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 prevent, 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.

Finding lung cancer early

Researchers are looking for ways to find lung cancer early, before any signs or symptoms appear. When cancer is found and treated early, the chances of successful treatment are better. The following is noteworthy research into finding lung cancer early.

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) (Lancet Oncology, PMID 29055736). 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 show that testing these body fluids or the breath is promising, but more research is needed before these tests 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 (how likely it is 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 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).

Biomarkers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are found 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 gene mutation or a change in the normal amount of a biomarker can mean that a person has a certain type of cancer. Biomarkers can also help doctors predict the prognosis or response to treatment in people with lung cancer. Researchers are looking at the following biomarkers to see if they can help doctors diagnose, predict a prognosis for and find out which treatments will benefit a person with lung cancer:

 

Testing for several tumour markers at the same time is more effective for diagnosing and predicting a prognosis for lung cancer than testing for any single tumour marker. Researchers showed that when they tested for several 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). Another clinical trial identified 15 specific genes that doctors can test for to help them make decisions about treating early stage lung cancer (Clinical Lung Cancer, PMID 27502323).

Losing weight and muscle mass during chemotherapy may be a negative prognostic factor. Programs to prevent weight and muscle loss and promote physical activity during treatment may help improve survival (Journal of Thoracic Oncology, PMID 26940529; PLoS One, PMID 28107410).

Positive pleural lavage cytology (cancer cells in the washings from the lining of the lung and rib cage) may be used to predict the chance that lung cancer will come back (recur) after surgery to remove the lung (called a lung resection). A recent study found that there was a higher risk of recurrence if pleural lavage cytology was positive (contained cancer cells). Researchers suggest that this may help doctors identify people who need more treatments after surgery (Annals of Thoracic Surgery, PMID 27012585; Surgery Today, PMID 28474203).

Metformin (Glucophage) is a drug used to help control diabetes. Some studies found that people with diabetes and early stage non–small cell lung cancer who took metformin had better survival than those who didn’t (International Journal of Cancer, PMID 28380674; BMC Cancer, PMID 27519177; 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). Further study is needed to find out if metformin can improve the prognosis for people with lung cancer.

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

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 for people who can’t have surgery.

Robot-assisted thoracoscopic surgery uses robotic arms to do surgery inside the chest. Researchers compared robot-assisted thoracoscopic surgery to standard surgical methods, including video-assisted thoracoscopic surgery (VATS) and removing part of the lung through a larger cut (incision) in the chest (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, PMID 27209613, PMID 29054214; Canadian Journal of Surgery, PMID 28562237; Annals of Surgery, PMID 28059973).

Microcoils are very thin, twisted loops of metal (usually platinum). Canadian researchers have developed a new method that uses microcoils to help surgeons find pulmonary nodules (very small lung cancer tumours) during VATS. Before surgery, the surgeon uses a CT scan to locate the nodule and place a microcoil into it. The surgeon then uses the image of the microcoil during surgery to find and remove the nodule. 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 nodule (Journal of Thoracic and Cardiovascular Surgery, PMID 25293355; Journal of Cardiovascular Surgery, PMID 25318843).

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; Academic Radiology, PMID 28888381).

Find out more about research in cancer surgery.

Chemotherapy

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

Chemotherapy drugs or combinations that are showing promise as treatments for non–small cell lung cancer include:

Irinotecan (Camptosar) is being studied to treat relapsed or refractory small cell lung cancer (Oncology, PMID 29444512).

Improving scheduling and doses of chemotherapy may help make chemotherapy work better and with fewer side effects. Some research is looking at metronomic chemotherapy to treat lung cancer. This involves using smaller amounts of drugs over a longer time (Lung Cancer, PMID 28285686; Anticancer Research, PMID 28551663).

Improving time and order (sequence) of chemotherapy is another area of lung cancer research. Chemotherapy is often used along with other treatments for lung cancer. Researchers are trying to find the most effective timing and order of giving chemotherapy with other treatments (Lung Cancer, PMID 28213006; BMC Cancer, PMID 28549414; Anticancer Research, PMID 28668866).

Alternating chemotherapy with targeted therapy seems to be effective for treating certain lung cancers (Anticancer Research, PMID 29599365).

Find out more about research in chemotherapy.

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.

Epidermal growth factor receptor (EGFR) targeted therapy can be used to treat lung cancer. EGFR is a receptor on the surface of cells that sends signals to cells that allow them to grow and divide. A mutation in the EGFR gene can cause cancer cells to grow and divide more than normal. EGFR tyrosine kinase inhibitors (EGFR TKIs) block EGFR from working, which stops or slows the growth of cancer cells. Tyrosine kinase inhibitors (TKIs) are used to treat metastatic lung cancer that has the EGFR mutation. Researchers are studying the following EGFR TKIs in clinical trials to treat non–small cell lung cancers:

Anaplastic lymphoma kinase (ALK) targeted therapy may be used to treat lung cancer. ALK is a protein that helps with cell growth and division. It is controlled by the ALK gene. Some non–small cell lung cancers have an ALK gene mutation that causes the cancer cells to grow and spread. Crizotinib (Xalkori) is an example of an ALK targeted therapy drug that blocks ALK from working. It is being used to treat lung cancers with the ALK gene mutation. Researchers are studying other ALK targeted drugs in clinical trials. Brigatinib is a targeted therapy drug that has been approved by the FDA to treat ALK-positive non–small cell lung cancer that does not respond to treatment by crizotinib (Journal of Clinical Oncology, PMID 28475456; Lancet Oncology, PMID 27836716).

Vascular endothelial growth factor (VEGF) targeted therapy may be used to treat advanced non–small cell lung cancer. VEGF is one of the main proteins that help build a blood supply, which a small tumour needs to grow. Researchers are studying the following drugs that block VEGF to prevent tumours from building a blood supply:

Poly (ADP-ribose) polymerase (PARP) inhibitors block the PARP enzyme, which prevents cancer cells from repairing their DNA and causes them to die. Researchers are studying PARP inhibitors, such as veliparib, to treat advanced non–small cell lung cancer (Clinical Cancer Research, PMID 27803064).

Anti-angiogenesis drugs slow or stop the growth of new blood vessels. Cutting off the blood supply will starve a tumour of oxygen and nutrients, which it needs to grow. Bevacizumab (Avastin) is an anti-angiogenesis drug used to treat lung cancer. Researchers are looking at other anti-angiogenesis drugs, such as nintedanib (Vargatef) to treat non–small cell lung cancer (Targeted Oncology, PMID 25894578; Therapeutic Advances in Respiratory Disease, PMID 25855060; Lung Cancer, PMID 27987591). They are also looking at combining anti-angiogenesis drugs with neoadjuvant chemotherapy (Oncotarget, PMID 27566586).

 

Combination targeted therapy uses drugs that work in different ways to target different mutated proteins or genes in cancer cells. One clinical trial is looking at using erlotinib (Tarceva) and bevacizumab together for people with advanced non–small cell lung cancer with EGFR and T790M mutations (Lancet Respiratory Medicine, PMID 28408243).

Immunotherapy

Immunotherapy helps strengthen or restore the immune system’s ability to fight cancer.

Monoclonal antibodies are a type of targeted immunotherapy that binds to specific antigens on cancer cells to help destroy them. Researchers are looking at rilotumumab to treat non–small cell lung cancer (Cancer, PMID 28472537).

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. Researchers are studying the checkpoint inhibitors ipilimumab (Yervoy) and pembrolizumab (Keytruda) in clinical trials to treat non–small cell lung cancer (ASCO, Abstract e20555; OncoTargets and Therapy, PMID 26889087; Journal of Clinical Oncology, PMID 28854067; PMID 24248694; Lancet Oncology, PMID 27932067; PMID 29129441).

Antibody drug conjugates are a type of targeted therapy that uses monoclonal antibodies to deliver chemotherapy. They target proteins on the surface of some cancer cells. Sacituzumab govitecan (IMMU-132) is an antibody drug conjugate that is showing promise in treating non–small cell lung cancer (Journal of Clinical Oncology, PMID 28548889).

 

Natural killer (NK) cell immunotherapy is being studied in clinical trials to treat lung cancer. Natural killer (NK) cells are often the first line of defence of the immune system against cancer cells. Allogenic NK cell immunotherapy involves transplanting NK cells from a donor to the person with cancer. Researchers are studying NK cell immunotherapy with cryotherapy to treat non–small cell lung cancer in clinical trials (Immunologic Research, PMID 28508945).

CIMAvax-EGF is a lung cancer treatment that was developed in Cuba. Researchers are studying it in clinical trials to treat advanced non–small cell lung cancer (Clinical Cancer Research, PMID 26927662).

Other immunotherapy drugs being studied in clinical trials to treat lung cancer include:

Find out more about research in targeted therapy.

Radiation therapy

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

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 can be aimed more precisely at the tumour so they deliver a higher dose of radiation but cause less damage to nearby tissues than conventional external beam radiation therapy. Studies have found that proton beam radiation therapy provides good survival rates with fewer side effects related to radiation (Radiotherapy and Oncology, PMID 26028228; ASCO, Abstract 8501; Cancers, PMID 26147335; JAMA Oncology, PMID 28727865; Radiotherapy and Oncology, PMID 28139305; Journal of the National Cancer Institute; PMID 29028221). Researchers are studying techniques such as pencil beam scanned intensity-modulated proton therapy (IMPT) to further improve proton beam radiation therapy. Pencil beam scanned IMPT focuses a narrow proton beam at the tumour to paint it with radiation, spot by spot, layer by layer (International Journal of Radiation Oncology, Biology, Physics, PMID 28964587, PMID 29254775; PMID 28816159; Radiotherapy and Oncology, PMID 28104299).

Image-guided radiation therapy (IGRT) uses imaging to make radiation therapy more accurate. Researchers are studying CT-adapted and PET/CT-adapted radiation therapy in clinical trials to treat lung cancer (Journal of Thoracic Oncology, PMID 28428149; JAMA Oncology, PMID 28570742; Radiation Oncology, PMID 28129789; European Journal of Nuclear Medicine and Molecular Imaging, PMID 27600280).

Dose-escalation radiation therapy gradually increases the radiation dose to both improve its tolerability and maximize its effect. Researchers are studying this technique to treat lung cancer (Journal of Thoracic Oncology, PMID 28089762; Radiotherapy and Oncology, PMID 28688525; Journal of Thoracic Oncology, PMID 28007628).

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.

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.

Web-mediated follow-up allows doctors to use the Internet to monitor and follow up with people with lung cancer, who use a web browser to view and respond to questions and report any symptoms. Studies show that web-mediated follow-up along with routine imaging tests can find lung cancer relapse early and improves performance status at relapse. As a result, web-mediated follow-up can improve overall survival for people with lung cancer. (Journal of the National Cancer Institute, PMID 28423407; ASCO, Abstract 6500).

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; Expert Opinion on Pharmacotherapy, PMID 25945893; Supportive Care in Cancer, PMID 27005463).

Sodium alginate is a substance found in brown seaweed. Studies show that it protects against esophagitis in people having chemoradiation (Clinical Lung Cancer, PMID 27847247).

Physical activity may help improve quality of life for people with lung cancer. Physical activity before surgery can also reduce lung problems after surgery (Interactive Cardiovascular and Thoracic Surgery, PMID 28520962; Journal of Surgical Research, PMID 28032568; Journal of Thoracic Oncology, PMID 27771425). 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, PMID 27811855). Other studies found that physical activity helped improve sleep and quality of life and reduced fatigue and shortness of breath (Supportive Care in Cancer, PMID 25855040, PMID 28102437; Physiotherapy, PMID 26597694; Journal of Pain and Symptom Management, PMID 26721747). Another study showed that physical activity improved quality of life for people with non-operable lung cancer having palliative treatment (BMC Cancer, PMID 27430336).

Heart problems can be a side effect of radiation therapy to an area near the heart. Researchers are looking at ways to reduce heart effects after radiation therapy (Journal of Clinical Oncology, PMID 28301264, PMID 28113017; Radiotherapy and Oncology, PMID 29050957).

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.

natural killer (NK) cell

A type of lymphocyte (white blood cell) that attacks abnormal or foreign cells, including cancer cells or cells infected with a virus.

allogeneic

Referring to DNA, cells, tissues or organs taken (harvested) from a donor to be given to a recipient who is a close, but not identical, genetic match.

For example, an allogeneic stem cell transplant takes blood or bone marrow from a donor (usually a first-degree relative) and gives it to a recipient.

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