Lung Cancer Treatment

by Food and Drug Administration (FDA)

(Page 2 of 3)

About 75 percent of lung cancer cases are categorized as non-small cell lung cancer, and the other 25 percent are small cell lung cancer. Lung cancer can multiply quickly and form large tumors, which sometimes spread to lymph nodes and other organs.

Once lung cancer is detected, a treatment plan is developed based on the patient's physical health, whether the lung cancer is small cell or non-small cell and how extensively the cancer has spread. (See "Stages of Lung Cancer.") Treatment may include surgery, chemotherapy, radiation, or a combination of two or more of these therapies.

FDA recently approved three therapies to treat non-small cell lung cancer: Photofrin (porfimer sodium), Taxol (paclitaxel) in combination with the commonly used cancer drug cisplatin, and Gemzar (gemcitabine hydrochloride) in combination with cisplatin.

Photofrin, a light-activated drug, was approved in January 1998 for patients with early stage, non-small cell lung cancer who cannot undergo surgery or radiotherapy due to other medical conditions. Administered intravenously, Photofrin accumulates in the tumor cells. A laser, directed toward the cancerous tissue, then activates the drug. A significant side effect is extreme photosensitivity, making it necessary for patients to stay out of the sun "almost completely for about a month," says Grant Williams, M.D., a medical team leader in the division of oncology drug products in FDA's Center for Drug Evaluation and Research.

Williams admits that the number of patients with early stage lung cancer who will be helped by Photofrin will be quite limited. "We're talking about a very small number of patients compared to the number of lung cancer patients who have extensive cancers that can't be operated on," he says.

Williams notes, however, that Photofrin may also be able to relieve symptoms in some patients with advanced non-small cell lung cancer. He explains that Photofrin has been demonstrated to be helpful in relieving breathing difficulties caused by tumors that are obstructing the flow of air through patients' bronchial tubes. Approval for this use was recommended by an FDA advisory committee in September 1998. Final FDA action is pending.

Taxol (paclitaxel), already approved to treat other cancers, was approved last year for use in combination with cisplatin for the first-line treatment of non-small cell lung cancer in patients who are not candidates for surgery or radiation therapy.

Gemzar (gemcitabine hydrochloride), another already approved cancer drug, received an additional approval in August for use in combination with cisplatin for the first-line treatment of patients with inoperable, locally advanced or metastatic non-small cell lung cancer.

Although results of some studies have shown that new treatments may only give patients an additional month or two to live, "there are not a lot of effective treatments for advanced stage non-small cell lung cancer," says Isagani Chico, M.D., a medical officer in FDA's division of oncology drug products.

Because small cell lung cancer has typically spread by the time it's detected, it generally cannot be cured by surgery. Treatment usually begins with a combination of two or more drugs to kill cancer cells throughout the body. Later, treatment with more drugs combined with radiation therapy or radiation alone, is often prescribed. Chemotherapy (drugs) and radiation therapy shrink tumors in most patients, and sometimes the disease goes into remission. But in many cases the cancer begins to grow again when it becomes resistant to treatment.

The Road Ahead

The future and course of lung cancer research seems to vary tremendously depending on who you talk to. Some experts believe prevention and early detection are the best bet. Others insist that improved treatments and gene therapy will be the answer. Paul Bunn Jr., M.D., believes that more research needs to be conducted to see if it's feasible to use x-rays to screen cigarette smokers and people exposed to asbestos, who are at highest risk of developing the disease. Bunn, the director of the University of Colorado Cancer Center and past chairman of FDA's Oncologic Drugs Advisory Committee, believes that the increased use of tobacco among teenagers and adults must be curtailed and that one of the best weapons against lung cancer is prevention.

As for lung cancer patient Ron Norgord, he's banking on a drug that's intended to cut off the blood supply to tumors using molecular technology. The 63-year-old resident of Pasadena, Calif., who has been on a variety of chemotherapy and radiotherapy treatments since he was diagnosed about a year and a half ago, was accepted in September into a clinical trial of a drug that inhibits the growth of tumor blood vessels at UCLA's Cancer Center. "I'm quite encouraged by the results so far," Norgord says. "It's too early to see yet, but I see some positive things coming out of the treatment." One positive sign came after his first treatment, when his chances for fighting infections improved because his white blood cell count finally came up into the normal range.

Researchers are currently studying a variety of drugs and drug combinations designed to extend patients' lives and improve their quality of life. They are also studying various aspects of the disease in the hope of someday developing more effective treatments. Here are just a few of the recent findings, studies and developments related to lung cancer:

Researchers at the Dana-Farber Cancer Institute and the Brigham and Women's Hospital in Boston have identified six factors that place patients with early-stage lung cancer at risk for recurrence. These factors include: large tumor size, a specific tumor subtype of adenocarcinoma (a type of lung cancer), evidence that the cancer has entered the channels of the lymph system, and the presence of certain proteins commonly associated with cancers. Patients with two or more of these risk factors have an increased chance of their cancers recurring. This knowledge may help doctors decide which patients would benefit most from chemotherapy after surgery.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.