Lung cancer remains a major national health hazard affecting more than 200,000 people every year in the United States. Tobacco smoking and asbestos exposure are among the leading causes of lung cancer. Non-small cell lung cancer constitutes more than 80 percent of all lung cancers.
Early signs and symptoms of lung cancer include unexplained cough, difficulty breathing, shoulder/arm pain, hoarseness of voice, chest pain and coughing blood. Sometimes it manifests by an asymptomatic mass on an imaging study, such as chest X-ray or CT scan.
Non-smokers could also develop lung cancer but this is a relatively an uncommon situation.
Approach to treatment
The patient should be initially seen by a cancer specialist to determine if he or she is a surgical candidate or not. This involves a thorough but quick workup, including imaging studies (CT scan, Bone scan, PET scan), lung function and heart evaluation.
From here, the patient will be directed either to surgery, chemotherapy, radiation therapy or chemoradiation therapy, depending on the stage.
New treatment era
The good news is that we are now able to test certain receptors on the cancer cells, such as EGFR and ALK, and if positive, we can treat with targeted oral therapy against these receptors using non-chemo medications (Tarceva and Xalkori) even in advanced lung cancer - with impressive results. We have a second generation anti-EGFR therapy (Afatinib) that is being used for patients who become resistant to Tarceva.
Another recent advancement in the treatment of lung cancer is the use of anti-angiogenesis (that block blood supply to the tumor), such as Avastin with chemotherapy in the advanced setting.
For patients with early lung cancer who cannot tolerate surgery or chemotherapy, Stereotactic Ablative Radiotherapy (SABR) can ablate the tumor through a well-tolerated, non-invasive technique.
What will be more exciting in the near future is the introduction of immunotherapy, which is totally different from traditional chemotherapy.
The aim of immunotherapy is to recognize the cancer cells as foreign and then develop an immune response to kill them. Promising immunotherapy approaches in lung cancer are the immune checkpoints (CTLA-4 and PD-1/ PDL-1) and cancer vaccination.
We already have three investigational medications that target those checkpoints, receptors or pathways. Studies are underway and soon will be reported in national conferences which could make an unprecedented breakthrough in treating this tough cancer.
Last but not least is the introduction of vaccine therapy, which works by recognizing certain genetic alterations in lung cancer as antigens, then developing a vaccine against them which further enhances the immune response toward lung cancer cells.
We expect to see more patients to do well even with advanced lung cancer, a situation that we regarded as dismal a few years ago.