Reasons for Optimism in Lung Cancer

Lung cancer can be a frightening diagnosis. However, new treatment approaches and promising research trends have made the outlook for patients a little more optimistic, says David Jackman, MD, an oncologist in the Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute.

Targeted therapies
A decade ago, researchers at Dana-Farber and elsewhere identified a series of gene mutations in the cancer cells of some lung cancer patients that caused them to respond differently to certain oral chemotherapies. Since then, researchers continue to find additional gene alterations that drive lung cancer and develop more effective drug therapies for them.

David Jackman outlines three areas of advancement in lung cancer treatment.

Tarceva (erlotinib), for example, targets tumors with mutations in the EGFR, while Xalkori (crizotinib) attacks tumors with a DNA rearrangement in the ALK gene. Now, lung cancer patients and their treating physicians are often having conversations that involve the word “years.”

“We’re excited that we’re finding a mutation that is either known, or hypothesized, to be targetable in over half of patients with lung adenocarcinoma,” says Jackman. “At present, there are newer agents in clinical trials that are attempting to attack these and other altered proteins in lung cancer.”

Immunotherapy
For decades, researchers have attempted to harness the body’s immune system to fight off lung cancer. A major advance came in 2000, when Dana-Farber scientists described the interaction between PD-1, a protein on the surface of T cells of the immune system, and PD-L1, a protein on the surface of some cancer cells. Interaction between these two proteins normally allows cancer cells to hide themselves from the immune system. Within the last few years, Dana-Farber physician-scientists have helped develop drugs that block this interaction, leaving lung cancer cells vulnerable to attack by the immune system.

“These studies are still very early in their development,” Jackman notes. “It may be years before we can determine whether there is sufficient efficacy and safety to warrant their approval. But we are excited about their potential.”

Precision surgery and radiation
For localized lung tumors, surgery can be an effective treatment, and in many cases, a cure. Surgical oncologists continue to develop minimally invasive thoracic surgery techniques for removing tumors that hope to get patients cured and back on their feet faster than before. Similarly, in radiation therapy, more precise aiming of the X-ray beams allows radiation oncologists to maximize the effect of radiation on cancerous tissues while minimizing the impact on surrounding, healthy tissues.