Cancer stem cells: advances in knowledge and implications for cancer therapy
ASCO Updates Guidelines For Stage IV NSCLC
ASCO Updates Guidelines for Stage IV NSCLC - Cancer Therapy AdvisorThe American Society of Clinical Oncology (ASCO) has updated its guidelines for stage IV non-small cell lung cancer (NSCLC) with and without driver alterations.1,2
The only update for patients with stage IV NSCLC without driver alterations is that patients who have HER2-overexpressing (IHC 3+) disease and good performance status can receive trastuzumab deruxtecan as second-line or later therapy (weak recommendation based on very low-quality evidence).1
For patients with stage IV NSCLC with driver alterations, the updated guidelines include new recommendations for first-line and second-line therapy.2
The updated guidelines note that patients with stage IV NSCLC who have EGFR exon 19 deletions or exon 21 L858R substitutions can receive osimertinib plus platinum doublet chemotherapy or amivantamab plus lazertinib as first-line treatment (weak recommendation based on moderate-quality evidence).
Patients whose disease has progressed on osimertinib or other EGFR tyrosine kinase inhibitors (TKIs) without emergent T790M or other targetable alterations can receive platinum-based chemotherapy with or without amivantamab (strong recommendation based on moderate-quality evidence).
"For patients whose disease has progressed on EGFR TKIs and not treated with amivantamab and chemotherapy, chemotherapy alone ± anti–vascular endothelial growth factor (VEGF)-targeting therapy combinations may be considered for those with adenocarcinoma histology and where anti-VEGF therapy is considered safe," the guidelines note.
The guidelines also note that anti-PD-(L)1 agents, with or without platinum chemotherapy, are not recommended for patients who have progressive disease on EGFR TKIs (strong recommendation based on high-quality evidence).
Disclosures: Some guideline authors disclosed conflicts of interest. Please see the original references for complete disclosures.
References:
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Small-Cell And Non-Small-Cell Lung Cancer: What's The Difference?
Lung cancer is the leading cause of cancer deaths among both men and women. Small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) are the two main types of lung cancer. Most lung cancers are NSCLC. Only about 15% of lung cancers are SCLC.
Their names stem from what their cells look like when you look at them under a microscope. SCLC cells look round and undersized in comparison to NSCLC cells. But the big difference is how aggressive they are. SCLC is more aggressive than NSCLC and often spreads to other parts of your body.
Here are the facts about SCLC and NSCLC and how they differ.
Small-cell lung cancer is when abnormal cells in your lung grow fast and uncontrollably. It's an aggressive form of cancer that often starts in your airways and then spreads, or metastasizes, to other parts of your body.
There are two types of SCLC, which are based on which cells are affected:
For most people, by the time you're diagnosed with SCLC, it has already spread to other parts of your body. The areas may include:
Non-small-cell lung cancer is a group of lung cancers that are different from SCLC. It's more common and less aggressive than SCLC. But it's important to catch it early so it doesn't spread to other areas.
The most common types of NSCLC are:
The main difference between SCLC and NSCLC is how aggressive they are. Another difference is how common they are. NSCLC is a less aggressive and more common form of lung cancer than SCLC.
Your doctor will know which type of lung cancer you have when they take a biopsy, or small sample of the tumor, and send it to a lab, where scientists will examine it under a microscope. They'll also see where the cancer started and how abnormal the cells are.
It's possible you won't notice any symptoms of lung cancer, especially in the early stages. It's common for doctors to find lung cancer when they do an X-ray for something else.
When present, symptoms of SCLC and NSCLC are similar:
Because SCLC is more likely to metastasize (or spread) early on, you may have symptoms that stem from lung cancer in other organs. They may include:
The main risk for both SCLC and NSCLC is smoking. About 98% of SCLC cases are linked to smoking tobacco. This includes cigarettes, pipes, and cigars.
The earlier you start smoking, the longer you smoke, and the more often you smoke, the higher your risk is. If you already smoke, quitting now lowers your chances of developing lung cancer.
It's best to avoid secondhand smoke, too, because it's also a risk factor.
Other risk factors for SCLC include:
Other risk factors for NSCLC include:
The more risk factors you have, the higher chance you have of developing lung cancer.
Lung cancer develops and progresses quickly. This is why it is often diagnosed at an advanced, incurable stage. Screening for lung cancer has been introduced for high-risk people in order to catch lung cancers early when there is still a chance of cure.
If you have a history of smoking, your doctor may do regular CT screenings. The American Society of Clinical Oncology recommends with low-dose CT if you're 50 - 80 and currently smoke or if you previously smoked and have at least a 20-pack-year history or you quit within the last 15 years. Screenings can stop when you've been smoke-free for 15 years or have a health problem that limits your treatment options or life expectancy.
Lung cancer screening for high-risk people is helpful because SCLC and some types of NSCLC grow fast and lung cancer are frequently not diagnosed before you notice symptoms. Survival depends on early diagnosis.
If your doctor is worried about lung cancer, they may:
They may also run tests and scans, including:
If they think you have lung cancer, they'll take a biopsy of the abnormal area in the lung to evaluate for cancer cells.
There are different options for treating lung cancer. The treatment you get depends on the type and stage of your lung cancer, and other factors like your age and overall health.
Lung cancer treatment may include:
The most common type of treatment for SCLC is chemotherapy. Your doctor may recommend combining it with radiation.
If you have NSCLC and it hasn't affected a large part of your lungs or spread to other areas of your body, your doctor may recommend surgery to remove the cancer cells.
You may consider joining a clinical trial. This is a study done to research lung cancer and find out if new treatments are safe and effective, or if they're better than standard treatment.
Some clinical trials may offer a better treatment for your cancer. Talk to your doctor about options.
The outlook for NSCLC is better than SCLC.
Most people find out they have SCLC when it's already spread to other parts of their body. Early detection helps, but it's often found late because you may not have symptoms.
With SCLC, the 5-year survival rate is about 7%. Without treatment, survival is about 2 to 4 months. With treatment, it's longer. If you have chemotherapy, it may be about 10 months. Even if treatment is successful, the cancer often comes back.
For men, SCLC is the leading cause of cancer-related death. For women, it's the second most common cause of cancer-related death.
Your chance of survival is higher for NSCLC, but it depends on a variety of factors. They include:
The 5-year relative survival rate for NSCLC may range from 64% if you catch it early and it hasn't spread outside your lung, to 8% if it has spread to other areas of your body like your brain, bones, liver, or other lung.
For SCLC, the 5-year relative survival rate may range from 30% in early stages to 3% if it has spread to other parts of your body.
Surviving Life-Threatening Lung Cancer: Lessons Learned
Life-threatening lung cancer has taught me many valuable lessons and made my new normal so fulfilling.
Sue McCarthy received diagnoses of breast cancer in 2001 and lung cancer in 2018. Catch up on all of Sue's blogs here!
My life has changed dramatically since my journey through stage 3B non-small cell lung cancer. I've learned, grown and lived my life more fully than I would ever have thought possible before the experience.
Living One Day at a TimeI can, and now do, live life "one day at a time" as often as possible. Our lives are precious and limited. Certainly, not every day am I blessed with sunshine, blue skies and spring flowers. There are days when I'm privileged to spend the afternoon with my best friend or hug my grandchild. However, every day provides me with something to be grateful for, something new to learn or teach to another.
Making Something Special of My Second Chance at LifeI want, and sometimes even feel the need, to make my second chance at life something special. Facing life-threatening cancer caused me to lose hope on several occasions. And yet, as I recovered spiritually at least twice, I knew that I could rise above so many, if not all, of life's greatest challenges. In addition to not letting fear dominate me when life was difficult, I began to take on and even master situations that would have been overwhelming to me in the past.
Keeping My Body HealthyI respect my body far more than I did before my diagnosis. Although I'm still striving for a better-balanced diet, I've come a long way. Although I liked to exercise in the past, I've moved on to the next level. Throughout my adult life, I've walked and occasionally hiked for pleasure and fitness. I now use my treadmill faithfully in inclement weather and walk outside when the weather is nice. More significantly, I've added more exercises. Alternate days, I lift weights, and once a week, I use a rowing machine as well as a stationary bicycle at the gym. I keep a regular bedtime, and most nights, I sleep seven hours. If I have a difficult night, I take a 20-to-30-minute nap.
Prioritizing FamilyRealizing now the value of family members, both blood relatives and individuals who are so close to me that we've informally "adopted one another," I am now making every attempt to maintain good relationships with all of them. Soon after reaching the five-year mark since my lung cancer diagnosis, I took on the role of cancer support person to cousins on both my mother's and father's sides of our family. I had not had a connection with either of them since we were children, so we were just getting to know each other as we started to share our cancer stories. It was challenging, but also rewarding.
Rising Above Serious ChallengesI now understand that I can become very ill, very weak, feel hopeless emotionally, or a financial failure, and yet climb back out of that hole, attaining comparative health and wealth. It took me one ominous physically, mentally, emotionally and spiritually overwhelming night during chemotherapy treatment to lead me to the realization that I can't and won't give up on myself and even life itself.
Practicing a Dynamic FaithI've learned that God's power in my life is limitless. Going forward, I will never forget that my life is a miracle. I will never minimize God's strength and his capacity to heal me and so many others who turn to Him in their hour of need. I changed churches, which led me to feel more fulfilled in my worship experience. I have become more actively involved as a volunteer in the cancer support group there.
Accepting That My Body Has Undergone Harsh TreatmentMy body has suffered damage as a result of chemotherapy and radiation that has likely weakened it. Yes, it is disappointing that I will probably struggle more with other illnesses; my life expectancy could be shortened. However, there is so much more to be grateful for in my new normal life.
Am I Really Cured?It's hard for any patient with cancer to forget the day he or she was told, "I can treat you, but I can't promise you that you can be cured." Hence, anxiety about recurrence is typically in the back of my mind. Because of this, I prefer the term "remission" to "cure."
And for me, the most important lesson I learned as a result of stage 3B non-small cell lung cancer was that it takes a long time to recover from life-threatening cancer and the treatment necessary to be cured. I had always been a very active person; I wanted and unwisely believed that I would finish treatment and get right back into my old life. I was very wrong, and now I know how important it is to walk, not run, out of treatment and into rest and recovery, then slowly evolve. In my new normal, I am wiser and more content. I am grateful to have become the person I was always meant to be.
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