Lung Cancer Management in 2010

The introduction of newer therapies and approaches for management has led to a renewed excitement in the field of lung cancer. This trend has continued in 2010 with the adoption of the new staging system recommended by the International Association for the Study of Lung Cancer (IASLC). Novel targets, such as EML4-ALK, have been identified and agents targeting these abnormalities have shown promise in uncontrolled clinical trials, while other strategies, including combining targeted agents with cytotoxic chemotherapy in unselected patients, have not proven to be successful. This review summarizes important recent clinical advances that could have a significant impact on the future care of patients with lung cancer.

Exciting advances in understanding the biology of lung cancer have occurred over the last few years. These biological advances, coupled with the availability of newer agents and newer surgical techniques and radiation modalities, have led to the design of trials exploring the clinical value of newer treatment approaches. The rapidity of advances across several disciplines makes the task of keeping up with these advances formidable not only for the general oncologist, but also for specialists in lung cancer. This review aims to summarize the most important recent clinical advances that could impact the management of lung cancer.

Prevention

Selenium has long been thought to protect against development of cancer.[1] Secondary analysis of a double-blind placebo-controlled trial showed that selenium supplementation decreased the incidence of lung cancer.[2] In an attempt to confirm these findings, a large double-blind placebo-controlled trial was conducted. Selenium supplementation did not decrease the risk of secondary primary tumors either in the lung or overall, when administered to patients with resected stage I non–small-cell lung cancer (NSCLC).[3] The incidence of second primary tumors (lung/overall) was 1.366/3.66 per 100 person-years for placebo vs 1.91/4.11 per 100 person-years for selenium (P = .15).

Screening

Advances in imaging technology have renewed an interest in lung cancer screening. However, all published studies of low-dose helical computed tomography (CT) screening are nonrandomized observational cohorts of volunteers; these studies have not been able to determine whether lung cancer–specific mortality is decreased with CT screening.[4] The National Lung Screening Trial (NLST) was a prospective randomized study of high-risk individuals (≥ 30 pack-years, ages 55 to 74 years) in which individuals were randomized to CT scans or chest x-rays annually for 3 years. The recently announced results of this study demonstrated that CT scan screening decreased lung cancer–specific mortality by approximately 20% and reduced all-cause mortality by about 7%, leading to early closure of the study. (For more information, please link to http://www.cancer.gov/newscenter/pressreleases/NLSTresultsRelease.)

Staging

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