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Targeted Therapies and New Drugs Offer Hope in Battling Lung Cancer
By Sameh Fahmy
The Tennessean
Lung cancer is the No. 1 form of cancer that kills both men and women, but new drugs that target tumors and advances in radiation and chemotherapy are helping patients live longer. When Connie DeWitt was first told that she had lung cancer, two words popped into her head: death sentence.
"My mother was perfectly active at 72, and they told her she had lung cancer and she lived six months," DeWitt says. DeWitt was diagnosed three years ago. But looking at her now, you wouldn't know she was undergoing treatment for cancer unless you asked. "They said, 'We've come a long way in 10 years,' " DeWitt recalls. " 'You're not your mother.' "
DeWitt, of LaVergne, Tenn., was one of the fortunate few who was diagnosed with lung cancer early. She had an unrelated cyst on her neck that doctors X-rayed, and they happened to find a 2-centimeter tumor.
A study of nearly 50,000 current and former smokers is under way to better understand how -- or if -- X-rays and more detailed spiral CT scans are useful for detecting lung cancer. Results from the National Lung Cancer Screening Trial won't be available for several years, but already some people are asking their doctors for a CT scan.
There are risks. Anywhere from 25 percent to 60 percent of current or former smokers have some kind of abnormality that a CT scan would find. These abnormalities could be scar tissue, areas of inflammation or other conditions that aren't lung cancer but can look like it. The test might also find small tumors that would never be life threatening. To examine these abnormalities, doctors remove a small piece of lung tissue. With this procedure, patients risk infection or other complications. Doctors might have to perform open lung surgery, which carries even more risk.
"The main risk, in my view, of screening is you can hurt the patient by trying to find out what's wrong when they really don't have cancer," says Dr. F. Anthony Greco, medical director of the Sarah Cannon Research Institute. "And this is not rare." He and others generally don't recommend it for former or current smokers. In addition to early detection, DeWitt had another advantage that her mother didn't. Doctors treated her with chemotherapy and an experimental drug called Avastin. It's one of two main types of so-called targeted therapies that attack cancer cells while sparing noncancerous cells.
Avastin prevents the growth of blood vessels that feed tumors, so tumors essentially starve to death. Dr. Alan Sandler, associate professor of medicine at the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., is leading a study of nearly 900 patients that compares combined treatment with the drug and chemotherapy versus chemotherapy alone. Sandler presented preliminary results of his study at a meeting of the American Society of Clinical Oncology in Orlando, Fla.
The study found that patients with the most common type of lung cancer lived an average of 12.5 months with the drug compared to an average of 10.2 months without it. "This the first time that an agent that targets new blood vessel development has shown a survival benefit in lung cancer," Sandler says. Patients enrolled in the study had relatively advanced lung cancer, and Sandler expects the drug might be used with earlier stage disease with better results. DeWitt credits the drug with holding her cancer at bay for a year, but her cancer has "outsmarted the drug," she says, and is growing again. She now is being treated with Iressa, another therapy that has shown mixed results.
While Avastin targets blood vessel growth, Iressa and a similar drug called Tarceva target a protein that's mutated in some cancer patients. The U.S. Food and Drug Administration approved Iressa in 2003 based on preliminary data for use in lung cancer patients who have tried two chemotherapy treatments without success. Although preliminary data suggests a benefit for Iressa, more recent data found no statistically significant benefit. In June, the FDA told doctors that the medicine should be used only in cancer patients who already take it with good results.
The agency does not want new patients to be given Iressa because a large study did not show that the drug made people live longer. The FDA continues to approve Tarceva, which a study found to have increased average survival from 4.7 months to 6.7 months.
As researchers search for and test new drugs, advances in delivering chemotherapy and radiation therapy are giving patients better treatment results. Sandler says doctors are increasingly giving chemotherapy to patients after surgery to improve their survival rate, and newer anti-nausea drugs and antibiotic use is making chemotherapy more tolerable.
Leavitt vows to help keep Libby asbestos clinic open
By The Associated Press
LIBBY - 03/11/06 - Health and Human Services Secretary Mike Leavitt is promising to do what he can to help the asbestos clinic here stay open and to support research opportunities for the town's unique and toxic form of asbestos.
Leavitt visited Libby Friday at the behest of Sen. Max Baucus, D-Mont., who wanted him to see for himself what health care providers and residents exposed to asbestos are going through. It was Leavitt's second trip to Libby.
Asbestos released into the air from the now-closed W.R. Grace and Co. vermiculite mine in Libby is blamed by some health authorities for killing about 200 people and sickening one of every eight residents there.
After spending an hour with doctors at the Center for Asbestos Related Disease, better known as the CARD clinic, Leavitt was greeted by a standing-room-only crowd at a town hall meeting. "I'm impressed with the level of community spirit that went into the CARD clinic," Leavitt told the crowd. "We'll do what we can to keep it going."
The clinic, which treats more than 1,400 asbestos victims, was created with a $250,000 donation from Grace to St. John's Lutheran Hospital. It later formed its own nonprofit corporation, and now relies heavily on reimbursements from HNA, the company that administers Grace's medical insurance plan for asbestos patients.
Last fall, HNA sent letters to about 700 of 870 Libby area residents enrolled in the Grace plan, saying their benefits were being scaled back.
The uncertainty of the Grace plan has left the clinic facing an unpredictable future for sustainable health care services and research, said Dr. Brad Black, medical director of the CARD clinic.
"Medicare has turned down a lot of these patients," said Pulmonary expert Dr. Alan Whitehouse. "And when they have insurance through Grace and Grace says it won't pay, there's no funds, and that's getting to be a problem."
Leavitt quizzed the doctors about the "labyrinth of health care" resources for asbestos victims. "If they (Grace) don't pay, why do they view themselves as providing insurance?" Leavitt said.
He urged officials to tap the attorney general's office for assistance, and to be a part of the proceedings as Grace "divvies up" its pool of assets.
He and Baucus also listened to the personal stories of asbestos victims dealing with the disease and the red tape that accompanies medical treatment.
"I feel the affection you have for each other, how you take care of one another," Leavitt said. "Both of my visits here have been extraordinarily important in terms of learning. You can't understand it until you've been here. ... I think we're on to something important here."
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