What`s new in small cell lung cancer research and treatment?

Lung cancer is currently being researched in medical centers throughout the world. Progress in prevention, early detection, and treatment based on current research is expected to save many thousands of lives each year.

Prevention

Tobacco

At this time, many researchers believe that prevention offers the greatest opportunity to fight lung cancer. Although decades have passed since the link between smoking and lung cancers was clearly identified, scientists estimate that smoking is still responsible for about 87% of lung cancer deaths, and this percentage is likely even higher for small cell lung cancers. Research is continuing on:

• Ways to help people quit smoking through counseling, nicotine replacement, and other medicines
• Ways to convince young people to never start smoking
• Inherited differences in genes that may make some people much more likely to get lung cancer if they smoke or are exposed to someone else's smoke

Diet, nutrition, and medicines

Although researchers are looking for ways to use vitamins or medicines to prevent lung cancer in people at high risk, so far none have been shown conclusively to reduce risk. Some studies have suggested that a diet high in fruits and vegetables may offer some protection, but more research is needed to confirm this. For now, most researchers think that simply following the American Cancer Society dietary recommendations (such as maintaining a healthy weight and eating a diet high in fruits, vegetables, and whole grains) may be the best strategy.

Early detection

As mentioned in the section "Can non-small cell lung cancer be found early?", a large clinical trial called the National Lung Screening Trial (NLST) found that spiral 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, more sensitive tests to look for cancer cells in sputum samples. Researchers have recently found several changes that often affect the DNA of lung cancer cells. Current studies are looking at new diagnostic tests that specifically recognize these DNA changes to see if this approach is useful in finding lung cancers at an earlier stage.

Diagnosis

Fluorescence bronchoscopy

Also known as autofluorescence bronchoscopy, this technique 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 fluorescent light causes abnormal areas in the airways to show up in a different color than healthy parts of the airway. Some of these areas might not be visible under white light, so the color difference may help doctors find these areas sooner. Some cancer centers now use this technique to look for early lung cancers, especially if there are no obvious tumors seen with normal bronchoscopy.

Virtual bronchoscopy

This imaging test uses CT scans to create detailed 3-dimensional pictures of the airways in the lungs. The images can be seen as if the doctor were actually using a bronchoscope.

Virtual bronchoscopy has some possible advantages over standard bronchoscopy. First, it is non-invasive and doesn't require anesthesia. It also helps doctors look at some airways that might not be seen with standard bronchoscopy, such as those being blocked by a tumor. But it has some drawbacks as well. For example, it doesn't show color changes in the airways that might indicate a problem. It also doesn't allow a doctor to take samples of suspicious areas like bronchoscopy does. Still, it may be a useful tool in some situations, such as in people who might be too sick to get a standard bronchoscopy.

This test will probably become more available as the technology improves.

Treatment

Chemotherapy

Many clinical trials are being done to compare the effectiveness of newer combinations of chemotherapy drugs. These studies are also looking to reduce side effects, especially in patients who are older and have other health problems. Doctors are also searching for better ways to combine chemotherapy with radiation therapy and other treatments.

Some new chemotherapy drugs, such as amrubicin and picoplatin, have shown promising results in early studies and are now being tested in larger clinical trials.

Targeted therapies

Researchers are learning more about the inner workings of lung cancer cells that control their growth and spread. This is being used to develop new targeted therapies. These drugs work differently from standard chemotherapy drugs. They often have different (and less severe) side effects. Many of these treatments are already being tested in clinical trials to see if they can help people with advanced lung cancer live longer or relieve their symptoms.

Anti-angiogenesis drugs: For cancers to grow, new blood vessels must develop to nourish the cancer cells within tumors. This process is called angiogenesis. New drugs that inhibit angiogenesis are being studied as lung cancer treatments.

Some have already been successfully used for other cancer types. For example, a drug called bevacizumab (Avastin) has been shown to help patients with some types of non-small cell lung cancer. In a study of small cell lung cancer, it helped stop some of the cancers from growing for a time, but didn’t seem to help the patients live longer. Other drugs already approved for use against other types of cancer, such as sunitinib (Sutent) and sorafenib (Nexavar), are also being tested for use against SCLC.

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 infections like measles or mumps, these vaccines are designed to help treat, not prevent, lung cancer. One possible advantage of these types of treatments is that they seem to have very limited side effects, so they might be useful in people who can't tolerate other treatments. At this time, vaccines are only available in clinical trials.