Reason for Hope in Lung Cancer Care

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Grandfather and kids; According to physicians with the UW Carbone Cancer Center, there is reason for hope in the care of lung cancerMADISON – Lung cancer is among the deadliest forms of the disease; it accounts for more deaths than breast, colon and prostate cancer combined.
According to the National Cancer Institute, an estimated 161,000 individuals will die from lung cancer in 2008 and there will be 215,000 new cases diagnosed. In Wisconsin, nearly 3,000 people die each year from lung cancer.

Even with those sobering statistics, oncologist Anne Traynor, MD, head of the UW Health lung cancer program, said there is tremendous reason for hope.

Traynor spoke at "Putting the Puzzle Pieces Together: The Latest in Lung Cancer Research," a panel discussion organized by the UW Carbone Cancer Center. During her introductory remarks at the event , Dr. Traynor explained that everyone in the field is awaiting the results of a significant clinical trial.

"We really need the results of those trials to be positive. We really need to discover a new technology that can diagnose lung cancer earlier, before it spreads, and can be cured by surgery," said Dr. Traynor.

The clinical trial is taking place across the country as investigators examine whether there is a better way to detect lung cancer earlier. Nearly 50,000 individuals are enrolled, with more than 17,000 from Wisconsin alone.

"There's a lot of hope and a lot of good work happening," commented Dr. Traynor. 

The Need for an Effective Screening Test
Part of the reason lung cancer is so deadly is that it can be hard to diagnose, and people often don’t show symptoms until the disease is advanced. An effective screening program would enable doctors to identify the disease earlier, when it is still curable.

"Over the last 30 years, the five-year survival rate for breast cancer has increased from 65 to 88 percent," explained Toby Campbell, MD, another oncologist with the UW Carbone Cancer Center. "During that same time, the five-year survival rate has risen from 12 to 15 percent for lung cancer."

Dr. Campbell explained that the difference comes from the significant gains made in breast cancer research, enabling doctors to find smaller tumors that can be cured.

"If we can identify a screening test that is effective, that would be a huge improvement in the care of patients that will eventually face lung cancer," said Dr. Campbell.

In the past, screening trials haven't proven effective because the sample size is so large. Dr. Campbell likened it to trying to find a needle in a haystack. If the size of the haystack is reduced, there is a greater likelihood of finding the needle. In the case of lung cancer, refining the screening methods and limiting the pool of individuals screened mean a greater likelihood of finding those individuals at greater risk for developing the disease.

Researchers at the University of Wisconsin are working under that very idea. They have identified a pattern of 30 genes that predicted with 100 percent accuracy those who went on to get lung cancer. The sample size was very small - only 24 individuals. But research is underway with a much larger sample of people to test the theory. According to Dr. Campbell, while it is still early, it is a very promising study.

Understanding the Disease
In addition to research into screening methods, scientists are also trying to better understand lung cancer cells and how to more effectively treat them. Currently, lung cancer is divided into small cell cancer and non-small cell cancer.

"That level of detection and distinction was about all we needed," said Dr. Campbell.

But researchers are beginning to identify important parameters in small cell cancer that may mean doctors will be able to differentiate their treatments between different sub-types of small cell lung cancers in the future.

"As we begin to learn a little more about the biology of a lung cancer cell, what makes it tick, we can begin to target our treatments a little bit better," explained Dr. Campbell.

It is a similar model to what is already taking place in breast cancer treatments. Doctors are able to target drugs to specific details of the cells for more effective treatment. Dr. Campbell commented, "it's a model to be envious of."

Advancements in Radiation Therapy
Just as researchers continue to investigate new agents to better treat lung cancer, there is also extensive research being done in the field of radiation therapy. Greg Richards, MD, radiation oncologist with the UW Carbone Cancer Center, explained that radiation uses high-energy x-rays which induce damage in the DNA of cells. Non-cancerous, normal cells are better at repairing themselves than cancerous ones. Multiple doses, or fractions, of radiation treatment are specially timed to give normal cells time to repair themselves while cancerous cells eventual die off. That is the therapeutic advantage of radiation.

Radiation is often used in conjunction with chemotherapy and surgery in the treatment of lung cancer. And it is used at nearly every stage of the disease. Advances at the UW Carbone Cancer Center have resulted in radiation techniques that can focus on the cancer cells, provide better control of the tumor with fewer side effects to the patient. One such technique is Stereotactic Body Radiation Therapy, or SBRT.

A four-dimensional CT scan is essentially a CT scan taken over a period of time. Through such a scan, physicians can see how a lung tumor moves as the patient breathes. This scan, combined with intensity-modulated radiation, enables physicians to pinpoint the tumor and avoid the normal tissue surrounding it. As a result, higher doses of radiation can be delivered with fewer fractions. In the past, as many as 33 fractions would have been needed. With the new technique, only five fractions delivered over two weeks are generally necessary. And the control rate of the tumor is greatly improved – from 40 percent under the old way, to 90 percent using the improved method.
The Advantage of a Multidisciplinary Program

Scott Ferguson, MD, pulmonologist with the UW Carbone Cancer Center, is relatively new to UW Health. He commented that while advancements in screening and radiation are significant, another advantage of the Carbone Cancer Center's practice is that it is a multidisciplinary program.

"One of the things I really like about this program is how everyone here really works together," said Dr. Ferguson. "This is a multidisciplinary program where different specialties come together to treat this one disease. And it is a huge advantage."

Pulmonologists are responsible for the prevention, screening, diagnosis, staging and therapies of lung cancer. Like his colleagues, Ferguson spoke about the challenges and advancements in treating the disease.

"The technology has become so advanced, we can detect lung cancer at a very early stage," Dr. Ferguson said. "The problem, and this is the lung cancer paradox, is that we can’t diagnose it at an early stage."

Today's imaging technology can allow physicians to see the smallest of nodules on a lung, but because the chest is so complex, it is nearly impossible to get to the nodule to determine whether it is actually cancerous. Work is underway to try and access those nodules, as well as to successfully screen individuals who are the most likely to have lung cancer.

Dr. Ferguson also referred to the work of Tracey Weigel, MD, who was successful at establishing endobronchial ultrasound, or EBUS, at UW last year. EBUS uses an ultrasound scope so physicians can examine lymph nodes in the middle of the chest in a much less invasive way. Previously, surgery would have been necessary.
The Challenges of Funding

While there have been significant gains, one of the underlying challenges in the field of lung cancer is the lack of funding. According to Dr. Campbell, the large grant money comes from the National Institutes of Health (NIH). As its funding has been cut, so too has the grant money available for research.

The lung-cancer specialists within the UW Carbone Cancer Center have formed a task force to help generate initial results from research that would then allow them to go for the large government grant money. While it is still early in the process, Dr. Campbell concluded, "There are a lot of reasons to be optimistic about the future."

Date Published: 09/18/2009

News tag(s):  anne m traynorcancertoby c campbellj scott ferguson

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