New Developments in Lung Cancer

Transcript: New Developments in Lung Cancer with Mark G. Kris, MD
November 5, 2003, 2:00 – 3:00 PM ET

Moderator: On behalf of the American Society of Clinical Oncology (ASCO), welcome to the Cancer.Net chat on New Developments in Lung Cancer, a live question-and-answer session hosted by Mark Kris, MD. During this hour, Dr. Kris will answer as many questions as time permits. Some questions may be adapted so that Dr. Kris' answers can help as many people as possible.

Dr. Kris will take questions from 2:00 to 3:00 PM ET. As you prepare your questions, please keep in mind that he is unable to give individual medical advice in this setting. In answering questions about specific drugs, his comments will focus on the state of current research and clinical trials.

The chat is governed by all terms and conditions of the Cancer.Net website.

Good afternoon and welcome. Thank you for joining us. Dr. Kris will now begin taking questions.

Dr. Kris is Chief of the Thoracic Oncology Service, Division of Solid Tumor Oncology, and Associate Chairman, Clinical Trials, Department of Medicine, at Memorial Sloan-Kettering Cancer Center. His research interests include the evaluation of new anticancer agents, the development of treatments targeting lung cancer, multimodality therapy, and symptom management to improve the care of all people with cancer.Dr. Kris is a member of the Cancer.Net Editorial Board.

Dr. Kris, thank you for taking the time to join us today.

Guest66: What is the status of a vaccine for lung cancer?

Dr. Kris: As of today, NO vaccine is approved for the treatment of lung cancer. However, many research institutions are testing vaccines that hopefully will prove to be helpful. To see if a vaccine is right for you, you need to discuss it with your doctor. In general, most vaccines are now being tested after your treatments have been completed.

newyork: Have there been any new developments in helping patients with malignant pleural mesothelioma manage their symptoms?

Dr. Kris: New treatments are available for all stages of malignant pleural mesothelioma (MPM). Just starting is a nationwide program using cisplatin (Platinol) and pemetrexed (Alimta) prior to surgery. Radiation is also part of this program being offered at Memorial Sloan-Kettering, Dana Farber Cancer Institute, University of Chicago, and other sites.Several hospitals are also testing the antiangiogenesis drug bevacizumab (Avastin) with chemotherapy. Again, you should contact your doctor to see if one of these programs is right for you.

Guest99: What can you tell me about poorly differentiated adenocarcinoma?

Dr. Kris: This is a type of non-small cell lung cancer (NSCLC) and is treated based upon the stage of the illness.

Guest134: What kind of drug is gefitinib (Iressa)? How effective is it for treating lung cancer?

Dr. Kris: Gefitinib is an entirely new type of treatment for lung cancer. It works by turning off a molecular switch within the cancer cell. When the switch is turned off, cancer cells die.This medicine is given as a tablet. It has been shown to help people who have already received several types of chemotherapy. When this drug is given, it leads to an improvement in the symptoms caused by lung cancer and, for many patients, it provides an additional option when no other options exist.

By the nature of this medicine, however, it will only work if your cancer cell carries the molecular switch. At present, there is no test to measure this. So, for now, it must be given to a person for a time to see if it helps them.This drug works in a matter of days, so you only have to take it for two to four weeks to know if it is helping you. We have found that women, people with bronchioloalveolar carcinoma (BAC), and people who have never smoked cigarettes have the best chance of success with this medicine.

Guest66: Are treatment options for cancer that has metastasized to the lung different than lung cancer treatments?

Dr. Kris: The site of origin of the cancer cells determines cancer treatment. For example, if your cancer started in the breast and spread to the lungs, it would be treated with medicines specific for breast cancer.

agent007: I was a smoker for 14 years. Is there anything I can take to prevent me from getting lung cancer in the future?

Dr. Kris: The single most important thing a person can do to lower their lung cancer risk is to stop smoking. Stopping smoking always improves your health, even if you already have lung cancer. Recent studies have shown that patients who stop smoking tolerate their lung cancer treatments better and live longer.

Guest126: The surgeon had to cut the laryngeal nerve to remove my husband's lung tumor. One doctor told us he would get his voice back; another told us it would never come back. What are your thoughts?

Dr. Kris: I agree with both doctors, because you cannot know whether your voice will return to normal.For most people, even when the nerve is cut, the voice is softened but never lost. In addition, special surgeries can improve the quality of your voice after the laryngeal nerve is damaged. If your voice is still a source of concern for you, I urge you to contact an ear, nose, and throat specialist to discuss what options are open to you.

barbie: Is there a class of drugs more helpful for non-small cell lung cancer (NSCLC) that has spread to the bone?

Dr. Kris: All of our treatments can help patients with cancer that has spread to the bone.

Guest377: In your opinion, where should someone go to get information about quitting smoking?

Dr. Kris: The American Cancer Society can provide information on how to quit. In addition, many states have established their own smoking cessation programs. Also, your doctor can recommend smoking cessation specialists and provide anti-smoking aids.

Barbara: Have you seen an increase in integrative therapies and, in your opinion, have they helped?

Dr. Kris: The majority of patients choose integrative therapies along with chemotherapy, radiation, and surgery.The type of therapy chosen depends on the specific needs of each person. For example, a person recovering from lung surgery may choose to use yoga to facilitate their recovery from the operation.

Many people also choose acupuncture, particularly for pain control. Many of my patients have told me of their success with these two techniques.I encourage you to discuss your use of complementary therapies with your doctor. Most oncology practices are familiar with the options available in your community and can often make referrals for you.

Ilene: What do you know about the drug erlotinib (Tarceva) as a treatment option?

Dr. Kris: Erlotinib (Tarceva) is now an experimental drug and is only available as part of a clinical trial. Erlotinib (Tarceva) works in the same way as gefitinib (Iressa).

Guest376: Since my radiation, the pulmonologist wants to put in a stent to expand one of my bronchial tubes. It shrunk due to the radiation. Is this common in your experience?

Dr. Kris: Sometimes radiation treatments can cause scarring that leads to constriction of the bronchial tubes. Opening the bronchial tubes during a bronchoscopy can sometimes help. Also, a surgeon can sometimes place a stent to prop the bronchial tube back open. You should discuss whether these options are right for you with your doctor.

BEO: What is the most promising recent research in lung cancer?

Dr. Kris: Similar to mesothelioma, new techniques and treatments are available for every stage of lung cancer. For surgery, video-assisted procedures and robotic surgery allow for more successful and less extensive operations, allowing for a quicker recovery and an equal chance of cure.

New techniques in radiation treatment allow stronger doses of radiation to be administered with pinpoint accuracy. In this way, we can fight the cancer better and cause less damage to the normal tissues.

We now have many chemotherapy drugs that can lessen the symptoms of lung cancer and lengthen life. When chemotherapy is used with radiation and surgery, cure rates are improved as well. We have many new types of treatments available, including drugs like gefitinib (Iressa), which turn off molecular switches in cancer cells, and monoclonal antibodies like bevacizumab (Avastin), which inhibit blood vessel formation necessary for tumors to grow. Drugs like gefitinib (Iressa) are available everywhere. The newer therapies can be administered if you choose to become part of a clinical trial.

Guest318: What is the chance of someone getting lung cancer who does not smoke?

Dr. Kris: Each year, approximately 20,000 Americans who never smoked cigarettes develop lung cancer. We don't know the exact cause of lung cancer in these people, although second-hand smoke, occupational exposures to radiation, and radon may play a role.One recent development is the observation that drugs like gefitinib (Iressa) and erlotinib (Tarceva) seem to work better in people who have never smoked. Many hospitals are trying to figure out why this is the case.

dmd: What do you suggest to treat a cough caused by a tumor on the bronchi while undergoing chemotherapy?

Dr. Kris: The best treatment for cough caused by cancer is to treat the cancer.In addition, codeine is still the best drug we have to control cough. Hycodan contains a codeine-like drug that is helpful for many patients. Also, dextromethorphan, which is available without a prescription, helps many people.

Guest377: What can you tell me about chemoprevention and lung cancer?

Dr. Kris: The best way to prevent lung cancer is to stop smoking or never start. No medicine has been shown to be an effective chemopreventive agent. In addition, if you continue to smoke, vitamin A derivatives and beta-carotene may actually increase your risk of lung cancer.

Barbara: Can you talk a little about the so-called "double stigma" in lung cancer?

Dr. Kris: Many people with lung cancer feel guilt that because they smoked they are responsible for their lung cancer. This is not the case. Lung cancer is a disease that strikes smokers and non-smokers alike. In fact, most people who develop lung cancer today have already stopped smoking.

I challenge the idea that people have a choice to smoke. Smokers start when they are in their early teens—a time when they are especially vulnerable to the lure of smoking presented to them by the extraordinarily well-funded and organized tobacco industry.

In truth, smokers are targeted by the tobacco industry to take up smoking. Once addicted, it is very difficult to stop, even with a strong will and the help of your family and friends.Do NOT feel guilty.

Guest425: What can help with numbness in the toes and fingers?

Dr. Kris: Numbness and tingling of the fingers and toes are common side effects of many chemotherapy drugs. It is important for you to let your doctor know if you experience these side effects so that your medications can be adjusted. In addition, there is some evidence that taking vitamin E can help lessen the risk of this problem caused by the drug cisplatin (Platinol). Also, physical therapy can help your body cope with the nerve damage brought on by chemotherapy.

marie: Can you talk to us about carcinoembryonic antigen (CEA) and its potential as a prognostic indicator of recurring lung cancer?

Dr. Kris: CEA is NOT an accepted prognostic indicator for lung cancer.

MARTY: Just to clarify an earlier statement you made on vitamin A, is it only in smokers that it can increase risk of lung cancer?

Dr. Kris: In the clinical studies of vitamin A, the drugs never prevented lung cancer and, as mentioned before, raised the risk of lung cancer for people who continued to smoke cigarettes.

Barbara: My father died of mesothelioma and I have NSCLC. Do you believe there is a predisposition for lung cancer in families?

Dr. Kris: Clearly, there are some families where lung cancer is common. Studying this phenomenon is very difficult because of the confounding effect of cigarette smoking. Unfortunately, many of us learn to smoke from our parents, which increases the likelihood of lung cancer within a given family.

Wan: What is the best therapeutic option for somebody with advanced lung cancer who has failed chemotherapy?

Dr. Kris: The best option for many people in this situation is to become part of a clinical trial. All the drugs we now use started out in this way, and people who had no other option received them and obtained benefit. To become part of a clinical trial, your doctor must be sure that treatment with an experimental drug of any kind would be safe for you. I encourage you to turn to your doctor to see if this is your best option.

pocky: What do you know about the combination of cisplatin (Platinol) and gemcitabine (Gemzar) used against bronchioloalveolar carcinoma (BAC)?

Dr. Kris: Although there is still some disagreement among doctors, most feel that BAC can be helped by all chemotherapy drugs effective in other types of lung cancer. In addition, patients with BAC appear to be especially sensitive to gefitinib (Iressa) and erlotinib (Tarceva).

Guest62: Are the side effects of gefitinib (Iressa) the same as other chemotherapy treatments?

Dr. Kris: Gefitinib causes an acne-like rash and loose bowel movements. It does NOT cause the other common side effects of chemotherapy like hair loss, anemia, low white blood cell counts, nausea, and nerve damage. The rash is treated like any other form of acne. It usually gets better even if you continue taking the gefitinib. The diarrhea is always controllable with loperamide (Imodium), available without a prescription.

Moderator: The chat is now ending. Thank you for your thoughtful questions. We hope this discussion has been valuable, and we regret not being able to answer every question. We want to thank Dr. Kris for lending us his time and expertise.

SAVE THE DATE: Please join Cancer.Net for a live chat about Coping With Cancer During the Holidays on December 2 from 2:00 to 3:00 PM ET. The featured expert is Diane Blum, MSW, Executive Director, Cancer Care, Inc. and Editor-in-Chief of Cancer.Net.

The chat room is now closed. Thanks again for joining us.

To receive a copy of the transcript by e-mail, please send a message to contactus@asco.org. To receive a copy of ASCO's revised patient guide on Advanced Lung Cancer Treatment following its release at the end of November, please send a message to contactus@cancer.net.