CancerWire
Alternative and Integrative Cancer News & Information
October 2007
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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 diagnose, treat, cure or prevent any disease without the supervision of a medical doctor.

Lung Cancer: Conventional Therapies Provide Little Improvement in Treatment Outcomes in 20 Years
 
lung cancer


Lung cancer remains the leading cause of cancer related deaths among men and women in the industrialized countries. According to the 1986 National Cancer Institute (NCI) Fact Book, (1) the five-year relative survival rate for lung and bronchus cancer in white patients was 13% and it was 11% in black patients. According to the 2006 NCI Fact Book (2) those percentages were 15% and 12% respectively. In other words, the survival rate improved 2% for white patients and 1% for black patients over a 20 year period.

Also, according to the NCI, in the last five years alone, over a billion dollars have been spent researching treatments for lung cancer. (The actual figure is $1,296,500,000 for expenditures between 2002-2006.) It appears that lung cancer is a glaring example of how our federal government can spend so much money and achieve so little.

Nonetheless, there are encouraging signs on the horizon, but they may not be from the conventional sources of chemo, radiation, and surgery. Today, biological modalities and even alternative approaches are providing hope to millions.

There are two main types of lung cancer: Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC).

Small Cell Lung Cancer (SCLC)

SCLC represents about 20 percent of lung cancers. A simplified staging system is used for SCLC - limited stage and extensive stage. Despite the response rate of SCLC to many anti-cancer agents (response means that a tumor shrunk or that a blood test indicated regression of the cancer), survival remains disappointing, particularly in extensive-stage disease. Most regimens have achieved a median survival of less than 12 months in clinical trials, and the standard regimen has remained the chemotherapy drugs cisplatin and etoposide. Clinical trials have shown that 3- and 4-drug regimens are no better than 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 in this disease since then. According to doctors, "a quarter of a century later, patients with this disease do not have a significantly better outlook." (4)

Non-Small Cell Lung Cancer (NSCLC)

NSCLC represents about 80 percent of all lung cancers and, as discussed in the accompanying article ("When Lung Cancer is Not Caused by Smoking"), may be caused by smoking, asbestos, or other agents. NSCLC is comprised of three separate types:

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 to 15 percent of cases.

NSCLC is staged according to the TNM classification of the International Staging System for Lung Cancer - the size or extent of the primary tumor (T), whether the cancer is in the regional lymph nodes (N), and whether there is distant metastases (M). The majority of patients with NSCLC (70 - 80 percent) have Stage III or IV at diagnosis, and overall five-year survival is poor.

Although there have been improvements in surgical techniques and the role of chemotherapy- radiotherapy in the treatment of NSCLC, the long-term outlook for patients has not changed significantly and treatment outcomes for advanced disease are still disappointing. The median survival for patients with 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.

End Notes

(1) Source: Five-Year Relative Survival Rates (male and female) from SEER Program 1974-1983. Available here.
(2) Source: NCI SEER 17 Areas for 1996-2003. Available here.
(3) El Maalouf G, et al., Could we expect to improve survival in small cell lung cancer? Lung Cancer. 2007 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 lung cancer. Anticancer Res. 2007 Jul-Aug;27(4C):2823-7 and Felip E, et al., Emerging drugs for non-small-cell lung cancer. Expert Opin Emerg Drugs. 2007 Sep;12(3):449- 60.


When Lung Cancer is Not Caused by Smoking
 
asbestos



Most people associate lung cancer with smoking. Indeed, a history of cigarette smoking is the leading cause of lung cancer. But what about those lung cancer patients who never smoked a day in their lives or had a cigarette only rarely? What caused their cancer?

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.

Asbestos

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 "studies have shown that exposure to asbestos may increase the risk of lung cancer … [and] all common commercial types of asbestos have been associated with lung cancer."

Consequently if you have lung cancer 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 lung cancer 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 lung cancer 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 info@cancermonthly.com


Lung Cancer and Traditional Chinese Medicine
 
TCM



Many cancer patients including those with lung cancer use alternative or complimentary therapies.

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 lung cancer.

Ganoderma lucidum

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 …" (1)

Selaginella tamariscina

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 effect in lung cancer cells in vivo and in vitro and found that it inhibited growth and metastasis. (2)

Nan-Chai-Hu

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. Unfortunately, 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.

Endnotes

(1) Tang W, et al., Ganoderic acid T from Ganoderma lucidum mycelia induces mitochondria mediated apoptosis in lung cancer cells. Life Sci. 2006 Dec 23;80(3):205-11.
(2) Shun Fa Yanga, et al., Antimetastatic activities of Selaginella tamariscina (Beauv.) on 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 19;73(18):2383-94.


Clinical Trials for Lung Cancer
 
doctor patient


Because there is no standard curative treatment for either small cell lung cancer or non-small cell lung cancer, there are many clinical trials available. It is important for a patient and their family to understand the purpose of a clinical trial and the process by which they should exercise informed consent. Here are some highlights from the National Cancer Institute (NCI) website. If you do decide to enroll in a clinical trial, you should discuss all aspects of the treatment with your doctor.

One benefit of enrolling in a clinical trial is that it allows you to access new treatments before they are widely available. Another is that you can help others by contributing to medical research. This underscores the fact that clinical trials are designed to contribute to our understanding of the safety and 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 treatment.
* The experimental treatment may not be effective for the participant.
* The clinical trial may require more patient time and attention than would a non-protocol treatment, including trips to the study site, more treatments, hospital stays or complex dosage requirements.

Before enrolling in a clinical trial, patients should exercise informed consent. According to the NCI, "Informed consent is the process of learning the key facts about a clinical trial before deciding whether or not to participate. It is also a continuing process throughout the study to provide information for participants."

There are different phases of clinical trial and each phase has its own goals. Again from the NCI website:

* In Phase I trials, researchers test an experimental drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.

* In Phase II trials, the experimental study drug or treatment is given to a larger group of people (100- 300) to see if it is effective and to further evaluate its safety.

* In Phase III trials, the experimental study drug or treatment is given to large groups (1,000- 3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the experimental 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 outcomes analyzed. 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 participant can leave a clinical trial at any time.

Currently there are 105 treatment clinical trials for small cell lung cancer listed as active in the NCI database and 475 for non-small cell.

The breakdown for the number of clinical trials is:

Small cell lung cancer treatment clinical trials:

Total Treatments 105
Chemotherapy 72
Radiation 16
Biological 26
Surgery 3
Complementary and alternative 1


Non-small cell lung cancer treatment clinical trials:

Total Treatments 475
Chemotherapy 302
Radiation 98
Biological 157
Surgery 41
Complementary and alternative 6

The chemotherapy and biological therapy represent the overwhelming majority of the trials. The complementary and alternative therapies represent roughly 1%.

Currently, the biological therapies are dominated by drugs that target the receptors or proteins involved in endothelial growth factor or vascular endothelial 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 tumor growth by blocking the formation of new blood vessels.
* Gefitinib (Iressa) inhibits epidermal growth factor receptor (EGFR). EGFR is also sometimes referred to as Her1 or ErbB-1. EGFR is often overexpressed in the cells of certain types of human cancers.
* Cetuximab (Erbitux) is a chimeric monoclonal antibody, an epidermal growth factor receptor (EGFR) inhibitor, given by intravenous injection.
* Similar to gefitinib, erlotinib (Tarceva) specifically targets the epidermal growth factor receptor (EGFR) tyrosine kinase, which is highly expressed and occasionally mutated in various forms of cancer.

While no definite survival benefit has yet been 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 trial for small cell lung cancer currently includes:

* Very low carbohydrate diet.

The Complementary and alternative clinical trials for non-small cell lung cancer currently include:

* Dietary supplement (selected vegetables and herbs mix), which consists of nontoxic botanicals containing known anticancer and/or immune-enhancing components vs placebo.

* Sun's soup dietary supplement vs placebo.

* Antineoplastons (differentiating therapy) for patients with large cell, undifferentiated, or poorly differentiated stage IV lung cancer.

* Mistletoe for patients with advanced non-small cell lung cancer.

* Iscador (Iscar Quercus) for patients with stage IV non-small cell lung cancer.

* 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 dissimilar were they to you, what were the results (both safety and 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 expect. (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 can contact that patient for their thoughts and feedback.)


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