;Although lung cancer is the leading cause of cancer-related death in the United States, and only 15.9% of lung cancer patients reach 5-year survival, significant advancements have been made toward improving patient outcomes.1,2,3 Overall cancer death rates have been declining for more than a decade, and lung cancer has accounted for approximately 40% of the total decline in men2 (Figure 1). This decrease may be a result of increased lung cancer screening, less invasive diagnosis and treatment techniques, and targeted therapies.1 This review discusses
- Supportive care for patients with lung cancer
- Available treatment options targeting lung cancer
- New drug approvals and indication updates
- Guideline updates.
PREVENTION AND DIAGNOSIS
Early detection of disease is pivotal to improved patient survival, and is achieved through screening targeted toward those patients identified as having a high risk for lung cancer.3 Common lung cancer symptoms such as cough, chest pain, shortness of breath and weight loss are often signs of advanced disease; therefore, screening high-risk patients before these symptoms occur is important.1,3 Risk factors for lung cancer include tobacco smoking, history of cancer or lung disease, occupational exposure to carcinogens, exposure to second-hand smoke, a family history of cancer, and residential radon exposure.3 Although a meta-analysis in 2005 of 13 studies showed a correlation between the risk of developing lung cancer and residential radon exposure, this risk is still uncertain.3,4
Overall, the NCCN guidelines recommend that only high-risk persons should receive annual screening for at least 2 years.3 High-risk persons are defined as patients who are 50 years or older with a 20 or more pack year smoking history and one additional risk factor, or patients age 55 to 74 years with a 30 or more pack year history, who stopped smoking less than 15 years ago.3
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The NCCN guidelines recommend the use of low-dose CT (LDCT) scans, not chest radiography, for lung cancer screening.3 A recent study reveals that LDCTs cause a relative risk reduction of 20% (P=.004) in comparison to chest radiography.5 The rate of death from any cause was shown to be 6.7% (P=.02) lower for patients receiving LDCTs instead of chest radiography screening.5
There are some risks associated with LDCT scans, including false-positive results, which can lead to unnecessary invasive procedures; false-negative results, which may delay diagnosis and treatment; increased costs; patient distress; and radiation exposure. For these reasons, the NCCN guidelines do not recommend screening for lower-risk persons.3
Supportive care for the smoking population Even though there are other risk factors, smoking and exposure to second-hand smoke account for 85% to 90% of lung cancer cases. Consequently, the NCCN guidelines continue to emphasize that patients who smoke should receive smoking cessation counseling and pharmacotherapy. Smokers should understand that lung cancer screening is not a substitute for smoking cessation.3 The guidelines recommend that health care professionals use the five A’s when managing supportive care of these patients.6
• Ask, identify, and document tobacco use
• Advise every tobacco user to quit
• Assess whether the tobacco user is willing to quit at this time
• Assist patients who are willing to quit by using counseling and pharmacotherapy
• Arrange a follow-up contact within the first week of the quit date if possible
Diagnostic aids The role of targeted therapy has been increasing over the past several years.1,7 In order to help identify one of the tumor mutations that can be targeted by some of these therapies, the Food and Drug Administration (FDA) has recently approved the use of Cobas EGFR (epidermal growth factor receptor) Mutation Test, a diagnostic aid.8 Epidermal growth factor receptors are expressed on the cell surface of both normal and cancer cells.8 Many metastatic NSCLCs have EGFR exon 19 deletions or exon 21 (L858R) substitution mutations, and, in some tumor cells, signaling through this receptor plays a key role in tumor cell survival and proliferation irrespective of EGFR mutation status.8
