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Generally, BAC tumors grow more slowly than other lung cancers, but after treatment these tumors often recur in multiple areas of the lung. BAC tumors are more common among women and less likely to be linked to smoking. As many as one-third of BAC patients have never smoked, compared with about 10% of all lung cancer patients.
BAC usually does not respond to treatment. However, a phase II study found that the drug erlotinib (Tarceva) shows promise in treating patients with BAC. Erlotinib fights cancer by blocking the actions of a protein called the epidermal growth factor receptor (EGFR). This protein is necessary for the growth of many cancer cells.
In 30 patients with BAC who had been treated with erlotinib for one month or more, eight (27%) responded to the drug. Researchers also found that erlotinib was more effective in patients who had never smoked.
Of the eight patients who responded to the drug, five had never smoked and two had smoked less than ten pack years. (A pack-year is a cumulative measure of smoking: One pack-year is equivalent to smoking one pack of cigarettes every day for one year). In comparison, only three of 22 former or current smokers' cancers responded to the treatment.
Lead investigator Vincent Miller, MD, of Memorial Sloan-Kettering Cancer Center, called the findings "encouraging," especially because the majority of the study's participants experienced only mild toxicity.
These findings suggest that lung cancer may behave differently in those who have never smoked than in former or current smokers. It also highlights the importance of doctors getting detailed information about patients' smoking histories.
Currently, erlotinib is only available in ongoing clinical trials. Dr. Miller and his colleagues are planning a phase III study of erlotinib in BAC patients, which is set to begin later this year.
"If the study's results can be confirmed in a phase III trial, erlotinib would be considered as an initial treatment option for many patients with inoperable BAC," said Dr. Miller.
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