The medical community should be aware of new chemotherapy treatments that are often more powerful, have fewer side effects and show more promise. What is on the horizon is equally exciting for patients, particularly those with non-small cell lung cancers.
“There are newer recommendations for adjuvant therapy,” said Dr. Lee Hicks. “That is when you treat someone after they have had their lung removed and there is no obvious evidence of cancer, but there is still a role for treatment to try to reduce the risk.”
Another issue is treating advanced stage 4 non-small cell metastatic cancer. “We have more and more data coming in that supports the use of chemotherapy to reduce the risk of recurrence in resected non-small cell lung cancer after a lobectomy,” said Hicks.
Treatments are more becoming individualized. “In the metastatic setting, there have been a lot of changes in the last year or two,” Hicks said. “It used to be that all we had to know was if the cancer was small cell or non-small cell. If it was non-small cell, we lumped everybody together, but that is no longer the case.”
People with squamous cell carcinoma of the lung have a different response to certain agents than those who have non-squamous cell carcinoma.
“We take the small tissue from a biopsy of the lung or node and define the subtype, then do specific tests that help us know what kind of chemotherapy will be helpful,” said Hicks. For instance, in broad categories for squamous cell carcinoma, generally treatment with drugs like Cisplatin and Taxol would be called for. There is also a newer drug called Tarceva.
Chemotherapy kills cancer cells by inflicting damage to the process of DNA replication. “It is basically a drug that directly kills cancer cells by impairing their ability to multiply,” Hicks said. “In the newer generation of drugs, we have found the mutations have to do with the coding for the processes of developing blood vessels. The tumor grows and communicates cell to cell, so this is a unique approach. In the past we tried to cure the cancer and make it vanish.”
Chemotherapy has potential side effects such as diarrhea, rashes and other challenges, but people tolerate it better now than they did in the past. “We also have drugs like Alimta or Pemetrexed that have activity in shrinking the tumor,” Hicks said. “These drugs are unique in that whether you start with them or use some other chemotherapy and later come to these, you can prolong the time to progression or treatment failure by continuing the drug even when the disease is stable.”
Another new approach is using Avastin, a drug routinely used in colon cancer. “This class of drugs inhibits growth of blood vessels. If tumors cannot grow their own blood supply, they cannot grow,” said Hicks. These drugs can improve a patient’s quality of life.
Scientists are developing an array of assays in which they study cancer at the molecular level to see how it will behave. This may enable them to predict ahead of time what treatments will or will not work. “My prediction is we are going to move from a model of anatomic orientation to tailored chemotherapy, looking into the molecular crystal ball,” said Hicks. It is not a fully realized dream yet, he added. “We are still one foot in the old days of treating with standard drugs, but we have another foot in the new molecular markings to guide us in treatment. The research is going to be heading in different directions,” he said.
Doctors’ realistic hope is that people with cancer will be able to enjoy their lives and function while the disease is kept in check. “I think the odds of us finding a drug or class of drugs that will kill a cancer cell forever and never have the cell mutate in a way where it will not outsmart chemotherapy is unlikely,” Hicks said. “But it is very possible that we may end up getting a series of treatments together whereby we are able to control it over time. We will be able to prolong people’s lives with good quality where we are not making them sick as a dog the whole time we are treating them. That is our dream and our hope.”
By Jamie Lober, Staff Writer