What’s new in non-small cell lung cancer research?
Lung cancer research is going on now in many medical centers around the world.
Prevention offers the greatest promise at this time for fighting lung cancer.
Tobacco: Smoking still accounts for almost 9 out of 10 lung cancer deaths. Studies are going on to look at how best to help people quit smoking through counseling, nicotine replacement, and other medicines. Other studies are looking at ways to convince young people not to start smoking. Still others are focused on gene changes that make some people much more likely to get lung cancer if they smoke or are exposed to someone else’s smoke.
Environmental causes: Researchers also continue to look into some of the other causes of lung cancer, such as exposure to radon and diesel exhaust. Finding new ways to limit these exposures could potentially save many more lives.
Diet, nutrition, and medicines: Research continues to test ways to prevent lung cancer in people at high risk by using vitamins or medicines. So far, these have not proved to help. Many researchers think that simply following the American Cancer Society’s advice about diet (staying at a healthy weight and eating a diet rich in fruits and vegetables) may be the best approach.
Finding lung cancer
As mentioned in the section “Can non-small cell lung cancer be found early?” a large study called the National Lung Screening Trial (NLST) recently found that low-dose CT scanning in people at high risk of lung cancer (due to smoking history) lowered the risk of death from lung cancer when compared to chest x-rays. This finding has led to the development of screening guidelines for lung cancer.
Another approach uses newer ways to look for cancer cells in sputum samples. Researchers have found many changes that often affect the DNA of lung cancer cells. New tests might be able to spot these changes and find lung cancer at an earlier stage.
Fluorescence bronchoscopy is a method that may help doctors find some lung cancers earlier, when they may be easier to treat. For this test, the doctor inserts a bronchoscope through the mouth or nose and into the lungs. The end of the bronchoscope has a special fluorescent light on it, instead of a normal (white) light. The light causes abnormal areas in the airways to show up in a different color than healthy parts of the airway. Some cancer centers now use this technique to look for early lung cancers, especially if there are no obvious tumors seen with normal bronchoscopy.
An imaging test called virtual bronchoscopy uses CT scans to make detailed 3-D pictures of the airways in the lung. The pictures can be looked at as if the doctor were really using a bronchoscope. There are benefits and drawbacks to this approach. But it can be a useful tool in some cases, such as in people who might be too sick to get a standard bronchoscopy. This test will likely be used more as the technology improves.
Doctors now use video-assisted thoracic surgery (VATS) to treat some small lung tumors. It lets doctors remove parts of the lung through smaller cuts, which can lead to shorter hospital stays and less pain. Doctors are now studying whether it can be used for larger lung tumors.
In a newer approach, the doctor sits at a special control panel inside the operating room to move long surgical instruments using robotic arms. This approach, known as robotic-assisted surgery, is now being tested in some larger cancer centers.
Real-time tumor imaging
Researchers are looking to use new imaging techniques, such as four-dimensional computed tomography (4DCT), to help improve treatment. In this technique, the CT machine scans the chest constantly for about 30 seconds. It shows how the tumor moves as a person breathes, as opposed to just giving a ‘snapshot’ of a point in time, like a standard CT does.
4DCT can be used to show exactly where the tumor is during each part of the breathing cycle, which can help doctors aim radiation at the tumor more precisely. This technique might also be used to help show if a tumor is attached to or invading important structures in the chest, which could help doctors figure out if it can be removed with surgery.
Doctors are looking at newer ways of combining chemotherapy (chemo) drugs in the hope of causing fewer side effects. Studies are testing the best ways to combine chemo with radiation and other treatments.
Doctors know that chemo after surgery may be more helpful for some people with early cancers than for others, but figuring out which patients to give it to is not easy. In early studies, newer lab tests that look at patterns of certain genes in the cancer cells have shown promise in telling which people might be helped the most. Other lab tests may help predict whether a lung cancer will respond to certain chemo drugs. More studies of these tests are now being done.
Some recent studies have found that with cancers that have not progressed during chemo, continuing treatment beyond the usual 4 to 6 cycles with a single drug may help some people live longer. This is known as maintenance therapy. Some doctors now recommend maintenance therapy, while others wait for further research on this topic.
We are learning more about the inner workings of lung cancer cells that control how they grow and spread. This is being used to develop new targeted drugs. Some of these treatments are already being used to treat non-small cell lung cancer. Others are being tested in clinical trials to see if they can help people with advanced lung cancer live longer or relieve their symptoms.
Researchers are also working on lab tests to help predict which patients will respond to which drugs. Studies have found that some patients do not benefit from certain targeted drugs, whereas others are more likely to have their tumors shrink quite a bit. Being able to tell who might respond could save some people from trying treatments that are unlikely to work for them and which could cause side effects.
Researchers are studying drugs that can help the body’s immune system fight the cancer.
Drugs that block PD-1 and PD-L1: Cancer cells often have a protein called PD-L1 on their surface that helps them evade the immune system. New drugs that block the PD-L1 protein, or the related PD-1 protein on immune cells, can help the immune system recognize the cancer cells and attack them.
In early studies, drugs that target these proteins have been shown to shrink tumors in some people with NSCLC. Many of the tumor responses have been long-lasting so far. Larger studies of these new drugs are now being done.
Vaccines: Several types of vaccines for boosting the body’s immune response against lung cancer cells are being tested in clinical trials. Unlike vaccines against measles or mumps, these vaccines are meant to help treat, not prevent, lung cancer. These types of treatments seem to have very few side effects, so they might be useful in people who can’t have other treatments. At this time, vaccines are only available in clinical trials.
Last Medical Review: 09/05/2013
Last Revised: 04/30/2014