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
2、 Speaking About Lung CancerRisk Factors:Smoking (90% of all cases)Second-hand smoke (25% of non-smoker cases)Occupational/environmental.5Frankly Speaking About Lung CancerNon-Small Cell Lung Cancer (NSCLC)Comprises 85% of all lung cancersTypes of NSCLC: Adenocarcinoma (most common) Squamous cell Bro
3、nchoalveolar Carcinoma Large Cell Carcinoma Adenosquamous .6Frankly Speaking About Lung CancerSmall Cell Lung Cancer (SCLC) Comprises 15-20% of all lung cancers Spreads more aggressively than NSCLC Is more responsive to chemotherapy Frequently found in smokers or former smokers.7Frankly Speaking Abo
4、ut Lung Cancer Stages of Non-Small Cell Lung Cancer Stage Iconfined to lung tissue alone Stage IIlung tissue and lymph nodes in lung Stage IIIlung tissue and lymph nodes outside of the lung Stage IVdistant spread (liver, adrenal glands, bone, brain, other sites).8Frankly Speaking About Lung CancerLU
5、NG CANCER STAGING (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 valu
6、e of adjuvant (after surgery) therapy.10Frankly 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) therapy.11Frankly Speaking About
7、Lung CancerTheoretical 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
8、Therapy “Sterilizes” 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 sh
9、ow no improvement.13Frankly 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 effect
10、s of treatment .14Frankly 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
11、Speaking About Lung CancerStage III A Non-Small Cell Lung CancerBulky vs. minimal diseaseChemotherapy + radiationCommonly used chemotherapy drugs: Platinum-based Non-platinum basedRole of surgery undefined.16Frankly Speaking About Lung CancerStage III B Non-Small Cell Lung CancerPleural effusion aff
12、ects treatment planChemotherapy + radiation or radiation aloneCommonly used chemotherapy drugs: Platinum-based Non-platinum based.17Frankly Speaking About Lung CancerTreatment of Stage IIIB-IV NSCLCReduce Chemotherapy Toxicity Recent study: Combination of 2 drugs provide same benefit as 3, but with
13、fewer side effects:Less nausea/vomitingLess hair lossLess nerve damageLower risk of infection Gemcitabine + 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: gemcitabi
14、ne + cisplatin paclitaxel + carboplatin or cisplatin vinorelbine + cisplatin docetaxel + cisplatin Other drug combinations.19Frankly Speaking About Lung CancerTreatment of Recurrent NSCLCChallenges of decision-making General health status of the patientSeveral treatment options with equivalent resul
15、ts but widely varying side effectsBalancing quality of life with side effectsPatients goals and wishes.20Treatment of Small Cell Lung CancerLimited stage: chemo+ xrt =standard of careetoposide + cisplatin + radiationcisplatin + irinotecanExtensive stage: first-line chemotherapyetoposide (VP-16) + ci
16、splatin (or carboplatin)+ radiationcisplatin + irinotecanCAV, CAE in clinical trials.21Treatment of Recurrent Small Cell Lung CancerPossible Chemotherapy Agents: topotecan (Hycamtin): only FDA-approved drug for recurrent disease oral etoposide (VP-16) paclitaxel (Taxol) irinotecan/CPT-11 (Camptosar)
17、 CAV others in clinical trialsPalliative radiation to relieve symptoms.22Newer 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
18、 effects.23 Epidermal Growth Factor Receptors Angiogenesis Antisense Protein Kinase C C-kit PDGF-r Cox-2 Ras inhibitors Raf inhibitors Map kinase OthersExamples of Lung Cancer Targeted Therapy in Development.24Frankly Speaking About Lung CancerEpidermal Growth Factor Receptors Iressa (AstraZeneca)Ta
19、rceva (Genentech)Erbitux (Imclone, BMS)Many others in development.25Frankly 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 inh
20、ibitorsOthers .26Frankly Speaking About Lung CancerAntisense DrugsAffinitac (Lilly)Antisense drug to protein kinase CPhase II studies completed combining with chemotherapyEvaluating effectiveness in recurrent lung cancerPhase III trials underway comparing chemotherapy + drug.27Frankly Speaking About
21、 Lung Cancer“What You Need to Know About Lung Cancer & Its Treatment”Questions and Discussion.28Frankly Speaking About Lung Cancer PATIENT ACTIVE BREAK.29Frankly Speaking About Lung Cancer“Issues to Discuss With Your Doctor When Making Decisions About Lung Cancer Treatment:A Patient Active Approach”
22、.30Frankly Speaking About Lung CancerMaking decisions about cancer 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
23、 it prolongation of life? Is to control symptoms? Is it palliation?.32Frankly 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 reas
24、onable treatment option for me?What are the risks and benefits?.34Frankly 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 m
25、y physician what quality of life means to me?.35Frankly Speaking About Lung 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.
