Advances May Give Lung Cancer Patients Hope
Apr. 7–In 2001, Humble resident Charles Gibson was hospitalized with what he thought was a bad respiratory infection. Instead of finding pneumonia in his lungs, an X-ray revealed something far worse — advanced lung cancer.
“I never will forget it. It was a Saturday evening,” said Gibson, 52. “They said I had a lot of cancer cells and it was inoperable.”
Today, four years since the death-sentence diagnosis and after failing standard chemotherapy regimens, he is able to take his 13-year-old son fishing. His disease is under control, thanks to the new drug Tarceva, which gives a small subset of lung cancer patients a near-miraculous reprieve from the usual course of the illness.
This week’s announcement that ABC news anchor Peter Jennings has lung cancer is refocusing attention on the nation’s No. 1 cancer killer and its typically poor prognosis. About 42 percent of lung cancer patients live a year, but only 15 percent of diagnosed patients are still alive after five years.
What many people don’t know is that, for a few patients, treatment advances are turning lung cancer into a chronic disease.
“Mr. Gibson is an extreme case,” said his doctor, Roy Herbst of the University of Texas M.D. Anderson Cancer Center. “He’s an example of how the new wave of therapies can help someone live longer. He’s not cured by any means, but he’s living with stable lung cancer.”
‘Targeted therapies’ Gibson represents an exciting twist in cancer treatment, in which “targeted therapies” interfere with specific molecules involved in cancer development but leave healthy cells virtually untouched — unlike traditional chemotherapy, surgery or radiation.
In addition to Tarceva, there is Gleevec, which targets abnormal proteins that stimulate uncontrolled cell growth in certain kinds of leukemia. Avastin, which starves tumors of their blood supply, is approved for people with colorectal cancer.
Gibson’s cancer, adenocarcinoma, belongs to a category called “non-small cell lung cancer,” which represents 80 percent of lung cancer. The cancer can be eliminated through surgery if it’s found early enough — before it has grown beyond the confines of one lung — but that is the case in fewer than half the patients. Symptoms are so subtle people usually don’t know they have a problem until the cancer is widespread.
In terms of improving early detection, past studies haven’t shown that routine chest X-rays make much difference, said Dr. Garrett Lynch, chief of hematology and oncology at Baylor College of Medicine. However, some studies show that high-resolution CT scans in high-risk populations — such as heavy or former heavy smokers such as Jennings — may pick up tumors at an early, curable stage. But because the scans are so sensitive, eight or nine benign lesions are removed for every one cancer found, subjecting patients to multiple, unnecessary biopsies, he said.
For some patients with advanced cancer, Tarceva can shut down and shrink tumors by inhibiting cell-to-cell signals that control growth. In 8 to 10 percent of patients with non-small cell lung cancer, the drug shrinks tumors by 50 percent or more. Researchers say patients who responded best tended to be women who had never smoked and who had tumors with a specific genetic mutation.
But there are exceptions, such as male, former smokers like Gibson. For patients outside that group with the most dramatic benefit, Tarceva, in one study, extended median survival time by about two months and delayed symptoms such as cough, shortness of breath and chest pain.
In November, the U.S. Food and Drug Administration approved Tarceva as a treatment for patients whose cancer has continued to progress despite other treatments, including at least one prior chemotherapy regimen. It’s also approved for pancreatic cancer. Approximately 14,000 new lung cancer patients could be among those who experience a strong response to the drug every year.
In the future, doctors might screen patients to determine which ones have tumors with the genetic mutation that responds best to Tarceva — and give that drug first, rather than subject patients to traditional chemo and its side effects. But for now, doctors are offering Tarceva to thousands of patients after they try standard chemo.
(Information about whether Jennings’ cancer might fall into this Tarceva-treatable category was not available. Jennings has said he is starting chemotherapy but not having surgery.)
Doctors treating Gibson told him that patients with Stage 4 lung cancer usually didn’t live more than 12 or 14 months. His first round of treatment was not encouraging. He underwent two types of chemotherapy, and withstood their harsh side effects, but he had to be hospitalized again because fluid was filling his lungs.
His doctor referred him to M.D. Anderson for a clinical trial involving Tarceva and another drug, Avastin. Herbst started Gibson on treatment immediately.
The side effects were minimal, just a bit of acne on his chest. Skin rashes and diarrhea are the most commonly reported problems with Tarceva, although 1 percent of patients may develop a life-threatening inflammation in the lungs.
Herbst said Gibson had a 70 to 90 percent shrinkage of his tumor. The former truck driver (or “transport technician,” as he likes to call himself) has since married and resumed hobbies and chores such as cooking, cleaning the house and mowing the lawn.
His Avastin regimen ended, but he’ll take Tarceva — one pill once a day — indefinitely. As a clinical trial participant, Gibson continues getting the pills, which cost more than $3,000 a month, and medical checkups for free.
“He came in three years ago … and this guy looked awful,” Herbst said. “He had one of those gee-whiz type of responses. … He’s the dream.”
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