Lung Cancer Treatments & Progress

[waltky]

New gene tests for lung cancer may improve treatment...

Gene Tests May Improve Lung Cancer Care
May 30, 2014 ~ Nearly a million people die every year from lung cancer, and the World Health Organization expects the death rate to rise as more people take up cigarette smoking. Researchers may have made an important step toward controlling this disease and extending lives.

Cigarette smoking is responsible for most lung cancers. Studies have established that connection. Others have established that inhaling toxins from someone else's cigarettes can also cause the disease. Nearly 1 million people die from lung cancer every year. Another 600,000 die from second-hand smoke. And, until recently, the treatment all patients received was the same chemotherapy. Sometimes it helped, but sometimes it didn't.

Researchers have been trying to come up with better treatments to shrink the tumors without affecting normal tissue or subjecting patients to the negative side-effects of chemotherapy. One new treatment relies on a test to identify damaged genes called oncogenes that allow cancer cells to grow and spread. Oncologist Mark Kris from Memorial Sloan Kettering Cancer Center led a study that examined the role oncogenes play in the spread of cancer. "That damaged gene makes certain proteins, and those proteins become absolutely critical to the growth of that cancer cell,” said Kris.

Kris led a study involving 1,000 patients with advanced lung cancer, analyzing tumors for 10 different mutations that drive the spread of the disease. “We had this vision that we could test the tumors of patients at the time they were diagnosed. We could test for 10 of these oncogenes that we know underlie lung cancer," said Kris. "We were able to find one of those driver oncogenes in 64 percent of the patients, and in 28 percent of the patients we were able to choose a therapy based on that information.”

Identifying those damaged genes would allow doctors to better target treatment. Dr. Kris said the testing is fast, accurate and cost effective. The results showed that patients whose driver oncogenes were specifically targeted lived, on average, a year longer than those who received standard chemotherapy. In addition, drugs directed at the damaged genes cause fewer side-effects. Kris said the results of the study will help treat people with all types of cancer as doctors learn more about genes that drive the disease. The study was published in the Journal of the American Medical Association.

Gene Tests May Improve Lung Cancer Care

 

[auditor0007]

My mother was diagnosed with lung cancer last year. She never smoked in her entire life. Luckily, they found it at a very early stage and were able to remove the lower lobe of her lung surgically. She required on chemo or radiation and has recovered fairly well, at least as well as you can expect from an 83 year old woman.

 

[carthymc9]

It is very good news that she recovery soon. Now I have to suggest, you should accept life or health insurance policy for your mum right now.

 

[DGS49]

It doesn't add to one's credibility when one makes uncorroborated bullshit statements as though they were proven fact, to wit,

"...Another 600,000 die from second-hand smoke."

Baloney.

 

[waltky]

Lung cancer can lay dormant for 20 years...

Scientists Find Lung Cancer Can Lie Hidden for 20 Years
October 09, 2014 — Lung cancer can lie dormant for more than 20 years before turning deadly, helping explain why a disease that kills more than 1.5 million a year worldwide is so persistent and difficult to treat, scientists said on Thursday.

Two papers detailing the evolution of lung cancer reveal how after an initial disease-causing genetic fault - often due to smoking - tumor cells quietly develop numerous new mutations, making different parts of the same tumor genetically unique. By the time patients are sick enough to be diagnosed with cancer, their tumors will have developed down multiple evolutionary pathways, making it extremely hard for any one targeted medicine to have an effect. The findings show the pressing need to detect lung cancer before it has shape-shifted into multiple malignant clones. "What we've not been able to understand before is why this is really the emperor of all cancers and one of the hardest diseases to treat," said Charles Swanton, an author on one of the papers from Cancer Research U.K.'s London Research Institute. "Previously, we didn't know how heterogeneous these early-stage lung cancers were."

Lung cancer is the world's deadliest cancer, killing an estimated 4,300 people a day, according to the World Health Organization. Around 85 percent of patients have non-small cell lung cancer (NSCLC), the type analyzed in the two studies. To get a clearer understanding of the disease, the two groups of British and American scientists looked at genetic variability in different regions of lung tumors removed during surgery and worked out how genetic faults had developed over time. What they found was an extremely long latency period between early mutations and clinical symptoms, which finally appeared after new, additional faults triggered rapid disease growth. In the case of some ex-smokers, the initial genetic faults that started their cancer dated back to the time they were smoking cigarettes two decades earlier. But these faults became less important over time and more recent mutations were caused by a new process controlled by a protein called APOBEC. The research was published in the journal Science.

An X-ray showing lung cancer.

New Drugs

Ramaswamy Govindan of Washington University School of Medicine, who was not involved in the studies, said better understanding of such genetic alterations was key to developing more effective treatments. There are also hopes for a new generation of immunotherapy drugs that boost the immune system's ability to detect and fight tumors, which could be particularly applicable to lung cancer. "The large number of mutations may be the tumor's Achilles heel because every time a new mutation forms there is a chance for the immune system to recognize it," Swanton told Reuters. Immunotherapy drugs from companies such as Bristol-Myers Squibb, Merck & Co., Roche and AstraZeneca are already undergoing tests in lung cancer, with data on Bristol's medicine Opdivo due later this year.

Apart from better drugs, a critical challenge is to find improved ways to detect lung cancer before it develops the multiple genetic faults that eventually trigger rapid tumor growth and spread. Currently, doctors use computerized tomography (CT) to detect lung cancer, but by the time a nodule is big enough to be spotted it on a scan it may contain a billion genetically diverse cancer cells. For the future, oncologists are pinning hopes on a new approach, known as liquid biopsy, that may be able to detect signs of cancer much earlier from DNA circulating in the blood. The current prognosis for NSCLC is grim, with most patients diagnosed when the disease has already spread and only around 15 percent surviving for at least five years after that.

Scientists Find Lung Cancer Can Lie Hidden for 20 Years

See also:

Experts Spotlight Major Killer on World Thrombosis Day
October 09, 2014 WASHINGTON — Thrombosis is the world's third leading cause of cardiovascular death after heart attack and stroke, but most people have never heard of it. Medical experts hope that will change after Monday, which they have declared World Thrombosis Day.

An estimated one to three people per one thousand develop venous thromboembolism, caused by a blood clot in the leg. The danger occurs if the clot, unnoticed, travels to the lungs and chokes off blood flow. Gary Raskob is with the University of Oklahoma Health Center’s College of Public Health, and is chairman of the World Thrombosis Day Steering Committee, which is highlighting the dangers of thrombosis. “In about a third of the cases and most of the deaths, the initial presentation is sudden death. And for that reason, prevention is the key to reducing death from this condition,” said Raskob.

Venous thromboembolism is sometimes called the “sitting disease” because a clot usually develops when people are inactive for a long period of time, such as when they are sitting on an airplane or in a wheelchair, or recovering from surgery in the hospital. Other risk factors include cancer and medications containing the hormone estrogen.

Susana Reyes sits in her living room. Reyes suffered a thrombosis attack in April 2012 which left her left hand and left leg partially paralyzed.

Raskob said individuals with concerns should speak with their health care providers and know the symptoms. “For clots in the legs, pain, tenderness or swelling, redness or warmth of the leg. And for crossing the lungs, shortness of breath, chest pain, rapid breathing, a sudden rapid heart rate, or sometimes collapse or passing out of the patient if it’s a very big embolism,” said Raskob.

The International Society of Thrombosis and Hemostasis is leading the global awareness effort to educate the public about the potentially deadly blood clots. World Thrombosis Day is being recognized by more than 100 medical and patient organizations. Five journals, including The Lancet, are publishing comprehensive reviews about the global burden of thrombosis. Raskob says early recognition is very important, because anti-clotting drugs are very effective in treating this silent killer.

Experts Spotlight Major Killer on World Thrombosis Day

 

[Politico]

Glad to hear some folks are surviving. Doesn't change the fact there is no cure for cancer.

 

[Delta4Embassy]

New gene tests for lung cancer may improve treatment...

Gene Tests May Improve Lung Cancer Care
May 30, 2014 ~ Nearly a million people die every year from lung cancer, and the World Health Organization expects the death rate to rise as more people take up cigarette smoking. Researchers may have made an important step toward controlling this disease and extending lives.

Cigarette smoking is responsible for most lung cancers. Studies have established that connection. Others have established that inhaling toxins from someone else's cigarettes can also cause the disease. Nearly 1 million people die from lung cancer every year. Another 600,000 die from second-hand smoke. And, until recently, the treatment all patients received was the same chemotherapy. Sometimes it helped, but sometimes it didn't.

Researchers have been trying to come up with better treatments to shrink the tumors without affecting normal tissue or subjecting patients to the negative side-effects of chemotherapy. One new treatment relies on a test to identify damaged genes called oncogenes that allow cancer cells to grow and spread. Oncologist Mark Kris from Memorial Sloan Kettering Cancer Center led a study that examined the role oncogenes play in the spread of cancer. "That damaged gene makes certain proteins, and those proteins become absolutely critical to the growth of that cancer cell,” said Kris.

Kris led a study involving 1,000 patients with advanced lung cancer, analyzing tumors for 10 different mutations that drive the spread of the disease. “We had this vision that we could test the tumors of patients at the time they were diagnosed. We could test for 10 of these oncogenes that we know underlie lung cancer," said Kris. "We were able to find one of those driver oncogenes in 64 percent of the patients, and in 28 percent of the patients we were able to choose a therapy based on that information.”

Identifying those damaged genes would allow doctors to better target treatment. Dr. Kris said the testing is fast, accurate and cost effective. The results showed that patients whose driver oncogenes were specifically targeted lived, on average, a year longer than those who received standard chemotherapy. In addition, drugs directed at the damaged genes cause fewer side-effects. Kris said the results of the study will help treat people with all types of cancer as doctors learn more about genes that drive the disease. The study was published in the Journal of the American Medical Association.

Gene Tests May Improve Lung Cancer Care

Wasn't this how "I Am Legend" began?

 

[Delta4Embassy]

Also,

"Cigarette smoking is responsible for most lung cancers. Studies have established that connection."

Uh no. According to CDC stats, less than 40% of lung cancer patients used tobacco.

Because pretty near everything in the modern world has been shown to contribute to cancer risks, what finally causes the cancerous cells present in everyone naturally to start replicating is impossible to determine. We can identify risk factors like smoking, obesity, chemical exposure as in flame retardant furniture and products, etc. but what finally does it isn't yet known.

Best you can do is minimize your risk factors. But to truly say 'smoking causes lung cancer' everyone who smokes would have to get it when less than 40% do.

"Tobacco's contribution to cancer deaths is currently estimated to be 30%."
Current Trends Smoking and Cancer

Many things contribute to cancer. But it's inaccurate to say smoking, or any other single source causes cancers. It is accurate to say if you don't smoke, become obese, expose yourself to chemical flame retardants you'll greatly reduce your chance of developing a cancer, but you're still gonna die from something eventually.

 

[waltky]

New treatment for advanced lung cancer...

FDA approves new treatment for advanced lung cancer
Oct. 6, 2015 - The drug shrank tumors in 41 percent of patients with a specific genetic mutation.

The Food and Drug Administration approved a new drug for patients with advanced non-small cell lung cancer whose tumors have a specific genetic mutation. The drug, Keytruda, was given breakthrough therapy designation and a sped-up approval because it was deemed to be a significant improvement over available treatments based on the results of clinical trials. "Our growing understanding of underlying molecular pathways and how our immune system interacts with cancer is leading to important advances in medicine," Dr. Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research, said in a press release. "Today's approval of Keytruda gives physicians the ability to target specific patients who may be most likely to benefit from this drug."

Lung cancer is the largest cancer killer in the United States, however the newly approved drug may help patients to survive longer with the disease.​

Keytruda blocks a cellular pathway found in the body's immune cells and some cancer cells, helping the immune system fight cancer cells. The drug specifically works in patients with a genetic mutation, which the FDA requires patients be tested for in order to be eligible for the treatment.

The drug was tested with 550 advanced lung cancer patients, 61 of whom had the genetic mutation and already been treated with chemotherapy. In 41 percent of patients, tumors shrank after treatment with the drug, an effect that lasted between 2.1 and 9.1 months. "The approval of this drug and a test to identify patients most likely to benefit has the potential to transform the way that lung cancer is treated," Dr. Edward Garon, a researcher at the University of California Los Angeles, told NBC News. "For people battling this deadly disease, this approach provides real hope of long-lasting responses while avoiding the toxicities of typical chemotherapy."

FDA approves new treatment for advanced lung cancer

 

[waltky]

Keytruda immunotherapy works either on its own or with chemotherapy....

'New day' in lung cancer as Merck drug shines, works with chemo
October 9, 2016 - Merck & Co scored a double hit on Sunday with new clinical data showing its Keytruda immunotherapy offered big benefits in previously untreated lung cancer patients, either when given on its own or with chemotherapy.

As a monotherapy, Keytruda halved the risk of disease progression and cut overall deaths by 40 percent compared to chemotherapy alone in pre-selected patients whose tumors had been tested using a biomarker. And when given with two older chemotherapy drugs in non-selected patients, it was almost twice as likely to shrink tumors as chemotherapy alone.

Another similar drug from Roche also demonstrated broad efficacy as a so-called second-line option in patients who had received prior treatment. "Remember this day. It's a new day for lung cancer treatment," Stefan Zimmermann of Lausanne's University Hospital told reporters at the European Society for Medical Oncology (ESMO) congress as the results were presented. An editorial in the New England Journal of Medicine, where the Merck monotherapy results were published, said Keytruda could become "a new standard of care".

The various findings suggest that treating lung cancer - the biggest cancer killer globally - with powerful new immune system-boosting medicines is going to involve more permutations than some experts originally expected. Rival drugmaker Bristol-Myers Squibb had tried a catch-all approach with its Opdivo drug but it failed to help previously untreated patients when given on its own in a trial that included people with low levels of a protein called PD-L1.

Keytruda, as a sole agent, was targeted only at patients with high PD-L1, making them more receptive to immunotherapy. Lead researcher Martin Reck of Germany's Lung Clinic Grosshansdorf predicted that testing for the PD-L1 biomarker would now become standard "from today". U.S. regulators are expected to decide whether to approve Keytruda for first-line non-small cell lung cancer, the most common type, by Dec. 24. Merck had already said in June that Keytruda worked in the trial but the scale of the benefit was only disclosed at ESMO.

COMBINATION THERAPY

 

[waltky]

Adding Chemo to Cancer Immunotherapy...

Roche Win Boosts Case for Adding Chemo to Cancer Immunotherapy
November 20, 2017 — Cancer doctors struggling to work out the best way to use modern immunotherapy drugs now have further evidence of the benefits of adding them to chemotherapy, despite earlier skepticism.

News that Roche's immune system-boosting drug Tecentriq delayed lung cancer progression when given alongside chemo and its older drug Avastin validates the approach for the first time in a large Phase III clinical trial. It is a significant milestone for physicians, patients and investors, who are trying to assess the competitive landscape as drugmakers race to develop better ways to fight tumors in previously untreated lung cancer. Lung cancer is by far the biggest oncology market and first-line treatment provides access to the most patients, opening up potential annual sales forecast by some analysts at $20 billion. Roche and Merck & Co have led the way in pioneering so-called "chemo-combo" treatment, while AstraZeneca and Bristol-Myers are betting primarily on mixing two immunotherapies. AstraZeneca notably failed to show a similar
benefit in a high-profile clinical trial in July.

Stefan Zimmermann, an oncologist at Lausanne University Hospital in Switzerland, said the Roche data would help scotch concerns that chemo might hamper the new class of immuno-oncology medicines. "Many experts in the field will be relieved because there has been uncertainty ... I think this will really encourage many of us to use this combination upfront," he told Reuters. "For now, the only positive data that we have is for chemo combination." Merck, in fact, already has U.S. approval to add chemo to its immunotherapy drug Keytruda - but this was based on a small trial and the company withdrew a similar European application last month, knocking confidence in its strategy.

Swiss drugmaker Roche's logo is seen at their headquarters in Basel, Switzerland.​

Since Keytruda, Bristol's Opdivo, Roche's Tecentriq and AstraZeneca's Imfinzi are all rival inhibitors of biological switches known as PD-1 or PD-L1, the market is "largely a zero-sum game," according to Bernstein analyst Tim Anderson. "Roche's good fortune means there is less to go around for other companies," he said. In the case of Merck, the U.S. drugmaker now faces a rival with a different and perhaps superior drug combination. Roche believes adding Avastin in addition to chemo can further help restore anti-cancer immunity. For AstraZeneca and Bristol, the bar has just been raised for two other key clinical trials sponsored by the drugmakers that are expected to report results in 2018.

Roche itself will present full results on the ability of its new combination to delay the worsening of lung cancer at a European Society for Medical Oncology meeting in Geneva on December 7. Data on whether it also helps patients live longer is expected in the first half of next year. Overall survival is the gold standard in cancer care but proving a treatment extends the time before disease progresses is an important marker on the way. "If there is positive progression-free survival then I think it is very, very likely this will also translate into an overall survival benefit over time," said Zimmermann.

Roche Win Boosts Case for Adding Chemo to Cancer Immunotherapy

 

[waltky]

Cost Effective to Test for All Lung Cancer Mutations at Once...

Study: Cost Effective to Test for All Lung Cancer Mutations at Once
May 16, 2018 — Testing advanced lung cancer patients for all of the possible genetic mutations that could be driving their cancer at once is more cost effective than testing for one or a limited number of genes at a time, U.S. researchers reported Wednesday.

There are eight targeted therapies doctors can use to treat nonsmall-cell lung cancer (NSCLC) patients based on genetic defects, and more treatments are in clinical trials or awaiting approval. Companies such as Foundation Medicine Inc. and Thermo Fisher Scientific Inc. offer genetic profiling tests using so-called next-generation sequencing that can identify hundreds of potential cancer-causing gene mutations from a small tissue sample at once. These tests are used to match patients to specific therapies targeting those genes or to clinical trials testing new drugs.

Insurance companies have been slow to pay for sequencing for all possible mutations at once, arguing such comprehensive testing amounts to funding research, not medical care. They often require doctors to test for individual genes sequentially or use a limited panel that looks for suspect genes associated with approved treatments. “Our results showed there were substantial cost savings compared with all the other strategies,” Dr. Nathan Pennell of the Cleveland Clinic’s lung cancer program said in a telephone briefing Wednesday.

Lab officer cuts a DNA fragment under UV light from an agarose gel for DNA sequencing as part of research to determine genetic mutation in a blood cancer patient in Singapore.​

Last November, the U.S. Food and Drug Administration approved Foundation’s next-generation test, and the Centers for Medicare and Medicaid Services in March said it would pay for next-generation sequencing for Medicare-eligible patients with advanced cancer. Often, tumor tissue from a biopsy is scarce, and sequential testing can sometimes require a second biopsy to gather more sections of the tumor. In the study released ahead of the American Society of Clinical Oncology Meeting in Chicago next month, researchers at the Cleveland Clinic and colleagues modeled the cost of next-generation sequencing versus other types of testing to Medicare and to a commercial health plan with one million hypothetical members.

In the model, which was based on the number and age of NSCLC patients in the United States, next-generation sequencing saved as much as $2.1 million for Medicare, the government health plan for older Americans, and more than $250,000 for commercial providers. The study did not factor in the cost of treatment. The study was funded by Swiss drugmaker Novartis, maker of Zykadia, a drug that targets ALK mutations found in about 4 percent of NSCLC cases.

Study: Cost Effective to Test for All Lung Cancer Mutations at Once