Lung Cancer: Treatment and Research PDF
Preview Lung Cancer: Treatment and Research
Cancer Treatment and Research Series Editor: Steven T. Rosen Karen L. Reckamp Editor Lung Cancer Treatment and Research Cancer Treatment and Research Volume 170 Series editor Steven T. Rosen, Duarte, CA, USA More information about this series at http://www.springer.com/series/5808 Karen L. Reckamp Editor Lung Cancer Treatment and Research 123 Editor Karen L. Reckamp Department ofMedical Oncology City of Hope Duarte, CA USA ISSN 0927-3042 Cancer Treatment andResearch ISBN978-3-319-40387-8 ISBN978-3-319-40389-2 (eBook) DOI 10.1007/978-3-319-40389-2 LibraryofCongressControlNumber:2016942037 ©SpringerInternationalPublishingSwitzerland2016 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpart of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilarmethodologynowknownorhereafterdeveloped. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained hereinorforanyerrorsoromissionsthatmayhavebeenmade. Printedonacid-freepaper ThisSpringerimprintispublishedbySpringerNature TheregisteredcompanyisSpringerInternationalPublishingAGSwitzerland Contents Lung Cancer Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geena X. Wu and Dan J. Raz Diagnosis and Molecular Classification of Lung Cancer . . . . . . . . . . . 25 Jaime Rodriguez-Canales, Edwin Parra-Cuentas and Ignacio I. Wistuba Lung Cancer Staging and Prognosis. . . . . . . . . . . . . . . . . . . . . . . . . . 47 Gavitt A. Woodard, Kirk D. Jones and David M. Jablons Surgical Treatment of Lung Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . 77 Osita I. Onugha and Jay M. Lee Treatment: Radiation Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Sagus Sampath Chemotherapy for Advanced Non-small Cell Lung Cancer . . . . . . . . . 119 Martin F. Dietrich and David E. Gerber Multimodality Therapy for NSCLC . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Lingling Du, Saiama N. Waqar and Daniel Morgensztern Targeted Therapies for Lung Cancer. . . . . . . . . . . . . . . . . . . . . . . . . 165 Thomas E. Stinchcombe Resistance to Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Gabriel Rivera and Heather A. Wakelee Immunotherapy in Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Emily H. Castellanos and Leora Horn Palliative Care in Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Arvind M. Shinde and Azadeh Dashti Management of Lung Cancer in the Elderly. . . . . . . . . . . . . . . . . . . . 251 Archana Rao, Namita Sharma and Ajeet Gajra v vi Contents Multidisciplinary Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 Megan E. Daly and Jonathan W. Riess Small Cell Lung Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Erica B. Bernhardt and Shadia I. Jalal Lung Cancer Screening Geena X. Wu and Dan J. Raz Abstract Lung cancer is the leading cause of cancer mortality in the United States and worldwide.Sincelungcanceroutcomesaredependentonstageatdiagnosiswith earlydiseaseresultinginlongersurvival,thegoalofscreeningistocapturelung cancerinitsearlystageswhenitcanbetreatedandcured.Multiplestudieshave evaluated the use of chest X-ray (CXR) with or without sputum cytologic examination for lung cancer screening, but none has demonstrated a mortality benefit.Incontrast,themulticenterNationalLungScreeningTrial(NLST)from the United States found a 20 % reduction in lung cancer mortality following three consecutive screenings with low-dose computed tomography (LDCT) in high-risk current and former smokers. Data from European trials are not yet available. In addition to a mortality benefit, lung cancer screening with LDCT also offers a unique opportunity to promote smoking cessation and abstinence and may lead to thediagnosesof treatable chronic diseases, thus decreasingthe overalldiseaseburden.Therisksoflungcancerscreeningincludeoverdiagnosis, radiation exposure, and false-positive results leading to unnecessary testing and possible patient anxiety and distress. However, the reduction in lung cancer mortality is a benefit that outweighs the risks and major health organizations currentlyrecommendlungcancerscreeningusingage,smokinghistory,andquit time criteria derived from the NLST. Although more research is needed to G.X.Wu(cid:1)D.J.Raz(&) DivisionofThoracicSurgery,CityofHope,Duarte,CA,USA e-mail:[email protected] G.X.Wu e-mail:[email protected] ©SpringerInternationalPublishingSwitzerland2016 1 K.L.Reckamp(ed.),LungCancer,CancerTreatmentandResearch170, DOI10.1007/978-3-319-40389-2_1 2 G.X.WuandD.J.Raz clearlydefineandunderstandtheapplicationandutilityoflungcancerscreening in the general population, current data support that lung cancer screening is effective and should be offered to eligible beneficiaries. Keywords (cid:1) (cid:1) (cid:1) Lung cancer Screening Computed tomography Cancer prevention Contents 1 WhyScreenforLungCancer?............................................................................................ 2 2 ScreeningwithChestX-RayandSputumCytologicStudies............................................ 3 3 ScreeningwithLow-DoseCToftheChest....................................................................... 8 4 BenefitsandRisksofLDCTScreening.............................................................................. 14 5 GuidelinesforLDCTScreening......................................................................................... 17 6 Conclusions.......................................................................................................................... 19 References.................................................................................................................................. 19 1 Why Screen for Lung Cancer? As the most common cause of cancer-related deaths in the United States and worldwide,lungcancerisapublichealthproblemofglobalmagnitude.In2015,an estimated221,200newcasesoflungcancerwillbediagnosedintheUnitedStates and158,040deathswilloccurasaresultoflungcancer[1].Worldwide,1.6million lung cancer-associated deaths were estimated in 2012 [1]. Five-yearrelative survival rate forlung cancer isonly17.4 %duetomore than half of patients being diagnosed with distant disease by the time-associated symptoms manifest. Lung cancer outcomes are highly dependent on stage at diagnosis.PatientswithstageInon-small-celllungcancer(NSCLC)havefive-year overallsurvivalofatleast60 %,whereasthosewithstageIVdiseasehavesurvival of less than 5 % [2]. Tumor size in early lung cancer (stage I) has also been identified as a predictor of nodal status and thus stage [3]. Incidentally detected NSCLCinasymptomaticpatientstendstobesmaller,earlierstage,andhavesimilar stage-specific overall survival as symptomatic disease [4, 5]. Data on screen-detected lung cancer report stage I disease in 85 % of participants and estimate 10-year overall survival to be 88 % [6]. Inadditiontohavinghighmorbidityandmortality,alongpreclinicalphase,and improved survival with early-stage diagnosis,lungcancer also hasidentifiable risk factors such as age and smoking history, which can be used for screening criteria. All these characteristics suggest that screening may be effective in improving lung cancer outcomes as it has for other malignancies including colon, breast, and cer- vical. For screening to be considered beneficial, it must lead to the reduction in LungCancerScreening 3 disease-specific and overall mortality. Effective screening ideally involves an inexpensive, low-risk, and easily accessible test that is sensitive and specific for detecting cancer initsearly stagesbefore symptoms manifest asadvanced disease. Chest X-ray (CXR) with or without sputum cytologic analysis and low-dose computed tomography (LDCT) have been studied as lung cancer screening tools, and the evidence is presented in this chapter. 2 Screening with Chest X-Ray and Sputum Cytologic Studies Six randomized controlledtrials (RCTs)from the 1960sand 1970s haveevaluated the use of CXR in lung cancer screening (Table 1). None of these studies clearly demonstrated a benefit in lung cancer mortality, although most studies had limitations due to methodological flaws [7]. The Northwest London Mass Radio- graphy Service Study began in 1960 and was a prospective trial of 55,023 male factory workers of variable smoking status (19 % former smokers, 67 % current smokers)whowere40 yearsorolder.Ofthese,29,723wererandomizedtoreceive CXRevery6 monthsand25,300wererandomizedtoacontrolgroupthatreceived screeningatbaselineandat3 years.After3 yearsofscreening,lungcancerpatients inthescreeninggrouphadahigherproportionofresectablelungcancerthanthose from the control group (44 % versus 29 %, p = 0.03). Five-year survival rate was alsobetterinlungcancercasesidentifiedbytheinterventionthaninthoseidentified in the control group (23 % versus 6 %, p < 0.01). However, the annual mortality rates fromall lungcancerswerenotsignificantlydifferent between thegroups (0.7 versus 0.8 deaths per 1000 person-years). Only 65 % of lung cancers in the intervention group were identified by 6-monthly CXR [8, 9]. In 1964, the Kaiser Permanente Study randomized 5156 Kaiser Foundation HealthPlanmenandwomenaged35–54 yearstobeencouragedtoundergoannual multiphasic health checkups (including CXR), while a comparable group of 5557 members were not encouraged to do so. Patients were followed for 16 years, and those in the intervention group had 6.8 mean checkups and a mortality of 8.6 per 1000person-yearscomparedtomean2.8checkupsandamortalityof7.6per1000 person-yearsintheparticipantsfromthecontrolgroup.Thedifferencedidnotmeet statistical significance [10, 11]. Inthe1970s,4RCTsstudiedlungcancerdetectioninmalesmokersusingCXR and sputum cytology. The Mayo Lung Project was the first study to evaluate the intense use of these dual-screening tools in lung cancer screening; 10,933 partici- pants aged 45 years or older underwent baseline (prevalence screening) CXR and sputum cytologic examination from 3-day pooled samples, and 91 (0.83 %) lung cancer cases were detected [12]. Following the prevalence round, 4618 men were randomized into the intervention group (CXR and sputum cytologic examination every 4 months for 6 years) and 4593 were assigned to the control group (annual CXR andsputumtesting advised asusual care). Over the6-year study period, 206 and160newlungcancercaseswerediagnosedinthescreeningandcontrolgroups,
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