Lung Cancer

Lung Cancer is the uncontrolled growth of abnormal cells in one or both lungs. These abnormal cells do not carry out the functions of normal lung cells and do not develop into healthy lung tissue. As they grow, the abnormal cells can form tumors and interfere with the functioning of the lung, which provides oxygen to the body via the blood.

There are three major types of lung cancer, non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC) and lung carcinoid tumors.

Non-small cell lung cancer: NSCLC is the most common (85%) type of lung cancer. Subtypes include squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.

Small cell lung cancer: SCLC, also called Oat Cell Disease, accounts for 10-15% of lung cancers. It is a type of neuroendocrine (hormone-releasing) tumor with cells that are smaller sized than most cancer cells.

Lung carcinoid tumor: Less than 5% of lung cancers are LCT, and are usually slow growing and localized neuroendocrine tumors. They are more common in the small intestine, but sometimes are found in the lungs.

Another rare type of cancer that can originate in the lungs: Mesothelioma is a cancer is associated with exposure to asbestos, and originates in the linings of the organs (lungs, abdomen, heart, and chest).

Types of non-small cell lung cancer tumors:

• Adenocarcinoma: Begins in the cells that form the lining of the lungs and makes up about 30% of lung cancers
• Adenocarcinoma in situ (AID): A rare subset of adenocarcinoma that begins in the alveoli.
• Minimally invasive adenocarcinoma (MIA): Describes small adenocarcinoma lung tumors.
• Squamous cell carcinoma: Begins in the cells that line the passages of the respiratory tract, and makes up about 30% of lung cancers.
• Large cell carcinoma: Poorly differentiated cell type cancer that is often fast growing.
• Large cell neuroendocrine tumors: Fastest growing type of non-small cell lung cancer that represents 2% of lung cancers.

The staging of lung cancer is based on whether the cancer is localized or has spread from the lungs to the lymph nodes or other organs.

Stages of non-small cell lung cancer

Stage I: The cancer has not spread from the lungs.
Stage II: The cancer is located in the lungs and nearby lymph nodes.
Stage III: Cancer is in the lung and the lymph nodes of the chest. If cancer has spread only to lymph nodes on the same side of the chest as the lung tumor, it is designated IIIA. If the cancer has spread to the lymph nodes of the opposite side of the chest, it is called IIIB.
Stage IV: Cancer has spread from the lung to lymph nodes and other organs.

Lung Cancer is the uncontrolled growth of abnormal cells in one or both lungs. These abnormal cells do not carry out the functions of normal lung cells and do not develop into healthy lung tissue. As they grow, the abnormal cells can form tumors and interfere with the functioning of the lung, which provides oxygen to the body via the blood.

Treatment for lung cancer includes the following modalities, alone or in combination:

Surgery
Chemotherapy
Targeted therapies
Immune treatments
Clinical trials

Treatment for non-small cell lung cancer: Most stage I and stage II non-small cell lung cancers are treatable with surgical resection of the tumor. Chemotherapy is usually given before surgery to shrink the tumor, or after surgery (adjuvant chemotherapy) to prevent reoccurrence.

For more advanced cancers that cannot be removed surgically, chemotherapy is often given in combination with radiation treatment. Among the drugs most commonly used are cisplatin or carboplatin plus docetaxel, gemcitabine, paclitaxel, vinorelbine, or pemetrexed.

Targeted therapies that are designed to kill cancer cells and preserve healthy cells can be added to the treatment plans. Significant developments in the area of targeted therapies have changed the treatment paradigm for NSCLC. New drugs targeting EGFR, EML4-ALK, and ROS-1 mutations have provided new therapeutic options for patients.

Erlotinib (Tarceva): erlotinib is a targeted therapy that blocks a specific kind of receptor on the cell surface, the epidermal growth factor receptor (EGFR) hindering cancer growth.

Bevacizumab (Avastin): bevacizumab blocks the growth of blood vessels that the cancer needs to grow by targeting vascular endothelial growth factor (VEGF).

Crizotinib (Xalkori): crizotinib targets the mutated ALK biomarker, decreasing cancer cell growth.

Immunotherapy for non small cell lung cancer: immunotherapy differs from traditional chemotherapy, which primarily targets rapidly dividing cells, and from targeted therapies, which interfere with key molecular events in tumor cells that drive tumor growth and invasion.

The aims of immunotherapy are to aid in the recognition of cancer as foreign by the immune system and to activate the host immune system to destroy the malignancies. In non-small-cell lung cancer (NSCLC), a variety of immunotherapy treatments, including nonspecific immune stimulants, vaccines and checkpoint inhibitors, are currently being evaluated in clinical trials and may be treatment options.

Treatment for small cell lung cancer: chemotherapy is the usually an essential part of treatment programs for small cell lung cancer. Chemotherapy regimes, such as etoposide plus cisplatin, or sarboplatin plus irinotecan, are often given with or without radiation treatment.

If no preventive measures are taken, about half SCLC cancers will spread to the brain. Radiation therapy to the head (prophylactic cranial irradiation, or PCI) is often used to prevent spread to the brain.

Targeted therapies: therapies, which target specific mutations within and between lung cancer cells, include epidermal growth factor (EGRF) inhibitors, anti-angiogenesis therapies, and monoclonal antibodies. These emerging treatment modalities target these mutations to arrest cancer growth.

National Cancer Institute Lung Cancer Trials
http://www.cancer.gov/clinicaltrials/results/type/lung

Lung Cancer.org Clinical Trials with Cancer Care
http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/272-clinical_trials

Center Watch non-small cell lung cancer
https://www.centerwatch.com/clinical-trials/listings/condition/683/non-small-cell-lung-cancer

Emerging Med Lung Cancer Clinical Trial Matching Service
https://www.emergingmed.com/networks/americanlungassociation/

American Cancer Society Clinical Trial Information
http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-new-research

National Cancer Institutes
http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-new-research

Lung Cancer Alliance Educational Resources
http://www.lungcanceralliance.org/get-help-and-support/practical-resources/

Lung Cancer.org
http://www.lungcancer.org/

American Lung Association
http://www.lung.org/associations/states/colorado/lung-disease/lung-cancer-resources.html

Free to Breathe
http://www.freetobreathe.org/

Cancer Compass
http://www.cancercompass.com/message-board/cancers/lung-cancer/1,0,119,3.htm

Following up on the Mystic Trial
Lung Cancer
September 9, 2019
https://www.cancernetwork.com/wclc/following-mystic-trial?rememberme=1&elq_mid=8594&elq_cid=31005&GUID=D05BB403-D400-4F32-A398-FE2D4019831F

Research Reveals Promising New KRAS Inhibitor for Lung Cancer
Lung Cancer
September 10, 2019
https://www.cancernetwork.com/wclc/research-reveals-promising-new-kras-inhibitor-lung-cancer?rememberme=1&elq_mid=8594&elq_cid=31005&GUID=D05BB403-D400-4F32-A398-FE2D4019831F

Can SBRT Improve Immunotherapy Outcomes in Metastatic NSCLC?
Lung Cancer
July 12, 2019
https://www.cancernetwork.com/lung-cancer/can-sbrt-improve-immunotherapy-outcomes-metastatic-nsclc

Imfinzi Is First Immunotherapy Approved for Advanced Non-small Cell Lung Cancer in US
February 21, 2018
https://immuno-oncologynews.com/2018/02/21/imfinzi-first-fda-approved-treatment-non-small-cell-lung-cancer/

Lycera Starts Phase 1b Trial of Non-small Cell Lung Cancer Combo Therapy of immunotherapy LYC-55716 and Merck’s Keytruda (pembrolizumab) as a Lung Cancer Therapy.
January, 2018
https://immuno-oncologynews.com/2018/01/10/lycera-starts-phase-1b-trial-of-combo-therapy-for-non-small-cell-lung-cancer/

FDA Approves Nivolumab for Advanced Non-Squamous NSCLC
Cancer Network
October, 2015
http://www.cancernetwork.com/lung-cancer/fda-approves-nivolumab-advanced-non-squamous-nsclc

A Novel Antibody-Drug Conjugate for Lung Cancer: An interview with Dr. Camidge from University of Colorado about an early stage lung cancer trial of IMMU-132.
Cancer Network
September, 2015
http://www.cancernetwork.com/wclc-2015/novel-antibody-drug-conjugate-chemotherapy-future-lung-cancer

Afatinib plus cetuximab shows promise in EGRF-mutated lung cancer
HemOnc Today
July 31, 2014
http://www.healio.com/hematology-oncology/lung-cancer/news/online/%7B71099a79-b4ea-477b-8d6b-941b9fcba816%7D/afatinib-plus-cetuximab-shows-promise-for-egfr–mutated-lung-cancer

Astrazeneca spartners with Roche, Qiagen for co-development of lung cancer diagnostics
Tech Times
July 30, 2014
http://www.techtimes.com/articles/11508/20140730/astrazeneca-partners-with-roche-qiagen-for-co-development-of-lung-cancer-diagnostics.htm

Treatment Combo for EGFR Inhibitor-Resistant Lung Cancer
Cancer Network
July 29, 2104
http://www.cancernetwork.com/lung-cancer/treatment-combo-egfr-inhibitor-resistant-lung-cancer

Drug Candidate AZD3965 Slows Tumor Growth
HealthLine
July 16, 2014
http://www.healthline.com/health-news/emerging-treatments-for-small-cell-lung-cancer-071614

FDA Grants Priority Review to Sotorasib to Treat Patients With KRAS G12C–Mutated
NSCLC Cancer Network
February, 2021
https://www.cancernetwork.com/view/fda-grants-priority-review-to-sotorasib-to-treat-patients-with-kras-g12c-mutated-nsclc

FDA Approves Trilaciclib for Patients With SCLC Being Treated With Chemo Cancer Network
February, 2021
https://www.cancernetwork.com/view/fda-approves-trilaciclib-for-patients-with-sclc-being-treated-with-chemo

Neoadjuvant Nivolumab Plus Chemo Improves Pathological Complete Response in Resectable NSCLC
April, 2021
The CheckMate-816 trial is the first positive phase 3 trial demonstrating a significant improvement in pathologic response with neoadjuvant immunotherapy plus chemotherapy in resectable non-small cell lung cancer. The addition of nivolumab (Opdivo) to chemotherapy improved pathological complete responses (pCR) compared with chemotherapy alone as a neoadjuvant therapy in patients with resectable non-small cell lung cancer (NSCLC)
https://www.cancernetwork.com/view/neoadjuvant-nivolumab-plus-chemo-improves-pathological-complete-response-in-resectable-nsclc

Lung Cancer Alliance
http://www.lungcanceralliance.org/get-help-and-support/coping-with-lung-cancer/support-groups/

Cancer.org A program of Cancer Care
http://www.lungcancer.org/find_support/support_groups

Lungevity
http://lungevity.org/l_community/index.php

Facing Lung Cancer from Day One
http://www.mylungcancersupport.org/support-from-day-one/support-groups.html

Daily Strength Online Community
http://www.dailystrength.org/c/Lung-Cancer/support-group