New Treatment Directions

Lung cancer treatment is changing, thanks to research in prevention, early detection, and treatment. Recent advances in science and medicine include new ways to operate on lung cancer, improvements in radiation techniques, and the approval of new therapies that target a specific feature of the cancer. These are some of the current major areas of research in lung cancer:

• Targeted therapies
• Vaccines
• Chemotherapy
• Maintenance therapies
• Chemoprevention
• Early detection

Targeted Therapies

The area of personalized medicine in cancer and the role that targeted therapies play is one of the most active areas of research in lung cancer. While several targeted therapies have already been approved for use in lung cancer (see Targeted Therapies), many more have been identified as possible treatments and are being tested in clinical trials. Here are just a few:

• Cetuximab (Erbitux) is a monoclonal antibody and an epidermal growth factor receptor (EGFR) inhibitor. Study results released in June 2008 showed a small but real increase in survival in NSCLC patients (including squamous cell carcinoma) who were treated with a combination of drugs including Cetuximab. In January 2009, the FDA application submitted to approve Erbitux as a treatment for advanced NSCLC was withdrawn because of potential differences in the drug formula within the US compared to what was available outside of the US in clinical trials. The application for approval is expected to be resubmitted.
• MetMAb is also a monoclonal antibody currently being studied. It showed interesting results in a study combined with erlotinib (Tarceva) in people with NSCLC who had a high level of a certain protein in their bodies.
• Afatinib is a small molecule drug currently being studied but is not yet approved. It targets the EGFR mutation. One problem with current EGFR inhibitors, such as Tarceva, is that eventually resistance to the drug will happen and the drug will stop working. Afatinib is considered a “next generation TKI,” and is meant to overcome these resistance issues and work permanently.

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Vaccines

The latest in new approaches involves the use of vaccines to treat lung cancer or to decrease the risk of recurrence. Most people are familiar with vaccines that are used to prevent common illnesses, such as the flu, measles and polio. The newest research in cancer vaccines involves triggering the immune system to recognize and attack cancer cells without harming normal cells. Scientists are able to take inherited (genetic) material from cancer cells to create a vaccine that will cause the immune system to recognize and destroy the cancer cells. This is an exciting area of research in lung cancer, and many trials are ongoing. The most promising studies all involve immunotherapy, an approach that triggers the body’s immune system and teaches it to identify and kill cancer cells:

• Mage A3 ASCI (Antigen-Specific Cancer Immunotherapeutic) is being studied for people with Stage 1b, II, or IIIa NSCLC that has been completely removed by surgery and which tests positive for MAGE A3, a tumor antigen that is present in about 30-40% of people with NSCLC.

2013 update: In December 2012, the Stimuvax trial was closed because it did not meet its primary endpoint. In February 2013, the Lucanix trial was also closed because it was not on track to meet its endpoint. There are earlier phase vaccine trials still going on for NSCLC, contact our Clinical Trial Matching Service to learn more. 

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Chemotherapy

While much research is focusing on developing novel approaches to lung cancer treatment in the form of targeted therapies and therapeutic vaccines, there is still research into new chemotherapies, or improvements on existing chemotherapies.

Amrubicin is a drug currently being studied for use in small cell lung cancer (SCLC) but is not yet approved. It was granted fast-track* designation in September 2008 for the treatment of SCLC after first line chemotherapy. It is a type of anti-cancer drug called an anthracycline. These drugs are known to be highly effective cancer chemotherapy drugs, but often carry high risk of heart damage (cardio toxicity). Amrubicin does not appear to cause the same heart side effects as other anthracyclines.

Nab-paclitaxel (Abraxane) is a drug currently being studied for use in NSCLC. It has been approved in use for other cancers, but is not yet approved for use in NSCLC. Another form of paclitaxel (Taxol) is already widely used in treatment. Nab-paclitaxel has shown some benefits over paclitaxel in clinical trials, including fewer side effects and better response. It also takes less time to give nab-paclitaxel than paclitaxel.

*FDA Fast Track status: Since 1997, the FDA has had the ability to grant fast track status to drugs that may treat serious or life-threatening diseases, address an unmet medical need or make a positive advancement in safety or effectiveness over existing drugs. Fast track status is designed to bring valuable treatments to the patient faster. It is important to understand that these drugs are currently only available to patients enrolled in clinical trials.

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Maintenance Therapies

While several drugs have been approved for use or are commonly used as maintenance therapy, oncologists do not fully agree on whether it is always the best option. Research is continuing to test maintenance therapies in an effort to better identify patients who will benefit from them.

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Chemoprevention

While important research is going on in the treatment and diagnosis of lung cancer, another area of research is in chemoprevention, or the use of substances to prevent lung cancer from developing. This research has many challenges, and so far researchers have had mixed results come from their studies. Current research is focusing on drugs that have been approved for treatment in other conditions but that potentially decrease risk of lung cancer. For example, in one study, oral Iloprost (a drug used to treat pulmonary arterial hypertension) used in former smokers appeared to decrease lung damage, which may also decrease risk of developing lung cancer.

Celecoxib (Celebrex) is an anti-inflammatory drug used to relieve pain associated with arthritis by blocking an inflammation-causing chemical called COX-2. Because this chemical is thought to play a role in developing lung cancer, Celecoxib is also being studied as a possible way to decrease risk of the disease. Other drugs that have been used to treat asthma and diabetes are also being studied. So far, chemoprevention trials have not shown anything certain, but many trials are ongoing.

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Early Detection

One reason why lung cancer is so difficult to treat is because it is frequently diagnosed after it has already spread. Unlike other diseases, there are no consistent early symptoms. The NLST (National Lung Screening Trial) showed that using a low dose chest CT scan to screen those at high risk for lung cancer reduces the number of lung cancer deaths by 20%.  For more information on what this means for you, please visit www.screenforlungcancer.org. Several other approaches are being explored as ways to detect and screen for lung cancer.  They include blood tests, breath tests, sputum cytology, and cell sampling from airway via bronchoscopy.  It is important to note that these tests are still being carefully studied and are not ready for wide based use.

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