ANNOUNCER: Across the globe, and across the US, cigarettes continue to kill.
EDWARD S. KIM, MD: If you just look at the United States figures, it's the leading cause of cancer-related death, both in men and in women: over 175,000 cases a year, and over 160,00 deaths a year.
CHRISTOPHER G. AZZOLI, MD: If I were to list the top ten causes of lung cancer, one through nine would be cigarette smoking.
EDWARD S. KIM, MD: Other causes can include industrial fumes; radon has been tied to it. Other things such as asbestos cause other forms of lung cancer like mesothelioma. But, still, the number-one culprit is going to be cigarettes.
ANNOUNCER: There are two main types of lung cancer.
CHRISTOPHER G. AZZOLI, MD: The most common form of lung cancer is called non-small cell lung cancer. About 15 percent of lung cancer is small cell lung cancer.
ANNOUNCER: Lung cancers don't tend to stay put. They often tend to spread, and how they do so is the basis of a system of staging.
CHRISTOPHER G. AZZOLI, MD: Non-small cell lung cancer starts in the lung tissue and it grows into a tumor and that tumor, if it stays where it started, is stage I. If the tumor has spread to lymph nodes within the lung, it's stage II. If the cancer has spread to lymph nodes in the center of the chest, that is stage III. And then, if cancer cells get into the bloodstream and move around the body, that's stage IV.
ANNOUNCER: In most patients with stage I or stage II disease, the cancer is resectable, which means it can be removed surgically. If a patient is well enough, treatment usually begins in the operating room.
EDWARD S. KIM, MD: The early-stage lung cancer is treated with surgery and, generally, this is at least with a lobectomy.
There are three separate lobes or areas of your right lung and two on your left lung. If a tumor falls within one of those discrete areas, then that lobe is removed which encompasses the tumor.
ANNOUNCER: Radiation is sometimes used, too. But mostly for people who are elderly and frail, or who otherwise cannot tolerate surgery.
A lung cancer patient's chances for survival depend on how the disease may have spread.
CHRISTOPHER G. AZZOLI, MD: If you have stage I disease, and you have successful surgery and removal of the cancer, your chance of being alive in five years is 60 to 80 percent. If you have stage II, it's 40 to 60 percent. And if you have stage III, it's 20 to 40 percent.
ANNOUNCER: There's always the possibility lung cancer returns after surgery. That's usually a very dangerous situation.
CHRISTOPHER G. AZZOLI, MD: If lung cancer were to come back after a successful surgery, chances are it would come back some place outside of the chest, which means that, before the surgeon had a chance to take the cancer out, cells had broken off, gotten into the bloodstream and moved around the body.
ANNOUNCER: It's to get those types of circulating cancer cells that doctors have traditionally used chemotherapy in treating other types of cancer.
There never had been any evidence this use of what is called "adjuvant" therapy had any value in lung cancer until recently.
EDWARD S. KIM, MD: The International Adjuvant Lung Trial was the largest trial ever reported in lung cancer. It consisted of 1900 patients who had stage I through III lung cancer and were surgically resected. Afterwards, they received one of four regimens of adjuvant chemotherapy. And the results showed that there was a benefit. This was 4.1 percent, a modest benefit, but very much similar to the review of studies reported in 1995 that showed a 5 percent at five years. Thus, based on the results of this study, adjuvant chemotherapy became the standard of care in early-stage lung cancer.
CHRISTOPHER G. AZZOLI, MD: This is big news. For the first time, we have data to justify giving patients chemotherapy after their surgery.
ANNOUNCER: But while chemotherapy is easier to manage than it has been in years past, it is still something many people want to avoid. And the research doesn't offer much help in deciding exactly which patients are most likely to benefit.
CHRISTOPHER G. AZZOLI, MD: The issue is, of course, if you're only improving five-year survival by 5 percent, you have to treat nearly twenty patients to save one. And so then there's the question: Which patient is the one who you're going to help?
EDWARD S. KIM, MD: I explain to a patient that there is some benefit. It's modest. But most patients want to be aggressive. They want to have their surgery done. They want the tumor taken out of them and they want treatment to try and give it as good a chance as possible to eradicate any cells that may be existing in their body at the time.
ANNOUNCER: Another possible use of chemotherapy in lung cancer might be even earlier, before surgery. It's called neoadjuvant therapy. The goal would be to shrink the tumor, to make surgery easier. And to kill cancer cell that may have already escaped from the original tumor.
EDWARD S. KIM, MD: Neoadjuvant approaches certainly have their place and that's why there are several studies looking at this approach. However, we have not seen a positive study in a controlled manner that has shown overall clinical benefit, and therefore, it is still considered experimental at this point, but still being tested.
ANNOUNCER: The studies in early stage non-small cell lung cancer usually use a platinum-based drug, plus one or more additional drugs, including vinorelbine, docetaxel, paclitaxel, and sometimes targeted therapies like cetuximab.
Doctors are gaining important knowledge and new tools in the treatment of lung cancer. But it remains a very serious disease. And no medical advance will ever counter the damage done by cigarettes, often by a remarkably small number of them.
CHRISTOPHER G. AZZOLI, MD: I think when you think about smoking and lung cancer risk, you have to think of a continuum. And, obviously, if you smoke a lot of cigarettes per day for many, many years, you have a much higher risk. If you smoked very little and for a short amount of time in your life, then you have a very low risk. But, if you smoked at all in your lifetime, greater than 100 cigarettes in your lifetime, your risk will always be slightly higher than someone who never smoked.