In this edition of CancerWire we discuss lung
cancer - treatments, options, and more. Some
of the information, especially about clinical
trials, is helpful in other cancers as well.
Disclaimer - Please Read: Of course, none of
this information in CancerWire is a
substitute for professional medical advice,
examination, diagnosis or treatment and you
should always seek the advice of your
physician or other qualified health
professional before starting any new
treatment or making any changes to an
existing treatment. No information contained
in Cancer Monthly or CancerWire including the
information below, should be used to
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Lung Cancer: Conventional Therapies Provide Little Improvement in Treatment Outcomes in 20 Years
cancer remains the leading cause of
cancer related deaths among men and women in the
industrialized countries. According to the
National Cancer Institute (NCI) Fact
Book, (1) the five-year relative survival
for lung and
bronchus cancer in white patients was 13% and it
was 11% in black patients. According to the
NCI Fact Book (2) those percentages were
and 12% respectively. In other words,
rate improved 2% for white patients and 1%
patients over a 20 year period.
the last five years alone, over a billion
been spent researching treatments for lung
(The actual figure is $1,296,500,000 for
between 2002-2006.) It appears that lung
cancer is a
glaring example of how our federal government
spend so much money and achieve so little.
Nonetheless, there are encouraging signs on the
horizon, but they may not be from the
sources of chemo, radiation, and surgery.
biological modalities and even alternative
approaches are providing hope to millions.
There are two main types of
Lung Cancer (SCLC) and Non-Small Cell Lung
Lung Cancer (SCLC)
SCLC represents about 20 percent of lung
cancers. A simplified staging system is used for
SCLC - limited stage and extensive stage.
the response rate of SCLC to many anti-cancer
agents (response means that a tumor
or that a blood test indicated regression of the
cancer), survival remains disappointing,
extensive-stage disease. Most regimens have
achieved a median survival of less than 12
clinical trials, and the standard regimen has
remained the chemotherapy drugs cisplatin and
shown that 3- and 4-drug regimens are no
2-drug regimens. (3)
Oncologists had devised the staging system and
established that some chemo agents could achieve
responses in SCLC 25 years ago. Unfortunately,
survival has not been significantly improved
disease since then. According to doctors, "a
later, patients with this disease do not have a
significantly better outlook." (4)
Lung Cancer (NSCLC)
NSCLC represents about 80 percent of all lung
cancers and, as discussed in the accompanying
Lung Cancer is Not Caused by
Smoking"), may be caused by smoking,
or other agents. NSCLC is comprised of three
1. Adencarcinoma is the most common type, and
accounts for 40 percent of cases.
2. Squamous Cell Carcinoma accounts for about 20
to 30 percent of cases.
3. Large Cell Carcinoma accounts for about 10
percent of cases.
NSCLC is staged according to the TNM
of the International Staging System for Lung
the size or extent of the primary tumor (T),
is in the regional lymph nodes (N), and whether
distant metastases (M). The majority of
(70 - 80 percent) have Stage III or IV at
overall five-year survival is poor.
Although there have been improvements in
techniques and the role of chemotherapy-
radiotherapy in the treatment of NSCLC, the
outlook for patients has not changed
outcomes for advanced disease are still
disappointing. The median survival for
advanced-stage NSCLC treated with platinum-based
chemotherapy is 8-10 months. (5)
It appears that no significant improvements
are going to come from radiation, chemo and
surgery, especially for advanced disease.
Today, as outlined in the accompanying
articles, more emphasis is being placed on
biological therapies and other modalities.
(1) Source: Five-Year Relative Survival
and female) from SEER Program 1974-1983.
(2) Source: NCI SEER 17 Areas for 1996-2003.
(3) El Maalouf G, et al., Could we expect to
survival in small cell
lung cancer? Lung
Aug;57 Suppl 2:S30-4.
(4) Lally BE, et al., Small cell lung
cancer: have we
made any progress over the last 25 years?
Oncologist. 2007 Sep;12(9):1096-104
(5) See Gkiozos I, et al., Developments in the
treatment of non-small cell
Res. 2007 Jul-Aug;27(4C):2823-7 and Felip E,
Emerging drugs for non-small-cell
Expert Opin Emerg Drugs. 2007 Sep;12(3):449-
Most people associate
lung cancer with
smoking. Indeed, a history of cigarette
smoking is the leading cause of
But what about those
lung cancer patients
who never smoked a day in their lives or had
a cigarette only rarely? What caused their
While the cause of each person's cancer is
specific to that individual, there is another
widely accepted cause of disease for many
lung cancer victims - asbestos.
is a naturally occurring mineral
that is resistant to heat, fire, and
chemicals and does not conduct electricity.
For these reasons, it has been widely used in
many industries and in thousands of products.
Electricians, mechanics, boilermakers,
pipefitters, shipyard workers, railroad
workers, insulators, factory workers,
carpenters, construction workers, and other
trades people are especially prone to
asbestos exposure. According to the National Cancer Institute
exposure to asbestos may increase the risk of
[and] all common commercial
types of asbestos have been associated with
Consequently if you have
1) were a non-smoker; and 2) and did any of
the kind of work mentioned above, asbestos
may be the cause of your cancer.
The Good News and the Bad News
Knowing that asbestos may have caused your
disease is both good and bad. It is good in
the sense that it at least answers the
question - why am I sick? Many
patients and their loved ones want to know
what caused the disease.
It can also be good from a financial
perspective. Asbestos was known to cause
cancer and other diseases for decades before
companies decided to warn workers and
consumers. This means you can file a claim
and potentially receive up to several million
dollars in compensation. This kind of money
can help with the expenses associated with
fighting this disease and provide your family
with financial security. (But, there are
statutes of limitations in each state which
means that these claims must be filed within
a certain amount of time.)
The bad news is that even knowing that
asbestos was the likely cause of your disease
does not help with conventional treatments.
Oncologists do not take into account the
different etiologies (causes) of
when they write a
treatment plan. The cause is irrelevant when
it comes to the therapy.
What to Do?
If you or a loved one has been diagnosed with
lung cancer and the patient is a non-smoker
who worked in a blue-collar trade, the lung
cancer may have been caused by exposure to
asbestos. A lawyer
can help answer the question if asbestos was
the cause and help you file a claim to
receive compensation for your injury.
Michael Horwin who is the manager of Cancer
Monthly (and is also a licensed attorney) can
point you to some reputable law firms that
handle these cases. You can email him at
Many cancer patients including those with
lung cancer use alternative or complimentary
Alternative therapies are defined
as treatments that are not used by
conventional physicians and can include:
vitamin and herbal therapies, Traditional
Chinese Medicine, mind-body medicine, and
anti-cancer diets. Complimentary or
"integrative" therapies are defined as using
alternative approaches in combination with
conventional therapies such as surgery,
chemotherapy or radiation.
Alternative approaches to treating lung
cancer are a mixed bag that contains some
therapies with a sound scientific basis (like
intravenous Vitamin C), a long historic
tradition (like Traditional Chinese Medicine)
and others that are complete nonsense.
However, anecdotal information (undocumented
reports from other patients) suggests that
treatments that can boost one's immune system
may provide better quality of life and
perhaps extend life in some patients. In
fact, it is biologically feasible that the
immune system can help the body deal with
invading carcinogens such as those from
tobacco or asbestos.
Traditional Chinese Medicine
With a history stretching back 4,000 years,
Traditional Chinese Medicine (TCM) has formed
a unique system to diagnose and cure illness.
It is comprised of a philosophy about illness
that is different than Western Medicine and has a
vast armament of herbs, mushrooms, and other
plants for specific diseases. Here are just
a few examples of studies from the
medical/scientific literature that have looked
at the effect of some TCM on
Ganoderma lucidum, called Reishi in Japan is
a mushroom that enjoys special veneration in
Asia. It has been called the "King of Herbs"
and been used in TCM for more than 4,000
years, making it one of the oldest mushrooms
known to have been used in medicine.
Ganoderma lucidum is the only known source of
a group of triterpenes, known as ganoderic
acids. In December 2006 a study was
published in the journal Life Science in
which Ganoderic Acid T (GA-T - one type of
ganoderic acid) was tested on human lung
cancer cells. The researchers stated that
GA-T "markedly inhibited the proliferation of
a highly metastatic
lung cancer cell line
Selaginella tamariscina (ST) is a traditional
medicinal plant for treatment of advanced
cancer in the Orient. Researchers at the
Chung Shan Medical University studied its
lung cancer cells in vivo and in
vitro and found that it inhibited growth and
Nan-Chai-Hu, the root of Bupleurum
scorzonerifolium, is a traditional Chinese
herb used in treatment of liver diseases such
as hepatitis and cirrhosis. An extract was
tested in human
lung cancer cells and "showed
a dose-dependant antiproliferative effect." (3)
The more they administered this root
the more the cancer cells stopped growing.
What to Do?
These early results are intriguing and
suggest that these herbs can play an
anti-cancer role in the human body.
Unfortunately, definitive clinical studies
have not been done to address these questions.
If you want to explore alternative approaches
to compliment your existing care it is a good
idea to work with a skilled clinician (such
as a medical doctor experienced an immune
boosting approaches) and not to rely on
conversations with non-professionals such as
the people who work in vitamin stores.
Science and medicine trudge along slowly at
their own pace and on their own schedule.
lung cancer patients do not
have the luxury of waiting for decades for
treatments to improve. But the good news is
that you can take more control of your
destiny starting today. Numerous studies
have shown that patients who learn more about
their disease and are more involved in their
treatment choices often have better results.
(1) Tang W, et al., Ganoderic acid T from
Ganoderma lucidum mycelia induces
mitochondria mediated apoptosis in lung
cancer cells. Life Sci. 2006 Dec
(2) Shun Fa Yanga, et al., Antimetastatic
activities of Selaginella tamariscina
lung cancer cells in vitro and in
vivo. Journal of Ethnopharmacology Volume
110, Issue 3, 4 April 2007, Pages 483-489.
(3) Cheng YL, et al., Acetone extract of
Bupleurum scorzonerifolium inhibits
proliferation of A549 human
lung cancer cells
via inducing apoptosis and suppressing
telomerase activity. Life Sci. 2003 Sep
Because there is no standard curative
either small cell
lung cancer or non-small
cancer, there are many clinical trials
available. It is
important for a patient and their family to
the purpose of a clinical trial and the
which they should exercise informed consent.
are some highlights from the National Cancer
website. If you do decide to enroll in a
you should discuss all aspects of the
One benefit of enrolling in a clinical trial
is that it
allows you to access new treatments before
widely available. Another is that you can
by contributing to medical research. This
underscores the fact that clinical trials are
to contribute to our understanding of the
efficacy of different treatments. Consequently,
helping the patient who is enrolled on the
trial may not
be the primary goal. The primary goal is often
gathering data about the treatment.
Therefore risks of
the treatment include:
* There may be unpleasant, serious or even life-
threatening side effects to experimental
* The experimental treatment may not be
* The clinical trial may require more patient
attention than would a non-protocol treatment,
including trips to the study site, more
hospital stays or complex dosage requirements.
Before enrolling in a clinical
exercise informed consent. According to the
NCI, "Informed consent is the process of
key facts about a clinical trial before
or not to participate. It is also a
throughout the study to provide information for
There are different phases of clinical trial
phase has its own goals. Again from the NCI
* In Phase I trials, researchers test an
drug or treatment in a small group of people
for the first time to evaluate its safety,
safe dosage range, and identify side effects.
* In Phase II trials, the experimental
treatment is given to a larger group of
300) to see if it is effective and to further
* In Phase III trials, the
treatment is given to large groups
3,000) to confirm its effectiveness, monitor
effects, compare it to commonly used
collect information that will allow the
drug or treatment to be used safely.
Therefore, if you are enrolled in a
Phase II or III
study, other patients have already received the
treatment and had some of their results and
This is something you can ask about.
A question that sometimes arises is whether a
clinical trial participant can leave the
trial after the
therapy has begun. The answer is yes. A
can leave a clinical trial at any time.
Currently there are 105 treatment clinical
lung cancer listed as active in
database and 475 for non-small cell.
The breakdown for the number of clinical
lung cancer treatment clinical
Total Treatments 105
Complementary and alternative 1
lung cancer treatment clinical
Total Treatments 475
Complementary and alternative 6
The chemotherapy and biological therapy
the overwhelming majority of the trials. The
complementary and alternative therapies
Currently, the biological therapies are
drugs that target the receptors or proteins
endothelial growth factor or vascular
growth factor. For example:
* Avastin (Bevacizumab) is a monoclonal antibody
against vascular endothelial growth factor.
It is used
in the treatment of cancer, where it inhibits
growth by blocking the formation of new blood
* Gefitinib (Iressa) inhibits epidermal
receptor (EGFR). EGFR is also sometimes
as Her1 or ErbB-1. EGFR is often
the cells of certain types of human cancers.
* Cetuximab (Erbitux) is a chimeric monoclonal
antibody, an epidermal growth factor receptor
inhibitor, given by intravenous injection.
* Similar to gefitinib, erlotinib (Tarceva)
targets the epidermal growth factor receptor
tyrosine kinase, which is highly expressed and
occasionally mutated in various forms of cancer.
While no definite survival benefit has
demonstrated with most of these agents,
researchers are confident that progress will
ultimately be made with some of these agents.
The complementary and alternative clinical
lung cancer currently includes:
* Very low carbohydrate diet.
The Complementary and alternative clinical
lung cancer currently
* Dietary supplement
vegetables and herbs mix), which consists of
botanicals containing known anticancer and/or
immune-enhancing components vs placebo.
* Sun's soup dietary
supplement vs placebo.
(differentiating therapy) for patients with
undifferentiated, or poorly differentiated
stage IV lung
* Mistletoe for patients with
advanced non-small cell
* Iscador (Iscar Quercus) for
patients with stage IV non-small cell lung
* Very low carbohydrate diet.
With any clinical trials it can be
helpful to find
out exactly how many other patients have already
received the therapy, how similar or
they to you, what were the results (both
efficacy), and whether you can speak to any
patients who have already recieved the therapy.
Speaking directly with these patients can
provide a human perspective on what to
(Note: there are many laws in place that protect
patient privacy and confidentiality.
However, it may be
possible for a doctor to approach their current
patients and ask whether newly diagnosed
individuals who are contemplating the therapy
contact that patient for their thoughts and
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