Cancer, Vol. 95, No. 6, 2002)18Frankly Speaking About Lung Cancer Stage IV NSCLC NCI Recommended First-Line Chemotherapy:gemcitabine + cisplatinpaclitaxel + carbopl
14、atin or cisplatinvinorelbine + cisplatindocetaxel + cisplatinOther drug combinations19Frankly Speaking About Lung CancerTreatment of Recurrent NSCLCChallenges of decision-making General health status of the patientSeveral treatment options with equivalent results but widely varying side effectsBalan
15、cing quality of life with side effectsPatients goals and wishes20Treatment of Small Cell Lung CancerLimited stage: chemo+ xrt =standard of careetoposide + cisplatin + radiationcisplatin + irinotecanExtensive stage: first-line chemotherapyetoposide (VP-16) + cisplatin (or carboplatin)+ radiationcispl
16、atin + irinotecanCAV, CAE in clinical trials21Treatment of Recurrent Small Cell Lung CancerPossible Chemotherapy Agents:topotecan (Hycamtin): only FDA-approved drug for recurrent diseaseoral etoposide (VP-16)paclitaxel (Taxol)irinotecan/CPT-11 (Camptosar)CAVothers in clinical trialsPalliative radiat
17、ion to relieve symptoms22Newer Strategies: Targeted TherapyChemotherapy targets general features of cells, including both cancer cells and normal cellsNormal cells usually recover, while cancer cells may notHowever, chemotherapy is associated with side effects23Epidermal Growth Factor ReceptorsAngio
18、genesisAntisenseProtein Kinase CC-kitPDGF-rCox-2Ras inhibitorsRaf inhibitorsMap kinaseOthersExamples of Lung Cancer Targeted Therapy in Development24Frankly Speaking About Lung CancerEpidermal Growth Factor Receptors Iressa (AstraZeneca)Tarceva (Genentech)Erbitux (Imclone, BMS)Many others in develop
19、ment25Frankly Speaking About Lung CancerAngiogenesis Inhibitors“Angio”=blood vessel, “Genesis”=formation or beginningMany agents being tested to inhibit this process:Anti-VEGF ThalidomideAngiostatin/EndostatinAnti-VEGF tyrosine kinase inhibitorsOthers 26Frankly Speaking About Lung CancerAntisense Dr
20、ugsAffinitac (Lilly)Antisense drug to protein kinase CPhase II studies completed combining with chemotherapyEvaluating effectiveness in recurrent lung cancerPhase III trials underway comparing chemotherapy + drug27Frankly Speaking About Lung Cancer“What You Need to Know About Lung Cancer & Its Treat
21、ment”Questions and Discussion28Frankly Speaking About Lung Cancer PATIENT ACTIVE BREAK29Frankly Speaking About Lung Cancer“Issues to Discuss With Your Doctor When Making Decisions About Lung Cancer Treatment:A Patient Active Approach”30Frankly Speaking About Lung CancerMaking decisions about cancer
22、treatment is a complex and sometimes overwhelming experience.You have choices. But you need to be informed & you need to evaluate many aspects of your care.31Frankly Speaking About Lung CancerWhat is the goal of my cancer therapy?Is it prolongation of life?Is to control symptoms?Is it palliation?32F
23、rankly Speaking About Lung CancerWhat is a clinical trial and would one be a reasonable treatment option for me?What are the risks and benefits?33Frankly Speaking About Lung CancerWhat is a clinical trial and would one be a reasonable treatment option for me?What are the risks and benefits?34Frankly
24、 Speaking About Lung CancerAm I ready and willing to participate fully and actively in my treatment plan?Do I know what the potential side effects of therapy are and how best to prevent or manage them?Have I communicated with my physician what quality of life means to me?35Frankly Speaking About Lun
25、g CancerMaking decisions about lung cancer and its treatment is never easy.By being informed & partnering with your physician & health care team, you can improve the quality of your life and may enhance the possibility of your recovery.36Frankly Speaking About Lung CancerMaking Decisions About Lung Cancer TreatmentQuestions and Discussion
