LUNG CANCER
Reducing Lung Cancer Mortality: 2014 Update
L
ung cancer is the leading cause of cancerrelated mortality with an estimated 228,190 new cases and 159,480 deaths anticipated in the United States in 2013. In this issue of Seminars in Oncology we present a decade of progress as we have witnessed a paradigm shift in the early detection, staging, and treatment of lung cancer worldwide. Despite progress, the overall survival for lung cancer patients remains poor at 15%. In lung cancer, clinical outcome is related to the stage at diagnosis and hence it is generally assumed that early detection of occult tumors will lead to improved survival. Cigarette consumption remains the leading risk factor for lung cancer development and smoking cessation remains an important preventive strategy. To date, large randomized phase III trials have failed to demonstrate a benefit to chemoprevention strategies. Siegfried and Stabile review the role of steroid hormones in lung cancer development and discuss the potential therapeutic benefits and role of endocrine therapies for lung cancer prevention. In patients diagnosed with lung cancer, accurate staging is critical to selecting an appropriate therapeutic plan. Maldonado and Jett review a decade of unprecedented technological advances allowing for more accurate and less invasive staging of lung cancer. The accurate determination of tumor histology and molecular testing has become essential to the selection of appropriate therapy. Sakashita and colleagues review the new complexities in the histologic classification of non-small cell lung cancer (NSCLC) and extraordinary advances in molecular testing. Padda and Wakelee review surgical approaches and the role of adjuvant chemotherapy in the treatment of patients with early stage disease. Despite advances in screening and diagnosis approximately 25% of patients will present with locally advanced disease and radiation therapy remains a cornerstone of treatment. Laine and colleagues discuss progress made in radiotherapy in this patient population, as well as review novel treatment strategies and advances in treating oligometastatic disease.
0093-7754/ - see front matter & 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1053/j.seminoncol.2013.12.004
Seminars in Oncology, Vol 41, No 1, February 2014, pp 3-4
Traditional platinum-based doublet chemotherapy remains a cornerstone of treatment for patients with stage IV disease. Carnio and colleagues review the nuances in selecting chemotherapy and antiangiogenic therapy based on tumor histology. Prior studies have demonstrated limited benefit to continuing a platinum doublet beyond six cycles. Maintenance chemotherapy in non-progressing patients (patients with a complete response, partial response, or stable disease) has been an active area of investigation. Johnson and Patel review two separate strategies that have evolved: (1) switch maintenance therapy, where patients receive four to six cycles of platinumbased chemotherapy and are switched to an entirely different regimen, or (2) continuation maintenance therapy, where patients receive four to six cycles of platinum-based chemotherapy and then the platinum agent is discontinued but the agent it is paired with is continued. As the efficacy of traditional cytotoxic chemotherapeutic agents plateaued in NSCLC, there was a critical need to define novel therapeutic strategies. These novel strategies have largely focused on the identification of somatic “driver mutations” within the tumor and the concept of personalized cancer therapy. As a result, subsets of NSCLC have been identified with specific genetic alterations within the tumor that direct the use of rationally chosen targeted therapies. The most well studied to date is the epidermal growth factor receptor (EGFR) mutation reviewed by Mok and colleagues. Berge and Doebele review additional identified driver mutations, including ALK, ROS1, RET, MET, BRAF, and HER2. Despite improvements in survival reported for patients treated with targeted therapies, all patients eventually develop progressive disease. Research has focused on the identification of mechanisms of acquired resistance and novel treatment strategies are reviewed. Brahmer reviews the role of immune checkpoint inhibitors, another novel treatment strategy for patients with advancedstage disease. While the majority of progress in the last decade has been in the treatment of NSCLC patients small cell lung cancer accounts for 15% of all new lung 3
4
cancer diagnosis. Pillai and Owonikoko review our limited progress and provide a glimpse into future research strategies and treatment options for this all too common disease. The rapidly evolving knowledge of cancer biology coupled with improvements in diagnostic techniques, staging, surgical approaches, conventional chemotherapy, radiation therapy, molecular testing and immunotherapy approaches have made a significant impact on lung cancer patient outcomes. This collection of articles provides a comprehensive review of current standards and future approaches to lung cancer prevention, diagnosis, and treatment.
L. Horn and D.P. Carbone
Leora Horn, MD, MSc Clinical Director Thoracic Oncology Assistant Director Educator Development Program Vanderbilt Ingram Cancer Center Nashville, TN
David P. Carbone, MD, PhD Director, James Thoracic Center James Cancer Center The Ohio State University Medical Center Columbus, OH Guest Editors
Reducing Lung Cancer Mortality: 2014 Update
L
ung cancer is the leading cause of cancerrelated mortality with an estimated 228,190 new cases and 159,480 deaths anticipated in the United States in 2013. In this issue of Seminars in Oncology we present a decade of progress as we have witnessed a paradigm shift in the early detection, staging, and treatment of lung cancer worldwide. Despite progress, the overall survival for lung cancer patients remains poor at 15%. In lung cancer, clinical outcome is related to the stage at diagnosis and hence it is generally assumed that early detection of occult tumors will lead to improved survival. Cigarette consumption remains the leading risk factor for lung cancer development and smoking cessation remains an important preventive strategy. To date, large randomized phase III trials have failed to demonstrate a benefit to chemoprevention strategies. Siegfried and Stabile review the role of steroid hormones in lung cancer development and discuss the potential therapeutic benefits and role of endocrine therapies for lung cancer prevention. In patients diagnosed with lung cancer, accurate staging is critical to selecting an appropriate therapeutic plan. Maldonado and Jett review a decade of unprecedented technological advances allowing for more accurate and less invasive staging of lung cancer. The accurate determination of tumor histology and molecular testing has become essential to the selection of appropriate therapy. Sakashita and colleagues review the new complexities in the histologic classification of non-small cell lung cancer (NSCLC) and extraordinary advances in molecular testing. Padda and Wakelee review surgical approaches and the role of adjuvant chemotherapy in the treatment of patients with early stage disease. Despite advances in screening and diagnosis approximately 25% of patients will present with locally advanced disease and radiation therapy remains a cornerstone of treatment. Laine and colleagues discuss progress made in radiotherapy in this patient population, as well as review novel treatment strategies and advances in treating oligometastatic disease.
0093-7754/ - see front matter & 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1053/j.seminoncol.2013.12.004
Seminars in Oncology, Vol 41, No 1, February 2014, pp 3-4
Traditional platinum-based doublet chemotherapy remains a cornerstone of treatment for patients with stage IV disease. Carnio and colleagues review the nuances in selecting chemotherapy and antiangiogenic therapy based on tumor histology. Prior studies have demonstrated limited benefit to continuing a platinum doublet beyond six cycles. Maintenance chemotherapy in non-progressing patients (patients with a complete response, partial response, or stable disease) has been an active area of investigation. Johnson and Patel review two separate strategies that have evolved: (1) switch maintenance therapy, where patients receive four to six cycles of platinumbased chemotherapy and are switched to an entirely different regimen, or (2) continuation maintenance therapy, where patients receive four to six cycles of platinum-based chemotherapy and then the platinum agent is discontinued but the agent it is paired with is continued. As the efficacy of traditional cytotoxic chemotherapeutic agents plateaued in NSCLC, there was a critical need to define novel therapeutic strategies. These novel strategies have largely focused on the identification of somatic “driver mutations” within the tumor and the concept of personalized cancer therapy. As a result, subsets of NSCLC have been identified with specific genetic alterations within the tumor that direct the use of rationally chosen targeted therapies. The most well studied to date is the epidermal growth factor receptor (EGFR) mutation reviewed by Mok and colleagues. Berge and Doebele review additional identified driver mutations, including ALK, ROS1, RET, MET, BRAF, and HER2. Despite improvements in survival reported for patients treated with targeted therapies, all patients eventually develop progressive disease. Research has focused on the identification of mechanisms of acquired resistance and novel treatment strategies are reviewed. Brahmer reviews the role of immune checkpoint inhibitors, another novel treatment strategy for patients with advancedstage disease. While the majority of progress in the last decade has been in the treatment of NSCLC patients small cell lung cancer accounts for 15% of all new lung 3
4
cancer diagnosis. Pillai and Owonikoko review our limited progress and provide a glimpse into future research strategies and treatment options for this all too common disease. The rapidly evolving knowledge of cancer biology coupled with improvements in diagnostic techniques, staging, surgical approaches, conventional chemotherapy, radiation therapy, molecular testing and immunotherapy approaches have made a significant impact on lung cancer patient outcomes. This collection of articles provides a comprehensive review of current standards and future approaches to lung cancer prevention, diagnosis, and treatment.
L. Horn and D.P. Carbone
Leora Horn, MD, MSc Clinical Director Thoracic Oncology Assistant Director Educator Development Program Vanderbilt Ingram Cancer Center Nashville, TN
David P. Carbone, MD, PhD Director, James Thoracic Center James Cancer Center The Ohio State University Medical Center Columbus, OH Guest Editors
![[Lung cancer screening--update 2014].](/assets/img/hold.png)
