Lung cancer news

Lung cancer is a terrible disease, with a significant impact on our community. The attached graph demonstrates mortality rates from lung cancer in Australia over the 94 years to 2004, per 100 000 people. Notice how the peak in deaths from lung cancer amongst men seems to be falling, where amongst women it has risen and -perhaps - plateaued. The late rise amongst women probably represents women taking up the right to smoke in the years around WWII.

In Australian women, lung cancer passed breast cancer as the most common cause of cancer deaths amongst woment - back in 2005. More than 50 Australian women die each week from lung cancer.

If picked up early, there is an 80% chance of being able to cure most lung cancer (Non-small cell lung cancers - NSCLC). However, most lung cancer is not picked up early. If not picked up early, the chance of a cure rapidly falls to below 20%. Generally a cure is only possible if the cancer, and any involved lymph nodes, can be surgically resected.

There has been some noise this week about a new-ish oral chemotherapy agent, Erlotinib (Tarceva). (Erlotinib is an inhibitor of epidermal growth factor (EGFR) tyrosine kinase). Presentations at the 13th World Conference on lung cancer have reported increased disease - free survival if this agent is used immediately following the standard accepted (platinum based) chemotherapy regimens for advanced non-small cell lung cancer. These studies looked at patients who received chemotherapy for NSCLC and did not demonstrate progression of tumour while receiving chemo. This does seem to be progress.

Erlotinib was initially licensed for use in patients who had failed first line chemotherapy (tumours got bigger on chemo) Trials indicated that in this patient group it increased median survival from 4.7 to 6.7 months, and 12 month survival from 21% to 31% of patients. Those numbers don't really float my boat, and are difficult to explain to patients. The recent Saturn trial, however, seems to demonstrate somewhat more impressive results. As always, it's hard to translate chemo / cancer trial results into real life. This trial, however, showed a 41% increase in disease free survival, and a 23% improvement in overall survival (the latter in patients without EGFR mutations - who constitute the bulk of patients with NSCLC but who are considered to respond less well to this sort of EGFR inhibitors). Precisely what these numbers mean in terms of years / months lived and numbers of people surviving is less clear. It is likely, however, that the numbers are more meaningful clinically than the results from the earlier trials, which applied to cancers that progressed on initial chemotherapy.

Erlotinib seems to cause generally tolerable side effects (rash and diarrhoea mainly), and is taken as a tablet once a day. It is likely to be most beneficial in patients with EGFR mutations, and the benefit in those patients has not yet been reported. However, tumours probably become resistant over time. In spite of that misgiving, and the cost - $3300 in Australia per month at present - it is starting to look as if Erlotinib is going to have a continued place in the treatment of advanced non-small cell lung cancer. Hopefully that will be good news for cancer patients.

It certainly seems to be creating a bit of buzz for Roche shareholders.

Andrew