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by Joan Schiller, MD Chief, Division of Hematology and Oncology University of Texas Southwestern Medical Center

Lung cancer is sometimes referred to as the “invisible” cancer. Its impact may not often be discussed; but it is often felt. This disease takes more American lives each year than breast, colon, and prostate cancers combined. One in 16 women will develop lung cancer in her lifetime,1 and anyone can get it. Do you know the facts you need to protect yourself and your family?

1Lung cancer takes nearly twice as many women’s lives as breast cancer.

In a nationwide survey conducted by the National Lung Cancer Partnership, 83 percent of women did not know that lung cancer takes more lives than breast cancer. 2 Lung cancer will claim about 30,000 more lives than breast cancer this year. In fact, lung cancer takes the lives of more women each year than breast, ovarian, and uterine cancers combined.Lung cancer is sometimes thought of as a man’s disease. However, of the 215,000 cases of lung cancer diagnosed in the U.S. each year, nearly 100,300 (close to 50 percent) are in women. Over 71,030 women die from lung cancer annually, accounting for 26 percent of cancer deaths among women.(1)One of the reasons this cancer is so deadly is because by the time symptoms are noticeable, the disease has often spread. The five-year survival rate for lung cancer is only 16 percent, compared to an 89 percent five-year survival rate for breast cancer.(1,3) A major reason for this is that lung cancer is more likely to be diagnosed at a later stage than many other types of cancers.1 Symptoms often don’t become noticeable until the cancer has grown or spread beyond the point where it can be removed surgically.

Smoking is the number one cause of lung cancer; but it is not the only cause.

Some women are under the false impression that if they don’t smoke, or they don’t live in a home with someone else who smokes, they are safe from lung cancer.While it’s true the greatest risk factors for lung cancer are smoking-related, there are other causes of the disease. The second most common cause of lung cancer is radon, an odorless, colorless natural gas.(4) Other risk factors include: lung scarring from tuberculosis and occupational or environmental exposure to secondhand smoke, air pollution, radiation, arsenic, asbestos and some organic chemicals.1 In some cases, no obvious risk factor is found.

One in five women with lung cancer have never smoked, versus one in ten men with lung cancer.

Women who have never smoked are more at risk for lung cancer than men who have never smoked.3 Of the approximately 20,000 to 25,000 people who’ve never smoked diagnosed with lung cancer in the U.S. each year, more than 60 percent of them are women.(5)Women are also more affected by lung cancer caused by secondhand smoke. Of the approximately 3,400 people who die from lung cancer in the U.S. annually due to exposure from secondhand smoke, 2200 (65 percent) of them are women.6 Some evidence suggests that women may be more sensitive than men to the cancer-causing effects of chemicals in cigarettes.(7-13)There’s an age difference, too. Approximately 9 percent of women diagnosed with lung cancer are younger then 50 years old, compared to 7 percent of men with lung cancer.(14)

Precision Cancer Medicine & Genomics Is Changing How Lung Cancer is Treated

There is no longer a “one-size-fits-all” approach to lung cancer treatment; the cancer and its response to treatment can vary widely. By exploring the reasons for this variation, researchers have begun to pave the way for personalized cancer treatment with precision cancer medicines and immunotherapy.

Not all cancer cells are alike. Cancer cells may differ from one another based on what genes have mutations. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. This “genomic testing” is performed on a biopsy sample of the cancer and once a genetic abnormality is identified, a specific precision cancer medicine or targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells.Precision cancer medicines can be used both instead of and in addition to chemotherapy to improve treatment outcomes and are now either administered alone or in combination with chemotherapy as initial treatment of non small cell lung cancer.

Learn About The Latest Advances in Lung Cancer Treatment

Targeted and More- Individualized Treatment for NSCLC Becomes a Reality

Historically, lung cancers were diagnosed solely by examining tumor tissue under a microscope; upon diagnosis all patients were treated with the same chemotherapy. Now doctors are personalizing care by finding the genetic alterations within the cancer that drive its growth, and they are using medicines that specifically counteract the cancer that develops as a result

of those genetic mutations. These targeted therapies are designed to treat only the cancer cells while minimizing damage to normal, healthy cells. The ability to test a patient’s cancer for individual differences at the genetic level, and to make treatment decisions based on those differences, is the hallmark of precision medicine.

Tailored treatments have emerged to match a person’s genetic makeup or a tumor’s genetic profile. As a result, all patients with lung cancer should undergo molecular testing for epidermal growth factor receptor (EGFR), the anaplastic lymphoma kinase (ALK) mutation, and the ROS1 mutation; the results of this testing can guide physicians in determining which therapies are more likely to be effective. In fact, guidelines now recommend molecular testing on a sample of the cancer taken during a biopsy so that the results can be considered before deciding on treatment.

Immuno-oncology

Immunotherapy treatment of NSCLC has also progressed considerably over the past few decades and has now become a standard treatment. The immune system is a network of cells, tissues, and biologic substances that defend the body against viruses, bacteria, and cancer. Doctors have been trying for years to find ways to harness an individual’s immune system to fight cancer.

The immune system recognizes cancer cells as foreign and can eliminate them or keep them in check—up to a point. Cancer cells are very good at finding ways to avoid immune destruction, however, so the goal of immunotherapy is to help the immune system eliminate cancer cells by either activating the immune system directly or inhibiting the mechanisms of suppression of the cancer.

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Recent promising clinical results have generated an explosion of interest—and research funding— in the field of immuno-oncology. Researchers are mainly focused on two promising types of immunotherapy. One type creates a new, individualized treatment for each patient by removing some of the person’s immune cells, altering them genetically to kill cancer, and then infusing them back into the bloodstream. This procedure has been pioneered mainly in the treatment of leukemia or lymphoma.

The second type of immunotherapy is a group of drugs that do not have to be tailored to each patient; these are called checkpoint inhibitors. These drugs block a mechanism, called a checkpoint, that cancer uses to shut down the immune system.1,3 These drugs have been approved by the US Food and Drug Administration (FDA) to treat several types of cancer, including NSCLC.

Checkpoint inhibitors work on killer T-cells—the white blood cells that are often described as the soldiers of the immune system. T-cells have built-in brakes, or checkpoints, to turn them off and keep them from attacking normal tissue, which could result in autoimmune diseases. One checkpoint stops T-cells from multiplying; another weakens them and shortens their life span.

Lung Cancer Resources

Staying informed with the latest news on the prevention, screening of high risk individuals, and treatment advances are all important in order to reducing the risk of developing lung cancer and ensure optimal care and achieve the best possible outcomes.

Ask The Experts About Lung Cancer

CancerConnect and the Personalized Medicine Foundation partnered with Lung cancer experts from Dana Farber Cancer Institute and the University of Pennsylvania to provide individuals the opportunity to engage with lung cancer experts. David M. Jackman, M.D, and Dr. Charu Aggarwal M.D. answered questions and relayed important information about lung cancer.

Our Favorite Advocacy Organizations & Cancer Resources

CancerConnect Lung Cancer Community provides a community where lung cancer patients and their caregivers can exchange information and get support and inspiration.

Lung cancer research is significantly underfunded.

Recently the National Cancer Institute and the Department of Defense spent approximately $1,900 per lung cancer death compared to $20,00 per breast cancer death, $12,000 per prostate cancer death, and $5,500 per colorectal cancer death.(1,15,16)The only way we are going to make a considerable impact on the survival rates is by funding research to find news ways to detect, diagnose, and treat the disease.

You can reduce your risk.

If you smoke, get the help you need to quit (state quit lines can be accessed at www.naquitline.org or by calling 1-800-QUIT-NOW).· If you live in an area with high levels of radon coming from the bedrock (see www.epa.gov/radon), the surgeon general recommends having your house tested for radon exposure. If radon levels are too high, a device can be installed to reduce them· Eat a well-balanced diet and exercise. These activities help reduce the risk of all cancers.· If you smoke now or smoked in the past, or have a family history of lung cancer, consider speaking to your doctor about screening tests that may be available to you. Lung cancer is most treatable when it is detected early.

References:

  1. American Cancer Society. Cancer Facts and Figures 2011. Atlanta: American Cancer Society; 2011.
  2. National Lung Cancer Partnership. Nationwide survey of lung cancer awareness. 2010.
  3. Wakelee, H.A., et al., Lung Cancer Incidence in Never Smokers. J Clin Oncol, 2007. 25(5): p. 472-8.
  4. National Research Council. Health Effects of Exposure to Radon: BEIR VI. National Academy Press, Washington, DC, 1999.
  5. MMWR Morb Mortal Wkly Rep. 2005. 54(25):625-628
  6. California Environmental Protection Agency. Proposed identification of environmental tobacco smoke as a toxic air contaminant-June 2005. California Environmental Protection Agency, California Air Resources Board, Office of Environmental Health Hazard Assessment; 2005.
  7. International Early Lung Cancer Action Program Investigators, Women’s susceptibility to tobacco carcinogens and survival after diagnosis of lung cancer. JAMA, 2006. 296(2): p. 180-84.
  8. Henschke, C.I. and O.S. Miettinen, Women's susceptibility to tobacco carcinogens. Lung Cancer, 2004. 43(1): p. 1-5.
  9. Nordlund, L.A., J.M. Carstensen, and G. Pershagen, Are male and female smokers at equal risk of smoking-related cancer: evidence from a Swedish prospective study. Scand J Public Health, 1999. 27(1): p. 56-62.
  10. Tang, D.L., et al., Associations between both genetic and environmental biomarkers and lung cancer: evidence of a greater risk of lung cancer in women smokers. Carcinogenesis, 1998. 19(11): p. 1949-53.
  11. Zang, E.A. and E.L. Wynder, Differences in lung cancer risk between men and women: examination of the evidence. J Natl Cancer Inst, 1996. 88(3-4): p. 183-92.
  12. Risch, H.A., et al., Are female smokers at higher risk for lung cancer than male smokers? A case-control analysis by histologic type. Am J Epidemiol, 1993. 138(5): p. 281-93.
  13. Harris, R.E., et al., Race and sex differences in lung cancer risk associated with cigarette smoking. Int J Epidemiol, 1993. 22(4): p. 592-9.
  14. Fu, J.B., et al., Lung cancer in women: analysis of the national Surveillance, Epidemiology, and End Results database. Chest, 2005. 127(3): p. 768-77.
  15. National Cancer Institute: http://budgettool.cancer.gov/budget-spending/funding-by-cancer-type/fiscal-year-2010.aspx
  16. Department of Defense Lung, Breast, and Prostate Research Program. Descriptions available at http://cdmrp.army.mil/researchprograms.shtml
  17. Merck’s KEYTRUDA® (pembrolizumab)Demonstrates Superior Progression-Free and Overall Survival Compared to Chemotherapy as First-Line Treatment in Patients with Advanced Non-Small Cell Lung Cancer [news release]. Merck website. Available at: . June 16, 2016.
  18. Leighl NB, Rekhtman N, Biermann WA, et al. Molecular testing for selection of patients with lung cancer for epidermal growth factor receptor and anaplastic lymphoma kinase tyrosine kinase inhibitors: American Society of Clinical Oncology endorsement of the College of American Pathologists/International Association for the Study of Lung Cancer/Association for Molecular Pathology Guideline. Journal of Clinical Oncology. 2014;32(32):3673-79. Available at: . Accessed September 30, 2016.
  19. Brahmer J, Reckamp KL, Bass P, et al. Nivolumab versus docetaxel in advanced squamous-cell non–small-cell lung cancer. New England Journal of Medicine. 2015;373(2):123-35. Abstract. doi: 10.1056/NEJMoa1504627.
  20. Borghaei H, Paz-Arez L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non–small-cell lung cancer. New England Journal of Medicine. 2015;373(17):1627-39. doi: 10.1056/NEJMoa1507643.
  21. Garon EB, Rizvi NA, Hui R, et al. Pembrolizumab for the treatment of non-small-cell lung cancer. New England Journal of Medicine. 2015;372(21):2018-20. Abstract. doi: 10.1056/ NEJMoa1501824.
  22. Bristol-Myers Squibb Announces Top-Line Results from CheckMate -026, a Phase 3 Study of Opdivo (Nivolumab) in Treatment-Naïve Patients with Advanced Non-small Cell Lung Cancer [news release]. Bristol-Myers Squibb website. Available at: . August 5, 2016.

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