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Innovations in Treating Lung Cancer

Innovations in Treating Lung Cancer

October 29, 2013
12:00 p.m. – 1:00 p.m. (EST)

  • Dr. Bruno Bastos

Moderator: Welcome to our "Innovations in Treating Lung Cancer" online health chat with Dr. Bastos. The chat will begin at noon. Please feel free to submit your questions online in advance.

pmharper: Can you predict statistically the odds of recurrence of LC, the longer the patient remains in a NED state? ie.  the longer the patient remains disease free, the less likely the cancer will recur OR since LC is known to have a tendency to recur, the odds of the cancer recurring remain the same for the rest of the patient's life?

Bruno_Bastos,_MD: Excellent question. The highest chance of recurrence is within the first 2 years, however since many lung cancer are related to smoking, late recurrences and/or development of new primary cancers may occur and therefore continuing surveillance with your oncologist is mandatory. There is new data arising with the use of genetic prediction models which may perhaps be able to calculate chances of recurrence, this is still investigational.

Xomue: A relative (male, 65-year-old) was treated for colon cancer 17 years ago.  Two years ago, he developed cancer in his lungs; however, the cells were found to be colon cancer cells.  One half of a lung lobe was removed to treat the cancer.  Recently, the cancer (presumably colon cancer cells) was discovered to have returned and he was told that it can be managed, but not cured.  He sought to enlist in a drug trial, but was turned down. What options  --- mainstream, non-tradtional, cutting edge, alternative--does he have to "manage it"?  Where (beside the Cleveland Clinic) should he seek treatment --- on the East Coast?  What is the best possible outcome? Thank you

Bruno_Bastos,_MD: I am sorry to hear about your relative's recurrence. It seems your relative has metastatic colon cancer to the lungs and he should be treated with therapies for colon cancer which mainly include use of chemotherapy or target agents. You should find an oncologist who will review his case and then discuss with you outcomes. Good luck.

Xomue: I had pleural effusion around my lungs several months ago --- they cleared up fairly quickly. No specific cause was ever found. What are my chances of getting lung cancer after one such episode?

Bruno_Bastos,_MD: In general, we don't consider an episode of pleural effusion as a cause to develop lung cancer, so if no cause has been found, I am not sure if I could say whether this episode would increase your chances of developing lung cancer.

Donald01: My name is Donald. I was diagnosed almost 5 years ago with Lymphoma. In 2008, it was discovered that I had a large tumor in my lungs. The tumor was surgically removed and I was treated with chemo. Four years after, I had to have another round of chemo treatments because the cancer appeared again in another part of my lungs. I am here today to listen to the new innovations in treating lung cancer...as I am battling with this disease now for the rest of my life. What new treatments are available now?

Bruno_Bastos,_MD: I am sorry to hear about the recurrence of your tumor. Assuming your lung tumor is lung cancer, I feel you should ask your oncologist about whether or not your tumor has any specific mutation such as EGFR, ALK, BRAF, ROS-1 or KRAS. in case of no mutation, I would be interested to know the extent of your disease (one lung nodule?, multiple nodules?, disease outside the lungs?) This is important because in case of an isolated spot, you may consider SBRT which is a special type of RT to the lung lesion. Good luck and please let me know if I can be of further assistance.

newyork1964: One of the side effects of chemotherapy is neuropathy How long does it last?

Bruno_Bastos,_MD: Yes, neuropathy is a side effect of many chemotherapeutic agents. The duration of neuropathy depends of the drug used and the duration and dose of chemotherapy received. In general, the neuropathy tends to improve gradually after discontinuation of chemotherapy. The improvement may take up to 1-2 years but sometimes, this is a life-long complication from the chemotherapy treatments.

pmharper: I understand that funding for Lung Cancer research is one of the lowest.  Why is this so considering it is a leading cause of death in men and women - more than breast cancer which receives enormous support as does prostate cancer?

Bruno_Bastos,_MD: I am not sure if I have an explanation about the disparities among cancer research funding. What I can say is that I have a feeling that there is a rising interest from the scientific community in better understanding the biology of lung cancer. I hope this will generate a positive reaction in the funding agencies so we can make progress in the care of patients suffering with this disease.

Dawn45: Are there any treatments for lung cancer involving vaccines? If there are, how do they work to treat the cancer?

Bruno_Bastos,_MD: Good question. Currently, the use of vaccines for lung cancer is considered experimental. There are no FDA approved vaccine therapies for lung cancer. However, in clinical trials there is a recent rising interest from the scientific community in incorporating immunotherapy which is the use of your immune cells to fight the cancer. 

Xomue: Are there any known dietary suggestions for preventing lung cancer specifically?  Besides not smoking and getting exercise, are there any other recommendations for preventing this disease?

Bruno_Bastos,_MD: Epidemiologic evidence has suggested that various dietary factors (antioxidants, cruciferous vegetables, phytoestrogens) may reduce the risk of lung cancer, but the role of these factors is not well established. So the answer to your question is that we currently do not know the role that diet plays in the risk of lung cancer.

digir: My son had the top right lobe of his lung removed due to lung cancer. It was a stage 1 and he was a heavy smoker. They never did chemo and he seemed to recover nicely. Two years later he started coughing and spitting up blood. When they did a bronchoscopy they saw that the tumor developed in the same place only much larger. He was 43 at the time. This time it was a stage 3b. Had they done chemo in spite of it only being a stage 1 the first time would that have happened again? I heard they left cancer cells in the fold of the incision. My son passed away 5 months later after trying radiation for 3 months.

Bruno_Bastos,_MD: I am sorry to hear about the passing of your son. I am not familiar with your son's case and treatment of his lung cancer, therefore it is difficult for me to answer your question. You may want to discuss these questions with his treating oncologist. 

pmharper: If there is a recurrence of cancer in another part of the lung after perhaps a couple of years of NED, why is it automatically staged at 4, even if the tumor is small and would have been a stage 1 or 2 if it were the original tumor?

Bruno_Bastos,_MD: Again, excellent question. I see your point. In general, the answer for your question is in the pathology report. You may want to discuss with the pathologist to see if they could determine whether or not you are dealing with a different second primary (which we call denovo cancer) or if this represents a recurrence from the previous primary. If this cannot be determined and there is no other site of disease, I would tend to treat the patient if he/she has a denovo lung cancer, like a stage 1 or 2 as you described.

Xomue: What---in general--are the innovations/ new treatments and therapies for non-specific lung cancer?

Bruno_Bastos,_MD: Lung cancer is in general classified in non-small cell lung cancer (NSCLC) and small lung cancer. Nowadays, NSCLC tends to be sub-classified based on the pathology such as adenocarcinoma, squamous cell carcinoma, etc. I am assuming you would be asking about a patient with NSCLC, no otherwise specified (NOS). In general, the therapy for this disease would be the same as the traditional therapies NSCLC.

Donald01: Based on the background info, what are my chances of reoccurrence again? So far it has occurred twice in my lungs, could I have a reoccurrence in another part of my body as well? 

Bruno_Bastos,_MD: Assuming that your recurrence was removed and you are currently NED (with no evidence of disease), it would be hard to predict a recurrence in your case. I would recommend you to continue surveillance and close monitoring with your oncologist.

pmharper: Have the survival rates for lung cancer been updated recently? They were pretty abysmal the last time I looked - although I tend to try not to dwell on them.

Bruno_Bastos,_MD: The best source to answer your question is www.cancer.gov which a NIH-based website. Another way of looking up specific survival rates for lung cancer would be to see the outcomes of the most recent phase III randomized trials in lung cancer which may also provide the survival rate seen in the clinical trial.

Moderator: Thank you for joining us today. We appreciate all of your questions. Unfortunately, Dr. Bastos was called away to see a patient. Please join us for our next web chat, "Epilepsy Innovations: New advances in epilepsy treatment options" on November 12 at 12:00 pm, with Jorge Gonzalez-Martinez, MD, Silvia Neme-Mercante, MD and Chetan Malpe, M.D.