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Lung Cancer Remains Among Most Difficult to Treat

Posted on: Thursday, 7 April 2005, 00:00 CDT

Apr. 7--ABC Anchorman Peter Jennings' disclosure that he has lung cancer has thrown a national spotlight on a relentless disease that usually claims its victims quickly.

A few glimmers of hope dot the horizon, in the way of new medications and treatments. But while advances in cancer care have extended survival for patients with other types of tumors, lung cancer remains one of the most difficult to treat, South Florida experts said Wednesday.

"About 80 to 85 percent of patients do not survive for more than a few years," said Dr. Israel Wiznitzer, medical director of cancer research at Broward General Medical Center in Fort Lauderdale.

Lung tumors -- 85 to 90 percent are caused by smoking -- generally are not detected until they have already spread beyond the lung to other parts of the body. That's too late to be cut out by a surgeon, which is the best chance for curing the disease. Chemotherapy and radiation often cannot contain it.

A few experimental approaches may boost the odds of survival.

The University of Miami's Sylvester Comprehensive Cancer Center is testing a promising vaccine designed to stimulate the body's own immune system to attack and kill the most common type of lung tumors, non-small cell cancer.

In the vaccine's initial testing, five of 19 end-stage patients who had relapsed after chemotherapy became cancer-free after the vaccine injections and are still well, said Dr. Luis Raez, co-leader of a lung cancer group at Sylvester. Unlike in chemotherapy, side effects were minimal.

"We saved five people. These are people who were supposed to die. They have been in remission for two, three years," Raez said.

He and others caution that the results are preliminary, and the vaccine needs to be studied for years to make sure it is safe and truly works.

Another advance -- a robotic, computer-guided radiation machine called CyberKnife -- targets tumors very precisely, allowing doctors to triple the amount of radiation used and to minimize damage to healthy cells. Oncologists are still studying whether the treatment works better for lung cancer.

In the meantime, the outlook for lung cancer is bleak enough that it should scare every smoker into quitting, oncologists said.

Jennings smoked for years and quit about two decades ago, but backslid during the Sept. 11 crisis. Smokers have as much as 20 times the risk of lung cancer than a person who never smoked, federal figures show. Smokers who quit lower their risk within months or years and can greatly reduce it over time, cancer doctors said. But even after 20 years, an ex-smoker still has about twice the risk of a non-smoker.

"The best treatment for lung cancer is prevention," said Dr. Jerome J. Spunberg, an oncologist at JFK Medical Center in Atlantis and an adviser to the American Cancer Society.

There are two types of lung cancer. Non-small cell tumors make up about 80 percent, and have a somewhat better prognosis because they grow slowly enough for doctors to cut out. If the cancer is caught before it spreads, and can be completely removed by surgery, up to 80 percent of non-small cell patients live five years, says the National Comprehensive Cancer Network.

But if it has already spread in the body, as in about two-thirds of patients, chemotherapy and radiation can only extend life. Less than one-quarter of so-called stage III patients and fewer than 1 percent of stage IV patients with advanced cancer live five years after diagnosis.

The second type of cancer -- small cell -- grows very aggressively and only rarely is found before it spreads to the brain, bones or liver. Patients typically live up to 20 months after a diagnosis.

Jennings has not revealed any details about his case.

"Most people don't come in until they have symptoms, like bleeding or pain, and by then it has spread into an advanced case," Spunberg said. The lung is so large that tumors can grow unnoticed until they irritate something.

Few people get screened for lung tumors and the practice is controversial. Computer tomography (CT) scans can detect tumors small enough to be curable, but there's no proof the expensive tests save lives. The oncologists and various cancer groups do recommend CT scans for those at high risk, namely smokers.

Nancy McVicar contributed to this report.

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DIS,

Source: South Florida Sun-Sentinel

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