The Sorry State Of Affairs For Lung Cancer

Recent article published in the Annals of Oncology summarizes European cancer statistics for the last 40 years and makes trend projection for several years ahead. The data show that cancer mortality is slowly but surely decreasing for the majority of cancers affecting both males and females.

There is one notable exception, however. The mortality from lung cancer is still staying at an exceptionally high level. Even despite significant decline in recent years, the disease remains a leading cause of cancer related deaths among men. In contrast with males’ statistics, lung cancer is on the rise among women and likely to become the most common type of malignancies among them in the next few years. Currently this place is occupied by breast cancer. It would be reasonable to ask why, despite billions of dollars invested in cancer research, lung cancer is still such a threat?

Why lung cancer mortality is so high?

There are several factors contributing to the stubbornly high mortality from lung cancer.

The disease tends to develop quickly. Early diagnosis of lung cancer is, however, problematic. Disease stays asymptomatic in the beginning and usually gets discovered at later stages when therapeutic intervention is not very efficient anymore. Lung cancer stands a good chance of successful treatment if it is identified at stage I of its development. This, however, can be reliably achieved only with the use of regular CT scans, an expensive and complicated technique.

Early detection tests based on easily identified molecular markers of lung cancer still wait to be developed. Molecular diagnostics in recent years plays an increasing role in early detection of other cancers. For instance, introduction of routine blood tests for general screening purposes was a game changer in prostate cancer. Unfortunately, no reliable molecular marker for lung cancer was found so far.

Another problem is the lack of good lung cancer-specific drugs. Lung cancer chemotherapy relies on the use of classic aggressive agents targeting any fast dividing cells. The agents cause multiple side effects which limit the extent of their usefulness. Many other cancer types can now be treated with newer drugs that have more targeted action. In the case of lung cancer, the targeted therapeutics only started to emerge recently, and they are still not very effective. In addition, most of them are so expensive that many national health services refuse to approve them for general treatment arguing that these drugs are simply not cost-effective.

Financial, Political And Social Issues Affect The Development Of Better Lung Cancer Therapies

Clearly, much more needs to be done to develop better drugs. The attempts to do so were limited, however. Most pharmaceutical giants do develop drugs against lung cancer but it seems that the list of drug targets is very small, and many of them were already proven to be not ideal. This means that the upcoming future drugs which are now under development will be just slightly better than existing analogues.

Pharmaceutical companies rarely generate new revolutionary ideas in cancer treatment. Usually new approaches are born in the academic circles. Once confirmed, good academic ideas tend to be picked up by big pharma and developed into practical treatment. This typical route of ideas evolution means that without proper funding of academic research, good drug prototypes don’t tend to get developed in the first place. Academic funding usually comes from governmental or charity sources, but this is where the problem with lung cancer lies. Despite being the commonest type of malignancies, lung cancer attracts just a fraction of research money. Most funds get allocated to research into other types of cancer such as breast cancer or leukemia. These branches of oncology are already more advanced and tend to bring quicker and more pleasing practical results.

An interesting, although a bit cynical, point of view was expressed by the publication in the Sydney Morning Herald in 2012. A high rate of fatality among lung cancer patients means that few patients can advocate the case. They struggle to receive a good hearing and few people are very interested. The result is that lung cancer receives just around 1% of research funding, even though the disease accounts for around 20% of cancer deaths in Australia.

Any positive changes on the horizon?

Not everything is doom and gloom, however.

Early diagnosis may soon improve significantly. New breath tests for lung cancer currently being developed may offer a hope of early detection technique available for general routine tests. The tests represent a very practical simple-to-use approach. Breath tests for lung cancer detect volatile products of cancer metabolism which can be picked up from the exhaled air and analyzed.

Recent research finally helped to identify lung cancer stem cells. Developing the drugs against these cells specifically, instead of the cells forming the bulk of tumor mass, provides a hope of developing a successful lung cancer treatment. Stem cells represent only a small portion of cancer cells, but they have a remarkable ability to restore tumor after chemotherapeutic treatment. They are not very sensitive to classic chemotherapy, since they don’t divide very often. Escaping chemotherapy helps them to re-establish cancer population upon completion of chemotherapeutic treatment.

Finally, we have recently witnessed the major change of attitude in the way our health regulatory bodies deal with the early detection of lung cancer.  Till this year, regulations related to screening and detection of lung cancer discouraged the use of advanced techniques such as CT scans in the USA. Official guidelines that were published by the American College of Chest Physicians (ACCP) in 2007 were based on the lack of convincing evidences that such screening programs have any visible impact on the survival of lung cancer patients.

The findings from the National Lung Screening Trial (NLST) published in 2011 indicate that CT can reduce the mortality from lung cancer by 20% in the high risk group such as heavy smokers of older age. Now the American Cancer Society has endorsed CT as a means to detect lung cancer. Lung Cancer Alliance, National Comprehensive Cancer Network and the American Association of Thoracic Surgeons have also supported the use of this technique. It looks like the chances of lung cancer’s early detection will improve greatly in the coming years.