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1、2,Frankly Speaking About Lung Cancer,“What You Need to Know About Lung Cancer&Its Treatment”,3,Frankly Speaking About Lung Cancer,Powerful 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.,4,Frankly
2、 Speaking About Lung Cancer,Risk Factors:Smoking(90%of all cases)Second-hand smoke(25%of non-smoker cases)Occupational/environmental,5,Frankly Speaking About Lung Cancer,Non-Small Cell Lung Cancer(NSCLC)Comprises 85%of all lung cancersTypes of NSCLC:Adenocarcinoma(most common)Squamous cellBronchoalv
3、eolar CarcinomaLarge Cell CarcinomaAdenosquamous,6,Frankly Speaking About Lung Cancer,Small Cell Lung Cancer(SCLC)Comprises 15-20%of all lung cancersSpreads more aggressively than NSCLCIs more responsive to chemotherapyFrequently found in smokers or former smokers,7,Frankly Speaking About Lung Cance
4、r,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),8,Frankly Speaking About Lung Cancer,LUNG CANCER STAGING(TN
5、M)T=Primary tumor size(T1-T4)N=Lymph node involvement(N1-N3)M=Distant metastasis(M0-M1),9,Frankly Speaking About Lung Cancer,Treatment of Stage I NSCLCEvaluate for surgerySurgery alone is the standard of carePathologic stage I:67%cureClinical trials are evaluating the value of adjuvant(after surgery
6、)therapy,10,Frankly Speaking About Lung Cancer,Treatment 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)therapy,11,Frankly Speaking About Lung Cancer,Theoretical Advant
7、ages 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”surgical mar
8、gins making local recurrence less likely,12,Frankly Speaking About Lung Cancer,Summary: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 improvement,13,Frankly Speaking
9、About Lung Cancer,Stage 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,14,Frankly Speaking Abou
10、t Lung Cancer,Treatment 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?,15,Frankly Speaking About Lung Cancer,Stage III A Non-Sma
11、ll Cell Lung CancerBulky vs.minimal diseaseChemotherapy+radiationCommonly used chemotherapy drugs:Platinum-basedNon-platinum basedRole of surgery undefined,16,Frankly Speaking About Lung Cancer,Stage III B Non-Small Cell Lung CancerPleural effusion affects treatment planChemotherapy+radiation or rad
12、iation aloneCommonly used chemotherapy drugs:Platinum-basedNon-platinum based,17,Frankly Speaking About Lung Cancer,Treatment of Stage IIIB-IV NSCLCReduce Chemotherapy ToxicityRecent study:Combination of 2 drugs provide same benefit as 3,but with fewer side effects:Less nausea/vomitingLess hair loss
13、Less nerve damageLower risk of infectionGemcitabine+vinorelbine slightly less toxicity but equivalent response(Cancer,Vol.95,No.6,2002),18,Frankly Speaking About Lung Cancer,Stage IV NSCLC NCI Recommended First-Line Chemotherapy:gemcitabine+cisplatinpaclitaxel+carboplatin or cisplatinvinorelbine+cis
14、platindocetaxel+cisplatinOther drug combinations,19,Frankly Speaking About Lung Cancer,Treatment of Recurrent NSCLCChallenges of decision-making General health status of the patientSeveral treatment options with equivalent results but widely varying side effectsBalancing quality of life with side ef
15、fectsPatients goals and wishes,20,Treatment of Small Cell Lung CancerLimited stage:chemo+xrt=standard of careetoposide+cisplatin+radiationcisplatin+irinotecanExtensive stage:first-line chemotherapyetoposide(VP-16)+cisplatin(or carboplatin)+radiationcisplatin+irinotecanCAV,CAE in clinical trials,21,T
16、reatment 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 radiation to relieve symptoms,22,Newer Strategies:Targeted
17、 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 effects,23,Epidermal Growth Factor ReceptorsAngiogenesisAntisenseProtein Kinase CC-kit,PDGF-rCox-2Ras
18、 inhibitorsRaf inhibitorsMap kinaseOthers,Examples of Lung Cancer Targeted Therapy in Development,24,Frankly Speaking About Lung Cancer,Epidermal Growth Factor Receptors Iressa(AstraZeneca)Tarceva(Genentech)Erbitux(Imclone,BMS)Many others in development,25,Frankly Speaking About Lung Cancer,Angiogen
19、esis Inhibitors“Angio”=blood vessel,“Genesis”=formation or beginningMany agents being tested to inhibit this process:Anti-VEGF ThalidomideAngiostatin/EndostatinAnti-VEGF tyrosine kinase inhibitorsOthers,26,Frankly Speaking About Lung Cancer,Antisense DrugsAffinitac(Lilly)Antisense drug to protein ki
20、nase CPhase II studies completed combining with chemotherapyEvaluating effectiveness in recurrent lung cancerPhase III trials underway comparing chemotherapy+drug,27,Frankly Speaking About Lung Cancer,“What You Need to Know About Lung Cancer&Its Treatment”Questions and Discussion,28,Frankly Speaking
21、 About Lung Cancer,PATIENT ACTIVE BREAK,29,Frankly Speaking About Lung Cancer,“Issues to Discuss With Your Doctor When Making Decisions About Lung Cancer Treatment:A Patient Active Approach”,30,Frankly Speaking About Lung Cancer,Making decisions about cancer treatment is a complex and sometimes over
22、whelming experience.You have choices.But you need to be informed&you need to evaluate many aspects of your care.,31,Frankly Speaking About Lung Cancer,What is the goal of my cancer therapy?Is it prolongation of life?Is to control symptoms?Is it palliation?,32,Frankly Speaking About Lung Cancer,What
23、is a clinical trial and would one be a reasonable treatment option for me?What are the risks and benefits?,33,Frankly Speaking About Lung Cancer,What is a clinical trial and would one be a reasonable treatment option for me?What are the risks and benefits?,34,Frankly Speaking About Lung Cancer,Am I
24、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?,35,Frankly Speaking About Lung Cancer,Making decisions abou
25、t 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.,36,Frankly Speaking About Lung Cancer,Making Decisions About Lung Cancer TreatmentQuestions and Discussion,
