Lung Cancer

Lung Cancer

Lung cancer is the leading cause of cancer death in the United States. with more than 200,000 Americans diagnosed with the disease annually. Due largely to aggressive anti-smoking initiatives, annual new U.S. cases have dropped 14 percent since the mid-1990s.

While once classified by appearance under a microscope, lung cancer tumors can now be treated with targeted drugs based on their genetic characteristics. Research has also shown CT scanning can reduce cancer deaths among heavy smokers by catching more cases early. Growing evidence also suggests that immunotherapy may offer hope for future advances in treating advanced lung cancer.

Long-term lung cancer survival, while low, has edged upward in recent decades and greater improvements are possible with continued research investment and increased use of screening advances.

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2016

Pembrolizumab extends NSCLC survival, with fewer side effects

Pembrolizumab extends NSCLC survival, with fewer side effects

Studies find that pembrolizumab (Keytruda) improves survival and causes fewer side effects than standard chemotherapy for patients with advanced non-small cell lung cancer (NSCLC) and high levels of PD-L1 protein in the tumor. These trials include patients who were newly diagnosed and previously treated with other therapies, leading the FDA to approve the drug for both populations of patients. These approvals establish a new treatment paradigm for this type of lung cancer, with immunotherapy becoming the preferred treatment over chemotherapy regimens for PD-L1-positive cancers. 

2015

Three immunotherapies introduced for most common type of lung cancer

Three immunotherapies introduced for most common type of lung cancer

Three new immunotherapies are approved by the FDA for patients with advanced non-small cell lung cancer (NSCLC) that worsened during or following chemotherapy. In clinical trials, the three drugs, nivolumab (Opdivo), atezolizumab (Tecentriq), and pembrolizumab (Keytruda), were each shown to extend survival and cause fewer severe side effects than chemotherapy. These treatments target the so-called immune checkpoint proteins PD-1 and PD-L1, respectively, helping the immune system fight cancer.

2010

Drug aimed at a newly identified target causes dramatic tumor shrinkages

Drug aimed at a newly identified target causes dramatic tumor shrinkages

The drug crizotinib (Xalkori), which targets the anaplastic lymphoma kinase (ALK) pathway, is shown to cause tumor shrinkage in a high percentage of patients whose tumors had an abnormality in the ALK gene. This ALK gene mutation only occurs in about 4 percent of lung cancers, and is more common in patients who never smoked. The development of crizotinib exemplifies the future of lung cancer therapy, in which tumors will be analyzed for their molecular make-up and then treated based on those findings.

In 2011, the drug is approved for patients with advanced lung cancer whose tumors harbor the ALK gene mutation based on longer-term data.

New lung cancer staging system is adopted

New lung cancer staging system is adopted

The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control issue new guidance on the system used by doctors to assess, or "stage," lung cancer, incorporating new information from clinical trials involving more than 5,000 patients. These revisions provide physicians with a better ability to classify the extent of the cancer in patients with both small cell and non-small cell lung cancer, and to more accurately determine their prognosis and select the best combination of treatments for each patient.

Adding palliative care to standard chemotherapy improves survival for advanced lung cancer patients

Adding palliative care to standard chemotherapy improves survival for advanced lung cancer patients

A head-to-head trial shows that patients who received standard chemotherapy along with palliative care (specialized treatment to address the symptoms of cancer, but not treat the disease) immediately after their diagnosis with advanced lung cancer lived three months longer and had a higher quality of life than patients who had chemotherapy alone. Patients who received the combination approach were also less likely to undergo aggressive therapy at the end of life, such as resuscitation. The results demonstrate the potential for palliative care to no only improve quality of life, but to extend patients' lives as well.

CT scanning reduces lung cancer deaths among heavy smokers

CT scanning reduces lung cancer deaths among heavy smokers

Results from a large clinical trial show that annual screening with low-dose spiral CT (LDCT) scans reduces the risk of lung cancer death by 20 percent, compared to annual chest X-rays, in current and former heavy smokers.

The National Lung Screening Trial, funded by the National Cancer Institute, compared LDCT scanning to standard chest X-rays in this group of people at high risk for developing lung cancer. This finding marks the first-ever lung cancer screening approach that has been shown to reduce lung cancer mortality. The debate about the appropriate use of LDCT screening for lung cancer among the general population, however, continues.

Older patients should be considered for the same aggressive chemotherapy as younger patients

Older patients should be considered for the same aggressive chemotherapy as younger patients

Older patients have traditionally received less aggressive therapy than younger patients, out of concern that they would not be able to handle the side effects. But a large study shows that a combination of two commonly used chemotherapy drugs, paclitaxel (Taxol) and carboplatin (Paraplatin, Paraplat), significantly increased survival in patients age 70 or older with advanced non-small cell lung cancer, compared to the standard single-drug therapy used among older patients. The findings suggest that older patients should be considered for the same aggressive combination therapy as younger patients.

2009

Maintenance therapy improves survival for advanced non-small cell lung cancer

Maintenance therapy improves survival for advanced non-small cell lung cancer

Large clinical trials show that patients with advanced non-small cell lung cancer who continued to receive drug therapy after completing their initial chemotherapy regimen lived longer than patients who did not receive such therapy. In separate studies, this finding is shown with the chemotherapy drug, pemetrexed (Alimta) and with the targeted therapy erlotinib (Tarceva). Based on this research, the FDA ultimately approves these agents for this use.

2008

Circulating tumor cells in the blood can help track treatment response in select patients

Circulating tumor cells in the blood can help track treatment response in select patients

Recent advances in lab technologies have made it possible to detect cancer cells that have broken free of the tumor, called circulating tumor cells, using a simple blood sample. In a new study, researchers show that tracking the number of these circulating tumor cells is useful for assessing how well a patient with non-small cell lung cancer is responding to therapy.

2005

New project to map lung cancer genome

New project to map lung cancer genome

Lung cancer is selected as one of three cancers to be studied in the National Cancer Institute's Cancer Genome Atlas Project. Using modern gene-mapping technology, the project aims to develop a comprehensive atlas of the genetic abnormalities in lung cancer to deepen understanding of the genetic pathways involved in the disease's development and growth. Researchers hope this information will lead to the identification of new therapeutic targets that can guide drug development.

Anti-angiogenic drug bevacizumab extends survival for advanced lung cancer

Anti-angiogenic drug bevacizumab extends survival for advanced lung cancer

A major study shows that adding the targeted drug bevacizumab (Avastin) to standard chemotherapy extends survival compared to chemotherapy alone for select patients with advanced lung cancer. In 2006, the FDA approves bevacizumab in combination with standard chemotherapy as an initial therapy for inoperable, non-squamous non-small cell lung cancer that has spread within or outside the lungs, or that has recurred. Bevacizumab is the first of a new generation of targeted drugs called "anti-angiogenics," which attack cancer by blocking the tumor's ability to develop the blood vessels it needs to grow.

2004

Adjuvant therapy proven effective in lung cancer

Adjuvant therapy proven effective in lung cancer

In findings that quickly change the standard of care, clinical trials show that giving chemotherapy after surgery dramatically improves survival for patients with early-stage non-small cell lung cancer, the most common form of the disease. Previously, chemotherapy was considered to be largely ineffective for lung cancer. These study results demonstrate that adjuvant chemotherapy could have an equal or greater impact on survival in lung cancer as it does in breast or colon cancer.

FDA approves second targeted drug, erlotinib, for non-small cell lung cancer

FDA approves second targeted drug, erlotinib, for non-small cell lung cancer

Erlotinib (Tarceva) is approved for patients with advanced non-small cell lung cancer that has worsened after at least one regimen of chemotherapy. The approval is backed by data showing that erlotinib improves survival by two months, compared to placebo. A follow-up analysis shows that erlotinib also improves patients' quality of life, reducing pain and allowing better physical function. Erlotinib is administered in pill form – a convenient alternative to traditional chemotherapy, which is generally administered intravenously in a doctor's office or hospital.

Studies show that specific EGFR mutations are associated with response to gefitinib

Studies show that specific EGFR mutations are associated with response to gefitinib

A series of major studies shows that lung cancer tumors with specific mutations of the EGFR (epidermal growth factor receptor) protein are highly responsive to EGFR-targeted drugs. EGFR is an important signaling pathway that stimulates cancer cell division, and these findings provide critical information for identifying a subset of patients most likely to respond to gefitinib (Iressa) and erlotinib (Tarceva). The relevant mutations are found most commonly in lung cancer patients without a significant smoking history.

2003

First targeted drug approved for non-small cell lung cancer

First targeted drug approved for non-small cell lung cancer

The FDA approves the first targeted therapy for non-small cell lung cancer, gefitinib (Iressa), following studies showing it shrinks tumors in some patients with advanced cancer that progresses despite other therapies. Gefitinib targets the epidermal growth factor receptor (EGFR), a protein on cell surfaces that drives lung cancer growth and spread. Use of gefitinib is restricted by the FDA in 2005 to patients who had already benefited from the drug or were receiving it through a clinical trial, after data from larger trials show gefitinib therapy did not extend patients' lives. However, later research suggests that gefitinib has value as a first-line treatment, and is more effective than chemotherapy in patients whose tumors carry an EGFR mutation.

2000

Second round of chemotherapy boosts survival in advanced non-small cell lung cancer

Second round of chemotherapy boosts survival in advanced non-small cell lung cancer

Studies report that patients with advanced non-small cell lung cancer that worsens after prior treatment with platinum-based chemotherapy (such as cisplatin or carboplatin) live significantly longer when they receive additional docetaxel (Taxotere) chemotherapy than when they receive only supportive care (treatment to ease their cancer-related symptoms, but not to fight their disease). These are the first data to show a survival benefit from administering a second round of chemotherapy to patients with advanced non-small cell lung cancer.

Study links household radon exposure to lung cancer

Study links household radon exposure to lung cancer

The Iowa Radon Lung Cancer Study demonstrates that ongoing exposure to residential radon – a naturally-occurring radioactive gas that can emerge through basements and crawl spaces – is associated with increased risk of lung cancer. The Environmental Protection Agency now estimates that more than 20,000 lung cancer cases in the U.S. are due to long-term radon exposure in the home. Since the study, radon inspections have become a routine part of homeownership, promising to reduce the future burden of the disease.

1999

Giving radiation to the chest twice-daily increases survival for small cell lung cancer

Giving radiation to the chest twice-daily increases survival for small cell lung cancer

A study finds that twice-daily radiation to the chest, together with chemotherapy, prolongs survival compared with once-daily radiation and chemotherapy in patients with small cell lung cancer that has not spread. Investigators showed that 26 percent of patients in the twice-daily group survived at least five years, compared with 16 percent in the once-daily group.

Simultaneous chemotherapy and radiation proven most effective for stage III non-small cell lung cancer

Simultaneous chemotherapy and radiation proven most effective for stage III non-small cell lung cancer

Researchers find that giving chemotherapy and radiation during the same treatment period, an approach known as concurrent chemoradiation, results in better survival for patients with stage III non-small cell lung cancer (disease with limited spread in the lungs and surrounding tissue) than the standard practice of waiting to give radiation therapy until after chemotherapy was completed. This finding echoes similar findings reported for small cell lung cancer in earlier years.

Cranial radiation reduces risk of small cell lung cancer spreading to the brain

Cranial radiation reduces risk of small cell lung cancer spreading to the brain

Radiation to the head is proven to significantly cut the risk that small cell lung cancer will spread to the brain, and thus improves survival. This result is initially shown in patients with earlier stage small cell lung cancer, and is later also proven effective in patients with advanced disease, who have an even higher risk of developing brain metastases.

1996

Topotecan approved as second round of treatment for small cell lung cancer

1995

Analysis affirms benefits of chemotherapy for advanced non-small cell lung cancer

Analysis affirms benefits of chemotherapy for advanced non-small cell lung cancer

An analysis of data from more than 50 clinical trials sheds important new light on the benefits of chemotherapy for advanced non-small cell lung cancer, concluding that cisplatin chemotherapy, in addition to surgery, radiation therapy or supportive care, substantially extends survival. Prior to this analysis, there was significant concern that the risks and side effects of chemotherapy outweighed the limited benefits for patients with advanced disease. The authors of the analysis also suggest that giving chemotherapy following the surgical removal of lung tumors – adjuvant chemotherapy, considered a novel approach for lung cancer at the time – extends survival by as much as 5 percent. This finding prompts the launch of several large clinical trials to test this ultimately successful new treatment strategy.

1994

New generation of chemotherapy drugs for non-small cell lung cancer

New generation of chemotherapy drugs for non-small cell lung cancer

Within just a few years, several new chemotherapy drugs for non-small cell lung cancer are shown to be effective, particularly when combined with cisplatin. These new drugs include paclitaxel (Taxol), docetaxel (Taxotere), vinorelbine (Navelbine) and gemcitabine (Gemzar). Randomized studies show that regimens containing these drugs provide comparable levels of efficacy for patients with advanced disease.

1993

Simultaneous radiation and chemotherapy boosts survival for small cell lung cancer

Simultaneous radiation and chemotherapy boosts survival for small cell lung cancer

Researchers demonstrate that starting radiation therapy together with chemotherapy dramatically improves the effectiveness of treatment for patients with early-stage small cell lung cancer, compared to starting radiation later in the course of treatment. This new approach is found to significantly delay cancer progression and improve survival.

1991

Combining chemotherapy and radiation prolongs survival for non-small cell lung cancer

Combining chemotherapy and radiation prolongs survival for non-small cell lung cancer

Two studies show that treatment programs involving both radiation and chemotherapy are more effective than either approach alone for patients with "stage III" non-small cell lung cancer (including patients with larger tumors that may or may not have limited spread within the lungs and in nearby lymph nodes). This two-pronged treatment approach soon becomes the standard of care for this disease.

1987

Scientists discover key genetic vulnerability in tumor cells – EGFR

1986

Second-hand smoke formally declared a carcinogen

1975

Chemotherapy combinations prove effective in small cell lung cancer

Chemotherapy combinations prove effective in small cell lung cancer

Researchers show that a treatment regimen involving the drug doxorubicin (Adriamycin), together with cyclophosphamide (Cytoxan), vincristine (Oncovin), and radiation therapy, causes significant tumor shrinkage in some patients with early-stage small cell lung cancer. These findings lead to many additional studies testing various chemotherapy combinations for this disease.

1974

Warning labels first appear on cigarette packs

Warning labels first appear on cigarette packs

Researchers tie sharp increases in bladder cancer deaths among British men to the rapid rise in cigarette smoking during prior decades.  Because smoking gained popularity more slowly among women, comparable increases in bladder cancer deaths take longer to emerge.

Years later, in 2011, researchers from the U.S. National Cancer Institute report that cigarette smokers have four times the risk of bladder cancer as non-smokers.  Overall, the study attributes about half of U.S. bladder cancer cases to smoking.

1955

Smoking first linked to cancer

Smoking first linked to cancer

In the 1950s, studies begin to show that smoking is a major cause of cancer, particularly lung cancer. By the early 1960s, both the U.S. Surgeon General and the U.K. Royal College of Physicians issue reports linking smoking to cancer and other serious health problems. In later years, second-hand smoke is declared a threat to the health of non-smokers. Tobacco control and smoking cessation soon become the most important strategy for reducing the worldwide toll of lung cancer.