Researchers take aim on finding treatments for women, never-smokers and those under age 40
DENVER, Colo. -- "Despite tremendous advances in treating lung cancer, there is still no specific, diagnostic approach available to treat women," said Dr. Silvia Novello, Associate Professor, Department of Oncology, University of Turin-Italy. Dr. Novello made her remarks while opening the press briefing today at the 16th World Conference on Lung Cancer (WCLC) hosted by the International Association of the Study of Lung Cancer (IASLC), which covered many topics including a new edition of the TNM Staging System, the new WHO Classification on Tumors of the Lung and increases in the number of lung cancer in patients who never smoked.
"Remarkably, [this situation with female patients] is the case even though there are several scientific assumptions we know about women and lung cancer," Dr. Novello said.
* There is evidence of changes in epidemiology regarding lung cancer and women
* Tobacco smoking is the primary cause of lung cancer also among women
* Women represent the majority of patients with lung cancer among never smokers
* Hormones may have a role and that role is still being debated
"It is important to examine the science behind each of these four assumptions and to discuss how treatment for women might be specified in the future," she said.
Following the discussion on gender and lung cancer by Dr. Novello, the IASLC also released seminal documents that will help clinicians diagnose and classify lung cancer, including the Revised (8th) Edition of TNM Staging System for Lung Cancer and the 2015 WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart (Fourth edition).
Available in 2016, the Eighth Edition of the TNM Classification of Lung Cancer consists of 94,708 patients diagnosed around the world from 1999-2010. The objective is to further explore and analyze the impact on prognosis of tumor size and of the different T descriptors; the prognostic significance of tumor burden in hilar and mediastinal lymph nodes; and the confirmation of the revised M1 categories (M1a and M1b) of the seventh edition of the classification along with the prognostic impact of number and anatomic location of metastases. Click here for more information and details.
"If cancer patients are to receive optimal treatment, clinicians must have an accurate histologic classification of the tumor and know its genetic characteristics," said Dr. William Travis, Attending Thoracic Pathologist, Dept. of Pathology, Memorial Sloan Kettering Cancer Center, New York. Dr. Travis said the pathology and oncology professions made a big step towards this goal with the release of 2015 WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart (Fourth edition), which is available at the conference and online at http://whobluebooks.iarc.fr/ or www.who.int/bookorders/. Click here for more information and details.
Dr. Novello also introduced researchers who presented data on a growing area of concern among lung cancer researchers: those who have never smoked, yet were diagnosed with lung cancer.
Increasing Incidence of Non-Smokers with Lung Cancer
Lung cancer researchers in Great Britain discovered that the incidence of people who never smoked and were diagnosed with non-small cell lung cancer (NSCLC) increased from 13 to 28 percent over six years. Many of the never-smokers presented with more advanced stage of the disease to doctors.
Dr. Eric Lim, Royal Brompton & Harefield NHS Foundation Trust, London and colleagues aimed to define the incidence and clinical features of never-smokers presenting sufficiently early for surgery to determine if it is possible to identify patients at risk. To accomplish this, he retrospectively analyzed data from a prospectively collected database of patients who underwent surgery at his hospital.
A total of 2,170 patients underwent lung cancer surgery from March 2008 to November 2014. The annual incidence of developing lung cancer in never-smokers increased per year from 13, 15, 18, 19, 20, 20 to 28 percent respectively, attributable to an absolute increase in number and not a change in the ratio of never smokers to current and ex-smokers.
Lim and his colleagues observed more than double the annual incidence of never smokers presenting with NSCLC in the last seven years, increasing from 13 to 28 percent. Lim's team identified a number of non-specific symptoms these patients presented with which suggest that imaging could play a more important role in diagnosing these patients at an earlier stage.
"Clearly, this research suggests that efforts need to be expended on early detection of lung cancer in this increasing cohort without any observable risk factors," Lim said.
Proportion of Lung Cancer Patients Who Never Smoked Increases
The rise in lung cancer rates among never smokers appears in the U.S. as well, according to a report conducted in three hospitals in Texas and Tennessee by Dr. Lorraine Pelosof, Assistant Professor, UT Southwestern Medical Center, Dallas, Texas.
Pelosof and her colleagues conducted a retrospective study and found that the percentage of never smokers increased among NSCLC patients between 1990 and 2013. The analysis also demonstrated an increasing proportion of never smokers among NSCLC cases and these patients were more likely to be female than males. In contrast, the percentage of never smokers among SCLC cases did not significantly increase during this time period.
"Because the biology and, thus, often the treatment options of lung cancer in never smokers differs from that of smokers, further investigation is warranted as to the etiology of the increasing incidence of never-smoker lung cancer," Pelosof said.
Researcher Finds Young Lung Cancer Patients Present with Actionable Mutation
In addition to never smokers, researchers like Dr. Barbara Gitlitz are increasingly interested in lung cancer patients under age 40.
Dr. Gitlitz, Associate Professor of Clinical Medicine at USC Keck School of Medicine, LA, presented data showing lung cancer patients under 40 show an association with an increased chance for a targeted genomic alteration that may lead to more effective treatments.
Primary lung cancer is increasingly understood as a heterogeneous disease made up of genomically defined subtypes requiring distinct treatment strategies. Dr. Gitlitz's research team theorized that being diagnosed with lung cancer under age 40 is a clinical characteristic associated with an increased chance for a targetable genomic alteration. Her team identified a genomically enriched subtype of lung cancer, facilitated delivery of targeted therapy and laid groundwork for further studies of heritable and environmental lung cancer risk factors.
"We aim to demonstrate that the prevalence of targetable genomic alterations will be greater in our population compared to the Lung Cancer Mutational Consortium (LCMC) and have powered our study to show an increase from 35 percent to 50 percent; and an improvement in use of targeted therapy from 22 to 40 percent," she reported. "Preliminary results exceed our statistical expectation with 75 percent of our metastatic adenocarcinoma patients having an actionable mutation."
Oncogenic Profiling in Lung Adenocarcinoma Emerged in the Youth
Researchers expect that the administration of molecular-targeted therapies will be considered for the advanced-stage of adenocarcinoma in young lung cancer patients, according to a presentation by Dr. Kosuke Tanaka, Department of Cancer Genetics, Nagoya University Graduate School of Medicine; Division of Molecular Oncology, Aichi Cancer Center Research Institute, Japan.
Dr. Tanaka and his colleagues retrospectively screened 67 consecutive patients diagnosed as stage I-IV adenocarcinoma at the age of 40 years or less in 2009-2014 and they analyzed their clinical and genetic characteristics. The median age of the 67 patients was 36 years and Dr. Tanaka and his colleagues identified 75 percent as having some driver oncogene. Tanaka's team examined rare oncogenes in 10 out of 14 triple-negative patients, which revealed three patients had HER2 mutation and two had RET translocation.
EGFR, Kras mutations and EML4-ALK translocations were frequently positive in adenocarcinoma among lung cancer patients. The study identified HER2, BRAF mutations, RET, and ROS1 translocations in fewer cases.
"One of the reasons why younger patients presumably have higher numbers of driver oncogenes is that they do not have long exposure to tobacco or other environment factors that induce cancer carcinogen. Indeed, most driver oncogene is associated with never-smoking history, except Kras mutation," said Dr. Tanaka.
About the WCLC:
The WCLC is the world's largest meeting dedicated to lung cancer and other thoracic malignancies, attracting more than 7,000 researchers, physicians and specialists from more than 100 countries. The conference goal is to increase awareness and collaboration so that the latest developments in lung cancer can be understood and implemented throughout the world. Falling under the theme of "Fighting Lung Cancer," the conference will cover a wide range of disciplines and unveil several research studies and clinical trial results. For the first time, IASLC has invited survivors to attend the conference free of charge. For more information on the 2015 WCLC, visit: http://wclc2015.iaslc.org/.
About the IASLC:
The International Association for the Study of Lung Cancer (IASLC) is the only global organization specifically dedicated to the study of lung cancer. Founded in 1974, the association's membership includes nearly 4,000 lung cancer specialists in 80 countries. For more information, visit: https://www.iaslc.org/.
Contact: Jeff Wolf Chris Martin
IASLC Director of Communications Public Relations Manager
IASLC Projects Specialist
Becky.Bunn@IASLC.org | 720-325-2946
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