2022 Southern Medical Research Conference
Non-Small-Cell Lung Cancer Treatments By Stage
There are many different ways to treat non-small-cell lung cancer or NSCLC. The treatments you get depend on many things, such as:
As with any condition, your treatment is an ongoing discussion with your medical team. Your doctors can make recommendations, but it's up to you to decide how much or what kind of treatment you want. As your treatments go along, be sure you tell your doctor about any side effects you're having, any pain you have, and how you're doing emotionally. Always feel free to ask questions, whether it's about changes you've noticed, nutrition or other lifestyle topics, or anything else that's on your mind. Your medical team cares about your whole self, not just your cancer.
Treatment GlossaryMost people with non-small-cell lung cancer get more than one type of treatment. For instance, you might have surgery and then get chemotherapy and radiation. And if one type of treatment stops working, there's often another kind that you can get.
These are the treatments most commonly used to treat NSCLC:
Chemotherapy (chemo) meds kill cancer cells or slow their growth. The drugs kill any cells that grow quickly, like cancer cells. Many times chemo drugs are used in combinations.
Clinical trials. NSCLC is often hard to treat. In a clinical trial, you get the best treatment available now and may also get new treatments. Talk to your doctor if you'd like to learn more about clinical trials that you might qualify for and what's involved.
Immunotherapy. These drugs can help your immune system better recognize and attack cancer cells.
Radiation. Radiation uses high-energy rays (like X-rays) to kill cancer cells. If you get external beam radiation, the rays come from a large machine that aims the beams at the tumor through your skin. Internal radiation may be another option. To do this, doctors put tiny radioactive pellets into the tumor to kill it.
Surgery. Surgery to take out the cancer gives the best chance of curing NSCLC. This may be an option if you have a small tumor that's only in your lung (early-stage NSCLC). The type of operation you get depends on how much cancer there is and where it is in your lung. A surgeon might remove the tumor, the part of your lung with the tumor in it, or your entire lung. If the cancer has spread to nearby lymph nodes, your surgeon may take them out, too.
Targeted therapy. These drugs are made to target specific proteins and gene changes in cancer cells to keep them from growing.
Stage I NSCLC TreatmentsYou'll get surgery if the tumor can be removed and it hasn't spread to your lymph nodes. The surgeon will remove the part of your lung with the tumor and also take out nearby lymph nodes to check them for cancer.
If tumor testing shows that all the cancer was taken out, this may be the only treatment you need. If there may be cancer left behind, you might need more surgery, maybe with chemo afterward. Or instead of surgery, you might be able to get radiation to the tumor site.
If you're too sick to have surgery and the cancer hasn't spread to your lymph nodes, you'll get radiation. You can get chemo along with it if you have certain high-risk factors that make the cancer more likely to come back.
If the cancer has spread to your lymph nodes, your doctors will treat it like a stage III cancer.
Stage II NSCLC TreatmentsYou'll get surgery if the tumor can be removed and it hasn't spread to your lymph nodes. The surgeon will take out the part of your lung with the tumor. Sometimes, you may have to have the whole lung removed. Your surgeon will also take out nearby lymph nodes to check them for cancer.
If tumor testing shows that all the cancer was taken out, this may be the only treatment you need. If you have certain high-risk factors that make the cancer more likely to come back, you may need chemo.
If there may be cancer left behind, you might need more surgery with chemo afterward. Or you can get radiation to the tumor site, maybe along with chemo.
The location of the NSCLC also matters. If it's in the very top of your lungs (called the superior sulcus), you'll get chemo and radiation together before surgery to remove the tumor. You'll get more chemo after surgery.
If you're too sick to have surgery and the tumor hasn't spread to your lymph nodes, you'll get radiation, maybe along with chemo if you have certain high-risk factors that make the cancer more likely to come back.
If the cancer has spread to your lymph nodes, your doctor will treat it like a stage III cancer.
Stage III NSCLC TreatmentsYou'll get surgery if the tumor can be removed and cancer has spread to your lymph nodes on the same side as the tumor.
If tumor testing shows that the surgery took out all the cancer in your lung, you'll get chemo after surgery. Depending on the number of your nodes with cancer in them, you may then get radiation to those nodes after chemo.
If there may be cancer left behind after surgery, you might get chemo and radiation. You may get them at the same time, or you might get the chemo first and the radiation later.
If the tumor is more than 7 centimeters (cm) across and hasn't spread to your lymph nodes, you'll get surgery to take out the tumor and nearby lymph nodes so a lab can test them for cancer. After surgery, you'll get chemo and radiation, either at the same time or chemo and then radiation.
If the tumor is in any part of your lung except the top of your lungs (the superior sulcus) and is large (more than 5 centimeters across), or has grown into the space between your lungs, or you have tumors in both lungs, your treatment will be one of these options:
Surgery, if possible. If tumor testing shows that the operation took out all of the cancer, you'll get chemo after surgery. But if those tests show that there may be some cancer left behind, you may need another operation followed by chemo, or you can get chemo and radiation, either at the same time or chemo first and then radiation.
Chemo and radiation before surgery. You can get them either at the same time or the radiation after you're done with chemo. Then you get surgery to remove the tumor. This may be the only treatment you get, if tumor testing shows that the operation removed all the cancer. If testing shows that some cancer was left behind, you may need more surgery.
If the tumor cannot be removed, you'll get radiation along with chemo followed by immunotherapy with durvalumab for up to 1 year.
If you have more than one tumor in the same lung, and at least one of the tumors is more than 5 centimeters across, you'll get surgery. Then your treatment depends on how many lymph nodes contain cancer.
If the cancer isn't in your lymph nodes or is only in nodes inside the same lung as the tumor, you'll get chemo.
If it's in lymph nodes around your windpipe or the space between your lungs on the same side as the tumor, and testing shows that all the cancer was removed, you'll get chemo and maybe radiation after the chemo is done.
If it's in lymph nodes around your windpipe or the space between your lungs on the same side as the tumor, and testing shows that some cancer may be left behind, you may get radiation and chemo at the same time, or the radiation may be given after the chemo is done.
If the Cancer Is in Your Mediastinal NodesThese are the lymph nodes in the space between your lungs. If the cancer has spread to them, and there's more than one tumor inside the same lung or the tumor is less than 7 centimeters across, your treatment options depend on whether the tumor can be removed.
If possible, you'll get surgery to remove the tumor and nearby lymph nodes. If tumor testing shows all the cancer was removed, you'll get chemo after surgery.
If testing shows that some cancer was left behind after the operation, you may get chemo and radiation, either at the same time or the radiation can be given after the chemo is done.
If your NSCLC cannot be removed, your treatment depends on how many lymph nodes contain cancer cells.
If the cancer is only in nodes inside the same lung as the tumor, you'll get chemo.
If it's in lymph nodes around your windpipe or the space between your lungs on the same side as the tumor, options include:
Radiation and chemo at the same time, then the immunotherapy drug durvalumab for up to 1 year.
Chemo, possibly with radiation, and then tests to see if the tumor is growing or spreading. If it's not, surgery may be an option, likely followed by more chemo and maybe radiation. If it's growing or spreading in the same area, you'll get radiation, maybe with chemo. If it has spread beyond the place where it first started, doctors will treat it like a stage IV cancer.
If You Have a Superior Sulcus TumorSuperior sulcus tumors are in the very top of your lungs. Doctors treat them based on their size.
If the tumor is less than 7 centimeters across, you'll get chemo and radiation together before surgery to remove the tumor. You'll also get more chemo after surgery.
If the tumor is more than 7 centimeters across, treatment options depend on whether it can be removed with surgery.
If it might be able to be removed, you'll get chemo and radiation together before surgery to shrink the tumor. You'll then get a chest CT scan to see if the tumor shrank enough to take it out. If it can be taken out, you'll get surgery and then more chemo.
If the tumor cannot be removed, you'll get radiation and chemo at the same time, then the immunotherapy drug durvalumab for up to 1 year.
Stage IV NSCLC TreatmentIn this stage, the cancer has spread to both your lungs, the fluid around your lung, the fluid around your heart, or to a distant lymph node or an organ in another part of your body, like your brain, liver, or bones. Stage IV cancer is rarely cured, but treatment can help keep it under control.
Whole-body (systemic) treatments: In most cases, targeted therapy, chemotherapy, and immunotherapy are the main treatments. A lab will test your cancer cells for certain markers and gene changes so your doctor knows which targeted therapy drugs will work best for you. Tests will also be used to find out the exact type of NSCLC you have.
Over time, the targeted therapy drug may stop working. When this happens, a new targeted drug is often used. (Your doctor may call this subsequent therapy.) Doctors can use many different chemo drugs, too, sometimes along with the targeted drugs. And they consider using immunotherapy to treat certain types of NSCLC.
Local treatments: Depending on where the cancer is, you may first get treatment to the part of your body with the cancer. Your doctor may call this "local" treatment. You can often get chemo, targeted therapy, and immunotherapy with any of these treatments.
If you have cancer cells in the fluid around your lung, your doctor will remove the fluid with a needle or a soft thin tube (catheter) that goes through your skin and into that space.
If you have cancer cells in the fluid around your heart, you may get surgery to create a pericardial window. This a small hole that's made in the sac around your heart so the excess fluid can drain into your chest. This way it doesn't affect how your heart works. Surgeons can do this using special scopes that are put in through tiny cuts in your skin. Or they can do it through one bigger cut in your skin.
If the cancer has spread to only a few areas, your medical team may be able to use radiation or surgery to treat the tumors. For instance, they might treat a small tumor in your brain with a special type of radiation that sends a high dose only to the tumor (called stereotactic radiation) or with surgery. Afterward, you may get radiation treatment for your whole brain.
Doctors may also use surgery and radiation to treat any problems the cancer is causing, like pain, bleeding, or a blocked airway.
Lung Cancer: How A Drug Combination May Help Reduce Tumors
Lung cancer is the second most common type of cancer among adults in the United States, with almost a quarter of a million new diagnoses each year.
There are two types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
NSCLC is generally less aggressive but is the most prevalent, accounting for around 80% of cases.
New research, conducted at the Salk Institute of Biological Studies and published today in the journal Science Advances, has highlighted a potential new targeted therapy for NSCLCs.
Researchers said a combination of two drugs was effective in significantly reducing tumor size during tests conducted on mice.
The researchers at Salk wanted to explore a new targeted therapy option for NSCLCs comprising the LKB1 genetic mutation.
Targeted therapies are drugs designed for specific molecular subtypes of NSCLCs, explained Dr. Andrew McKenzie, the vice president of personalized medicine at Sarah Cannon Research Institute in Tennessee as well as the scientific director at Genospace.
"As these therapies are 'tailored', "if you test a patient and see a mutation, it's better to give the targeted therapy than immunotherapy or immunotherapy and chemotherapy," he told Healthline.
First, the Salk team established that histone deacetylase 3 (HDAC3), a type of protein in the body, is critical in the growth of NSCLCs with the LKB1 mutation.
In a statement, Lillian Eichner, PhD, a professor at Northwestern University in Illinois and the co-lead of the study who was a postdoctoral fellow at Salk during the research, said that this came as a surprise.
"We thought the whole HDAC enzyme class was directly linked to the cause of LKB1 mutant lung cancer," she stated.
However, Eichner continued, "we didn't know the specific role of HDAC3 in lung tumor growth."
From here, she and the team turned to two medications.
The first drug was entinostat. While this drug is not currently approved by the Food and Drug Administration (FDA), it has been shown in clinical studies to target HDACs.
The second drug was trametinib, which is designed to stop cancer cells from multiplying.
"Trametinib is FDA-approved in the treatment of NSCLCs but only in combination with a partner drug called dabrafenib," noted McKenzie.
"These two drugs together are only approved in one specific subtype of NSCLC; cancers which have the BRAF V600E mutation," he added.
"Trametinib on its own has not been very efficacious and needs to be combined with dabrafenib to see the clinical outcomes associated with FDA approval," McKenzie said.
Tumors are known to become resistant to trametinib, which is why it's used in combination with dabrafenib.
The researchers wanted to see if combining trametinib with HDAC3-targeting entinostat would have the same effect on reducing resistance.
The drug combination was given to mice with LKB1-mutated NSCLC for 42 days, after which their tumors were reassessed.
Compared to mice not given the drug treatment, tumors in recipient mice had reduced in size by 79%. The treated mice also had 63% fewer lung tumors, the researchers reported.
As the research was conducted in mice, what does this mean for human patients?
Alexandre Chan,PharmD, a professor of clinical pharmacy and founding chair at University of California, Irvine – School of Pharmacy & Pharmaceutical Sciences, stated that the results are "encouraging."
However, he noted, "clinical trials [in humans] will need to be done" before the treatment can be considered.
These trials will establish "whether this combination is efficacious in patients with lung cancer," Chan told Healthline.
Furthermore, he said they will also determine "whether the toxicity profiles of the two drugs are safe to be administered together."
McKenzie asserted the new findings are "exciting" — and that "this type of study is really important for us to build that knowledge base of how we might overcome resistant targeted therapies in NSCLCs."
However, he added, while many will get excited about the prospect of a new targeted therapy to overcome resistant NSCLC, it's important to "temper hope."
"The reality [is] that these experiments and [results] we see in mice don't always pan out in humans," he stated.
"But even when that is the case," McKenzie continued, "the scientific community still learns an awful lot."
Dr. Ranee Mehra, a professor of medicine at the University of Maryland School of Medicine and a medical oncologist at the University of Maryland Greenebaum Comprehensive Cancer Center, agreed with taking a cautious approach.
"For patients, we hope a reduction in tumors will help them to live longer," she told Healthline. "But we cannot make that assumption from laboratory studies done in mice."
Ultimately, though, "this data does provide more justification for considering further studies," Mehra noted.
"NSCLCs can have mutations associated with them that drive the growth of the cancer," stated Mehra.
Up to 30% of NSCLCs involve driver mutations of the LKB1 gene — which plays a vital role in suppressing tumor growth.
So what does driver mutation do? "[It] supports the growth of cancer cells, enabling cells to quickly duplicate, survive, and spread," explained Chan.
While scientists now better understand driver mutations, added McKenzie, "we're still trying to figure out exactly where these come from and what brings them about."
For instance, factors such as smoking — which you might expect to lead to more severe lung cancer — don't seem to play a role.
"In people who have never smoked, we see a high prevalence of these very actionable mutations," McKenzie noted.
According to Chan, treatment approaches and their efficacy can vary depending on the genetic mutation (if present).
"During the initial diagnosis, a number of diagnostic procedures will be performed, including CT scans and PET, as well as biopsies," he explained.
The test results are then used to determine which treatment approach(es) is best suited to the patient.
Unfortunately, NSCLCs with LKB1 mutations are often less responsive to traditional treatments, such as immunotherapy alone or immunotherapy and chemotherapy combined.
While these can still be beneficial, McKenzie shared, "they're not as effective as targeted therapies — because these take advantage of what's driving the tumor to be so aggressive."
Either way, it's crucial to appreciate that lung cancer outcomes have made notable strides in recent years.
"[They're] much better than 10 years ago," revealed McKenzie. "And that's thanks to the advent of novel immunotherapies and targeted therapies that are now part of standard care."
Understanding Lung Cancer Symptoms In Women
The symptoms of lung cancer in women are virtually the same as those in men. Still, some differences can affect the outlook and treatment options for women with lung cancer.
Lung cancer is the second most common form of cancer. Women are more likely than men to develop lung cancers that are unrelated to smoking.
Everyone shares the same risk factors for developing lung cancer, regardless of sex. This is especially true of chronic exposure to tobacco smoke, which is responsible for 85% of lung cancer diagnoses overall.
Symptoms of lung cancer in women are similar to those experienced in men. These can include:
However, men and women are more likely to develop different forms of lung cancer, which can cause different symptoms.
Men are more likely to develop lung cancers that affect the main airways in the lungs. They may have more symptoms such as coughing and breathing difficulty.
Women who develop cancers in other parts of the lungs may instead experience early symptoms such as fatigue and back or shoulder pain.
A few rare but related conditions can also occur, though some are more common in men than women. Some examples follow.
Horner's syndromeHorner's syndrome causes symptoms in your face, most commonly the eyes. It's caused by a disruption in nerve pathways from your brain to your face. The condition can be associated with some types of lung cancer tumors.
Horner's syndrome can cause:
Pancoast tumors, a rare type of lung cancer, can cause Horner's syndrome. These tumors are more likely to affect men than women.
Superior vena cava syndromeSuperior vena cava syndrome refers to symptoms that occur when the superior vena cava, a primary vein that transports blood to your heart, is blocked or compressed, and blood flow is compromised.
The most common symptoms include:
Lung cancer tumors in your chest or lymph nodes may press on the superior vena cava, causing this compression.
Paraneoplastic syndromesParaneoplastic syndromes are rare disorders caused by an immune system response to a tumor. They can cause symptoms such as:
Paraneoplastic syndromes are mostly seen in lung cancers that are more common in men, such as:
Smoking is the biggest risk factor in developing lung cancer. This risk factor affects everyone differently. There's no medical consensus on why women smokers are more likely than men smokers to:
There's no medical consensus on why women nonsmokers are more likely than men to:
Some studies have hypothesized that carcinogens may have a larger effect on women than men. More research needs to be done to confirm this.
While both men and women are susceptible to lung cancer, they're not equally susceptible to the same types.
There are two main types of lung cancer:
Small-cell lung cancer is generally the most aggressive and rapidly progressing type.
Non-small cell lung cancer is the more common form of lung cancer. There are three types:
When women develop lung cancer, they're more likely to present with adenocarcinoma than men are. On the other hand, men are more likely than women to present with squamous cell lung cancer, the most common type in smokers.
One major difference between these lung cancers is that squamous cell produces more symptoms and is easier to detect, which provides the greatest opportunity for an early diagnosis. An early diagnosis can help provide you with the best outlook.
Both hormones and genetics may play a role in the differences in lung cancer between men and women.
Examples of these potential factors for women include:
Ultimately, much more research needs to be done to fully understand how genetics and hormones affect the likelihood and outcome of lung cancer in women.
There's been a gradual rise in lung cancer deaths among women as opposed to a gradual leveling off among men.
The American Lung Association reports that lung cancer rates have decreased by 36% in men over the last 42 years, but the rates in women have risen by 84%.
The American Cancer Society estimates that women account for more than half of people with new lung cancer diagnoses in the United States.
Depending on the specifics of the diagnosis, the treatment for lung cancer for both women and men is usually:
The survival rates following treatment are different for women and men with lung cancer. A 2012 study found that:
This is positive news for women, but women also encounter problems that men don't, including:
There's no agreement in the medical community for a direct explanation for these differences between men and women. Potential reasons include:
While lung cancer is less common in women than it is in men, that gap is getting smaller. Women may be more negatively affected by the dangers of smoking. Also, certain hormonal factors may potentially aggravate and spur cancer growth.
More time, research, and advancements in medicine should add to a better understanding of the sex-linked differences in lung cancer. More treatments are being researched every day to address the overall outcome of this disease.
Speak with a doctor about your specific circumstances and symptoms.
Comments
Post a Comment