Lung cancer

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Research in lung cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help find and treat lung cancer. They are also looking for ways to improve the quality of life of people with lung cancer.

The following is a selection of research showing promise for lung cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine. Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract). We have also included links to abstracts of the research presented at meetings of the American Society of Clinical Oncology (ASCO), which are held throughout the year. You can find information about ongoing clinical trials in Canada from CanadianCancerTrials.ca and ClinicalTrials.gov. Clinical trials are given an identifier called a national clinical trial (NCT) number. The NCT number links to information about the clinical trial.

Finding lung cancer early

Researchers are looking for ways to find lung cancer early, before any signs or symptoms appear. This is important because the majority of people with lung cancer are diagnosed with advanced disease. The following is noteworthy research into finding lung cancer early.

CT scans for current and former heavy smokers can be a screening tool for lung cancer. Researchers found that using CT scan to screen heavy smokers can reduce lung cancer deaths by 20%. Another study by Canadian researchers found that using CT scans to find lung cancer early can also help lower healthcare costs (Journal of Thoracic Oncology, PMID 25105438).

A low-cost tool to predict if a smoker has a high risk of developing lung cancer was created by the Pan-Canadian Early Detection of Lung Cancer Study (PanCan). In addition to the person’s smoking history, this tool also looks at the following factors: age, ethnicity, socio-economic status, family history of lung cancer, personal history of chronic obstructive pulmonary disease, personal history of cancer and body mass index (BMI). People who this tool identifies as having a high risk for lung cancer are the most likely to benefit from screening with a CT scan. A recent study also confirmed that this tool can help identify people who don’t need to be screened as often for lung cancer (British Journal of Radiology, PMID 26882046).

Testing blood, urine, sputum or exhaled breath may be a way to find lung cancer early. Some studies have shown promise, but more research is needed before these body fluids or breath can be used for screening in the general population (Lung Cancer, PMID 26973212; Cancer Epidemiology, Biomarkers and Prevention, PMID 27013655; Oncotarget, PMID 26440312).

Find out more about research in screening and finding cancer early.

Diagnosis and prognosis

A key area of research looks at better ways to diagnose and stage lung cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.

Endobronchial ultrasound biopsy

During an endobronchial ultrasound biopsy, the doctor uses ultrasound to guide a special bronchoscope to collect tissue samples from the lung and lymph nodes. It is used to find and diagnose lung cancer and see if it has spread. Tissue samples collected during this type of biopsy can also be tested for genetic mutations. Endobronchial ultrasound biopsy is less invasive than a thoracoscopy or a mediastinoscopy. Recent research shows that this type of biopsy may have a key role in diagnosing lung cancer faster and more safely than other tests. It can also provide information that helps doctors decide on the best treatment options (American Journal of Clinical Pathology, PMID 26386084; Translational Lung Cancer Research, PMID 26380180).

Tumour markers

Tumour markers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are naturally in the body. They can be measured in body fluids like blood and urine or tissue that has been removed from the body. A change in the normal amount of a tumour marker can mean that a person has a certain type of cancer.

Testing for the following single tumour markers may help doctors diagnose lung cancer or develop new drugs to target lung cancer cells:

Testing for several tumour markers at the same time is more effective in finding lung cancer than testing for any single tumour marker. Researchers showed that when they tested for all of the following tumour markers they found lung cancer more often than when they tested for each marker alone (American Journal of Respiratory and Critical Care Medicine, PMID 26465739):

  • carcinoembryonic antigen (CEA)
  • carbohydrate antigen 15-3
  • squamous cell carcinoma–associated antigen
  • cytokeratin-19 fragment
  • neuron-specific enolase
  • pro-gastrin-releasing peptide

Gene-based tests

Gene-based tests find differences between normal genes and genes that are changed, or mutated, in cancer cells. Microarray analysis is a type of gene-based test that allows researchers to look at many genes together to see which ones are turned on and which ones are turned off. Analyzing many genes at the same time to see which are turned on and which are turned off is called gene expression profiling. Researchers hope that developing more gene-based tests will help doctors identify the best treatments for certain cancers, including lung cancer. Gene-based tests will also help doctors tailor more treatments to each person’s cancer based on their unique genetic makeup.

FGFR1 amplification means that there are more than the normal number of copies of the FGFR1 gene. Researchers examined and combined the results of a large number of studies that looked at the role of FGFR1 amplification in lung cancer. They found that people with lung cancer and FGFR1 amplification were more likely to be men, to be smokers and to have squamous cell carcinoma. Researchers also found that people with FGFR1 amplification tend to have a shorter survival time than people who didn’t have the FGFR1 amplification (Oncotargets and Therapy, PMID 26793001).

Anaplastic lymphoma kinase (ALK) mutation and epidermal growth factor receptor (EGFR) mutation are found in lung cancer cells. Researchers looked at lung cancer with a CT scan to see if they could identify tumours with these gene mutations. Results of the study show that on a CT scan tumours with the ALK mutation look very different from tumours with the EGFR mutation (European Radiology, PMID 25577516; Radiology, PMID 25575117).

Prognostic factors

Researchers are looking for prognostic factors that can help them identify people who will respond well to lung cancer treatment.

Losing weight early during chemoradiation therapy may be a negative prognostic factor. Radiation therapy for lung cancer can cause inflammation of the esophagus, and adding chemotherapy to this treatment makes this side effect worse. It is very difficult to swallow when the esophagus is inflamed, so many people lose weight after inflammation develops. A recent study found that people who lose weight before the esophagus becomes inflamed don’t survive as long as people who don’t lose weight (Journal of Thoracic Oncology, PMID 26940529). The authors of the study suggest that programs to prevent weight loss during treatment may help improve survival.

Washings from the lung before and after surgery may be used to predict the recurrence of lung cancer after surgery to remove the lung (called a lung resection). A recent study found that there was a higher risk of recurrence if there were cancer cells in the fluids used to flush the lung after surgery. Researchers suggest that this may help doctors identify people who need more treatments after surgery (Annals of Thoracic Surgery, PMID 27012585).

Metformin (Glucophage) is a drug used to help control diabetes. Some research suggests that people with non–small cell lung cancer who are taking metformin may have a better prognosis. One recent study found that people with early stage non–small cell lung cancer who took metformin had a better progression-free survival than people who did not take the drug, but there was no effect on overall survival (Journal of Thoracic and Cardiovascular Surgery, PMID 27157918). Another clinical trial found that people taking metformin had fewer recurrences of lung cancer than people who were not taking the drug (ASCO, Abstract e20072).

Find out more about research in diagnosis and prognosis.

Treatment

Researchers are looking for new ways to improve treatment for lung cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer. The following is noteworthy research into treatment for lung cancer.

Surgery

Surgery is commonly used to treat lung cancer. Researchers are looking for ways to improve surgical techniques and reduce side effects. They are also looking for treatments that can be used instead of surgery.

New surgical techniques

Researchers are trying to find out if less invasive surgery can play a role in treating lung cancer that has not spread outside the lung.

Video-assisted thoracic surgery (VATS) and robotic surgery are 2 ways that surgeons can remove part of the lung (called a lobectomy) through a small incision, or cut, in the chest. VATS uses video cameras to guide the surgeon during surgery. During robotic lobectomy, the surgeon uses robotic arms to do the surgery. Researchers compared VATS and robotic surgery to the more common type of surgery, which is done through a large incision in the chest (called an open lobectomy). They found that there was little difference between the 3 techniques and overall survival was the same. But people treated with VATS or robotic surgery had slightly shorter hospital stays than those who had an open lobectomy (Annals of Thoracic Surgery, PMID 26822346).

Microcoils are very thin, twisted loops of metal (they are usually platinum). Canadian researchers have developed a new method that uses microcoils to help surgeons find very small lung cancer tumours during VATS. Before surgery, the surgeon uses CT scan to locate the tumour and place a microcoil into it. The surgeon then uses the image of the microcoil during surgery to find and remove the tumour. Researchers found that using microcoils significantly lowered the number of VATS that had to be changed to more invasive surgery to open the chest (called a thoracotomy) because the surgeon couldn’t find a small tumour (Journal of Thoracic and Cardiovascular Surgery, PMID 25293355).

Alternatives to surgery

Researchers are looking for different ways to treat tumours in the lung other than removing them with surgery. This may be helpful for people who can’t have surgery.

Cryosurgery uses extreme cold to kill cancer cells. Researchers are studying cryosurgery as an alternative to surgery for people who have small tumours that haven’t spread outside of the lung. Studies show that people who have cryosurgery instead of surgery have good overall survival with very few side effects (Journal of Vascular and Interventional Radiology, PMID 25735518). More study is needed to find out what role cryosurgery may have in treating lung cancer and which people will benefit most from cryosurgery (Biomed Research International, PMID 24991559).

Radiofrequency ablation (RFA) uses heat from an electric current to destroy tissue. One study used RFA as an alternative to surgery for people who had small tumours that hadn’t spread outside of the lung and who couldn’t have surgery. The study showed that RFA did not affect lung function and that it worked better in healthier people who had tumours that were smaller than 2 cm. It also found that people who were treated with RFA survived for 2 years, which is similar to the survival rate for people who were treated with radiation therapy (Cancer, PMID 26096694). Another study looked at using RFA in people who had lung cancer that had spread outside the lung. The study found that RFA did shrink tumours, and so it may have a role in controlling advanced lung cancer (International Journal of Clinical and Experimental Medicine, PMID 26770411).

Find out more about research in cancer surgery.

Radiation therapy

Researchers are looking for different ways to use radiation therapy to treat lung cancer.

Stereotactic body radiation therapy (also called stereotactic ablative radiotherapy) uses focused beams of radiation that are given from many different directions to treat all of a tumour. The beams are directed specifically at the tumour, which helps limit the amount of radiation to the tissue around the tumour. Studies show that stereotactic body radiation therapy could be an alternative to surgery for people with small tumours that haven’t spread outside of the lung. It may be especially helpful for elderly people and people in poor health. More study with larger numbers of participants is needed before stereotactic body radiation therapy can be used as a standard treatment (Lancet Oncology, PMID 25981812; Lung, PMID 26842723). Another study compared stereotactic body radiation therapy to conventional fractionated radiation therapy, which divides the total dose of radiation into a number of smaller doses that are given more often. The study found that stereotactic body radiation therapy improved survival in people who had lung cancer that had not spread outside the lung (ASCO, Abstract 7513).

Intensity-modulated radiation therapy (IMRT) uses radiation beams shaped into different lengths, thicknesses and strengths. Researchers reviewed a large database of treatment results to find out how effective IMRT is for lung cancer. The results showed that IMRT improved overall survival for people with large lung tumours or tumours that had spread to tissues around the lung. The results also showed that IMRT improved overall survival compared to standard radiation therapy (Clinical Lung Cancer, PMID 26936682).

Proton beam radiation therapy is a form of external beam radiation therapy that uses high-energy, or charged, proton particles instead of x-ray beams. Protons deliver a higher dose of radiation but cause less damage to nearby tissues than conventional external beam radiation therapy because they can be aimed more precisely at the tumour. Studies have found that proton beam radiation therapy provides good survival rates with fewer side effects related to radiation (Radiotherapy Oncology, PMID 26028228; ASCO, Abstract 8501). More study is needed to find out the role that proton beam therapy may have in treating lung cancer (Cancers, PMID 26147335).

Post-operative radiation therapy is radiation therapy given after surgery. A recent meta-analysis looked at clinical trials using post-operative radiation therapy for people whose cancer was completely removed with surgery. The results show that people who received radiation therapy after surgery actually didn’t live as long as people who were not given radiation therapy. Researchers concluded that radiation therapy should not be offered after surgery to people who have non–small cell lung cancer that was completely removed with surgery (Cochrane Database of Systematic Reviews, PMID 27727451). Another meta-analysis looked at using post-operative radiation, with or without chemotherapy, in people with stage IIIA non–small cell lung cancer that had spread to the lymph nodes on the same side of the body as the tumour (N2). The analysis found that giving post-operative radiation therapy to these people lowered the risk that the cancer would come back in the same area and improved overall survival. This improvement was found whether or not a person was given chemotherapy as well (ASCO, Abstract 8546).

Find out more about research in radiation therapy.

Targeted therapy

Targeted therapy is an important part of treatment for lung cancer. Researchers are looking for new drugs that can be used when cancer becomes resistant to current targeted therapies. They are also looking for more effective ways to combine targeted therapy with other treatments.

EGFR tyrosine kinase inhibitors (TKIs) are used to treat metastatic lung cancer that has the EGFR mutation. Over time, lung cancer can develop a gene mutation called EGFR T790M, which makes it stop responding to TKIs. Researchers are looking for new targeted drugs that can overcome the EGFR T790M mutation. These include:

PD-1/PD-L1 checkpoint inhibitors work by stopping cancer cells from affecting immune system cells in our bodies. They are a promising area of research for lung cancer because they use different targets than the drugs that are currently being used to treat the disease (ASCO, Abstract e20555; Oncotargets and Therapy, PMID 26889087).

Ninetadanib(Vargatef) is an anti-angiogenesis drug. This means that it stops the growth of blood vessels, which tumours need in order to grow. Researchers compared treatment with nintedanib and docetaxel (Taxotere) to treatment with docetaxel and a placebo in people with lung cancer that had come back after it was treated. Results showed that the nintedanib combination improved progression-free survival but didn’t improve overall survival. People who had adenocarcinoma benefited the most from this treatment (Targeted Oncology, PMID 25894578; Therapeutic Advances in Respiratory Disease, PMID 25855060).

Bevacizumab (Avastin) is another anti-angiogenesis drug. A recent study looked at combining bevacizumab and docetaxel as a treatment for advanced non–small cell lung cancer in people who had already received 1 or 2 types of chemotherapy. The study compared bevacizumab and docetaxel to docetaxel alone. Results show that bevacizumab and docetaxel improved progression-free survival and relative survival compared to docetaxel alone (ASCO, Abstract 9005).

Find out more about research in biological and targeted therapy.

Chemotherapy

Researchers are looking for new chemotherapy drugs and new ways to combine current chemotherapy drugs to improve treatment for lung cancer.

Nedaplatin (Aqupla) is a new drug that is similar to cisplatin, which is used to treat lung cancer. Compared to cisplatin, nedaplatin causes less severe and less frequent nausea and vomiting and doesn’t damage the kidneys as much. Researchers compared nedaplatin combined with docetaxel to docetaxel and cisplatin in people with advanced or recurrent squamous cell carcinoma of the lung. Results showed that nedaplatin and docetaxel improved overall survival and had less serious side effects than the cisplatin and docetaxel combination (ASCO, Abstract 8004).

Docetaxel combined with tamoxifen (Nolvadex, Tamofen) may be a treatment option for people who have already received standard chemotherapy for non–small cell lung cancer. Researchers compared this combination to docetaxel alone to find out how well the drugs lowered the amount of P-glycoprotein in the tumour cells. The results show that docetaxel and tamoxifen reduced the amount of P-glycoprotein more than docetaxel alone. People who were given both drugs had better progression-free and overall survival compared to people who were given docetaxel alone (Anticancer Drugs, PMID 26882453).

Find out more about research in chemotherapy.

Supportive care

Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects. The following is noteworthy research into supportive care for lung cancer.

Anamorelin is a drug that increases appetite and changes the way the body uses the energy it gets from food. People with lung cancer often have severe loss of body weight and muscle mass (called cachexia), which lowers their quality of life and shortens survival. In 2 recent clinical trials, people with advanced lung cancer were given anamorelin or a placebo. The studies showed that people who received anamorelin kept or gained lean muscle in their bodies and gained significantly more body weight than people who received the placebo. They also showed that people who kept or gained this muscle tissue survived for a longer period of time and with a better quality of life (Lancet Oncology, PMID 26906526).

Physical activity may help improve quality of life for lung cancer survivors. One study found that survivors who followed a walking program had lower anxiety and depression than survivors who did not do any physical activity (British Journal of Cancer, PMID 25490525). Other studies have found that physical activity helped improve sleep and quality of life and reduced fatigue and shortness of breath (Supportive Care in Cancer, PMID 25855040; Physiotherapy, PMID 26597694).

Learn more about cancer research

Researchers continue to try to find out more about lung cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage lung cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for lung cancer were first shown to be effective through clinical trials.

Find out more about cancer research and clinical trials.

mediastinoscopy

A procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat the organs in the mediastinum (the space between the lungs) and nearby lymph nodes.

Cells or tissue may be removed for examination under a microscope. Doctors often use mediastinoscopy to get a sample of tissue from the lymph nodes on the right side of the chest.

The type of endoscope used for this procedure is called a mediastinoscope.

progression-free survival

The amount of time after treatment that a person lives with a disease (such as cancer) without the disease getting worse.

Researchers may measure progression-free survival in clinical trials to find out how well a treatment works.

placebo

A harmless, inactive substance or treatment that looks the same as, and is given in the same way as, an active drug or treatment.

Placebos may be used in controlled clinical trials. One group is given a placebo and the other is given the substance or treatment being studied, then researchers compare the effects of the placebo and the active substance or treatment.

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