Lung Cancer procedures:


Lung cancer is cancer that begins in
the lungs, the two organs found in the
chest that help you breathe.

The lungs are made up of areas called
lobes. The right lung has three lobes;
the left lung has two, so there's room
for the heart. When you breathe, air
goes through your nose, down your
windpipe (trachea), and into the lungs
where it spreads through tubes called
bronchi. Most lung cancer begins in
the cells that line these tubes.

There are two main types of lung
cancer:

Non-small cell lung cancer (NSCLC) is
the most common type of lung cancer.
Small cell lung cancer makes up about
20% of all lung cancer cases.




SMOKERS QUIT WITH CHEAP
REMEDY
Used in Bulgaria for 40 Years,
for as little as $6, there may be a
smoking-cessation remedy that
actually works.

A clinical test of Tabex, sold in eastern
Europe for more than four decades,
shows that the plant-based medicine
can triple smokers' chances of quitting
compared with a dummy pill. The
results of a study on 740 people were
published in September 2011 in the
New England Journal of Medicine.

The tablet, developed and sold by
Bulgaria's Sopharma AD, may help
smokers with limited means quit.  

Most of the 6 million people who die
from tobacco use each year are from
low- and middle-income countries,
according to the World Health
Organization. Sopharma Chief
Executive Officer Ognian Donev and
Rick Stewart, former CEO of Amarin
Corp., have formed a company called
Extab Corp. that's trying to raise $20
million to fund more tests and find a
marketing partner.

In the study, 8.4 percent of patients
taking Tabex for 25 days with "minimal"
counseling abstained from smoking for
a year, compared with 2.4 percent of
those given a placebo. The smokers
who took the plant-based remedy
reported more gastrointestinal upset.

Tabex tablets contain cytisine, a
substance found in the seeds of a tree
called laburnum that produces yellow
pea- flowers, which mimics the effect of
nicotine.

Pfizer Inc.'s Chantix, a
smoking-cessation drug available in
the U.S. and Europe on prescription, is
also derived from cytisine. One week's
worth of tablets for a patient taking
three a day costs about $63 on the
website drugstore.com.

The absolute difference in rates of
tobacco abstinence between the two
patient groups in the Tabex study was
lower than for Chantix and similar to
what has been found for nicotine-
replacement therapy, the scientists
wrote in the study.




LUNG CANCER: ARTIFICIAL AIRWAY
IS A WORLD FIRST
French doctors said that at a medical
first  a 78-year-old man was given a
section of artificial airway to save a
lung afflicted by bronchial cancer.
The bronchi are the main tubes for
taking air from the trachea to the two
sides of the lung.

In cases of early, non-metastasizing
cancer of the bronchus, surgeons
typically remove a whole lung, as well
as the bronchus itself, if the tumor is
located in the centre of the organ.

In more than a quarter of cases, this
leads to death within three months of
the operation.

A team led by  surgeon Emmanuel
Martinod removed the diseased part of
the bronchus and grafted a
replacement, thus saving the lung.

The transplant, carried out in a
three-hour operation on October 28
2009, entailed a small metal
tube-shaped frame, or stent, which
supported a section of artery taken
from a deceased donor and frozen in a
tissue bank.

The advantage of aortal tissue is that it
does not require anti-rejection drugs,
which are not recommended for cancer
patients, whose weakened immune
system is less able to combat infection.

"The patient is doing very well,"
Martinod, a professor at the Avicenne
Hospital in eastern Paris, told a press
conference.


TRIAL TESTING   BIOMARKERS FOR
LUNG CANCER
A pioneering Phase II trial is the first to
demonstrate the use of multiple
biomarkers to guide the treatment of
patients with non-small cell lung cancer
(NSCLC).The BATTLE  study has
demonstrated that it is feasible, using
fresh tissue biopsies,  to identify
groups of patients with NSCLC who are
more likely to benefit from a specific
agents.


OTHER DEVELOPMENTS
EBUS
A new tool in the fight against lung
cancer  is endobronchial ultrasound,
also known as EBUS. It enables
pulmonologists  to see through the
walls of patients' airways and into
chest and lung tissue. This is important
in order to obtain biopsies of tumors,
masses and lymph nodes that aid in
diagnosis and treatment.
Before EBUS, biopsies performed in
these areas were made by a
calculated guess on their location
based on landmarks within the body to
find the lymph nodes and masses that
are oftentimes close to large blood
vessels and other important structures.
EBUS helps to visualize in real time
while the procedure is being done
these lymph nodes and tumors.
This new technology also helps to
biopsy masses and tumors deep within
the lung.


RapidArc Technology by Varian;

Novalis Tx System by Varian and
Brainlab;

Cyberknife by Accuray Inc;

Chemo: PEMETREXED (brand name
Alimta);


OVERVIEW

LUNG CANCER TREATMENT
HOPES

Lung cancer is the most common
cancer killer, with 1.61 million
cases a year worldwide, according
to the International Agency for
Research on Cancer and it kills 1.2
million of them.

But there are some hopeful new
developments in treatment.

RADIOSURGERY

Stereotactic body radiation therapy  
should now be considered a
standard treatment in early-stage
lung cancer patients with
co-existing serious medical
problems, such as emphysema,
heart disease and stroke. And   
maybe it should be considered in
healthier patients with lung cancer
who are treated with surgery.

Stereotactic body radiation therapy
is a specialized type of external
beam radiation therapy that
pinpoints high doses of radiation
directly on the cancer in a shorter
amount of time than traditional
treatments.
Cancer centers often call the
treatment  by the brand names of
the manufacturers, including
Axesse, CyberKnife, Gamma Knife,
Novalis, Primatom, Synergy, X-
Knife, TomoTherapy or Trilogy.


CYBERKNIFE

A key reason lung  cancer is so
deadly is that a quarter of lung
cancer patients are too sick, too old
or too weak to survive surgery.

The standard treatment for lung
cancer is surgery to remove
diseased tissue. But it's highly
invasive, meaning the patient will
have scars, a long healing time and
blood loss.

Early-stage nonsmall cell lung
cancer patients treated with
targeted, high-dose radiation
delivered in three or four treatments
can have the same, if not better,
chance of survival as patients
undergoing surgery.
To prove this, Accuray (the maker
of Cyberknife)  has partnered with
The University of Texas M. D.
Anderson Cancer Center in
Houston on a clinical study to
compare survival rates between
traditional surgery and CyberKnife
three years after treatment. (Trial
no: NCT00840749)

Accuray and M. D. Anderson hope
to have their study, which began in
2007 and may include more than
1,000 patients, wrapped up by the
end of 2013.


Cyberknife shoots radiation into the
tumor without harming the rest of
the lungs even as the patient
breathes in and out.
A five-year study found cyberknife
destroyed 95 percent of tumors.
The three-year survival rate is 80
percent, a big difference from
traditional radiation, which destroys
30 percent of tumors and carries a
30 percent survival rate.


NOVALIS TX
A traditional linear accelerator has
a minimal size limitation typically on
the order of 4 centimeters by 4
centimeters. When we are in close
proximity to structures, where
surrounding tissue may be
vulnerable to radiation therapy,
sometimes we want to pinpoint
more accurately than that.

The Novalis Tx platform allows
radiation oncologists to treat an
area that may be less than a
centimeter with submillimeter
accuracy.
The beams of radiation are
dynamically shaped to fit the
tumor's shape and location, and
that allows surrounding normal
tissues to be spared unnecessary
radiation.

Novalis TX is made by Varian and
software provided by Brainlab.

It is extraordinarily precise, and it
enables doctors  to do things they
couldn't  do on a standard linear
accelerator. It also follows the
patient's moves.
This is a breakthrough because
ensuring the precise dose actually
reaching the targeted tumor often
was hampered by a patient's
involuntary movements during
treatment. A small cough, a sneeze,
even the simple act of breathing
could cause the tumor to shift.


NEW DRUGS

CIZOTINIB  FROM PFIZER

A study in the New England Journal
of Medicine shows  that 57% of 82
lung cancer patients with the ALK
gene alteration experienced
dramatic tumor shrinkage with the
Pfizer drug.
In some cases, the cancer became
undetectable in body scans.

Pfizer has already moved into a
final-stage trial of the drug and
hopes to apply for approval early
next year for treating lung cancer.
It will come with a companion
diagnostic test to spot patients who
have the gene alteration.
Crizotinib is an oral pill, an
investigational anaplastic
lymphoma kinase (ALK) inhibitor.

Lung cancer is the most common
type of cancer with the ALK
alteration.
Roughly 5% of lung cancer patients
have gene alterations in the ALK
gene, or about 9000 American
patients a year.

Updated results from the study
were presented in October 2010 at
the  Congress of the European
Society for Medical Oncology in
Milan, Italy.
It reported  on a total of 113
patients and the impressive activity
of the drug in these patients
remained high. The preliminary
median progression-free survival
(PFS: the time it takes for the
cancer to first start to grow again)
was 9.2 months.

Initially the cancer melts away, but
it's still there. And at some point, it
usually figures out a way to get
around this particular drug.
Researchers need to keep looking
for new innovations so that when
this happens, crizotinib can be
replaced with other treatments.

Pfizer's drug is not a miracle cure
for most patients. In lung cancer, it
keeps the disease under control for
a median of nine months. It has
side effects including odd vision
disturbances and leg swelling. It
has not been proven to extend lives.
Yet overall, an "unheard of" 90% of
lung patients appear to get some
benefit from the drug.

It is crucial for anyone diagnosed
with lung cancer to get their tumor
tested. Several commercially
available tests are available but the
definitive test that qualifies for entry
into the study is only conducted in
those hospitals  that conduct the
trial.

One problem with aggressive lung
cancer is that it can come up with
new mutations faster than
researchers can come up with new
drugs.

The New England Journal of
Medicine gives an example from
Japan.

A  28-year-old lung patient  initally
responded to the Pfizer drug. Five
months later the tumors "abruptly"
started to grow again. The tumor
had developed mutations that
made it resistant to the drug.
With all these targeted therapies,
there is resistance that develops.

It is amazing that  nowdays  the
mechanism of resistance is
published at  the same time with the
trial data.
Since the  resistance mechanism is
already known, companies can
start working on better second
generation drugs that avoid the
problem.
Numerous other companies,
including Novartis, Ariad and
Cephalon are working on ALK
blocking drugs.


REOLYSIN FROM ONCOLYTICS
Oncolytics is a Canadian company,
 that has concluded 12 human
clinical trials with Reolysin.
against various cancer types.

The Phase 2 lung cancer data,
expected later in 2010, is of
particular importance as it may be
a trigger for the company for a
partnership with Big Pharma for
final development.

Experts have hailed the new drug,
made from a harmless bug that can
cause stomach upsets, as a major
new weapon in the battle to find a
cure for cancer.

Early evidence from a trial carried
out in patients with advanced,
untreatable cancers who had
stopped benefiting from
radiotherapy has seen remarkable
results.The simple injection has
stopped the spreading of the
deadly disease in its tracks and
has even successfully reversed its
growth.

In one remarkable case, a man who
had a large tumor mass saw it
shrink enough to be surgically
removed. Another patient with the
most deadly form of skin cancer
which had spread was still alive 17
months after treatment started.

TARCEVA IS EFFECTIVE FOR
LUNG CANCER WITH CERTAIN
MUTATIONS

Already, there is a body of
evidence showing that lung cancer
with tumors that harbor a mutation
of the epidermal growth-factor
receptor (EGFR) benefit from the
EGFR inhibitor Tarceva (erlotinib)
with about a 70% response rate.

This drug has become a first-line
therapy and is used alone in this
patient subgroup.

EGRF mutations are found in about
10% of patients with NSCLC, and
ALK gene rearrangements in about
3% to 5% of these patients.

But these 2 biomarkers are
mutually exclusive.

Tarceva is marketed in the United
States by Genentech and OSI
Pharmaceuticals and elsewhere by
Roche.

Lung cancer patients given drugs
such as Tarceva and Nexavar fare
better when personalized: their
tumors are first tested for certain
genetic traits and then matched
with the corresponding treatment.

NEXAVAR FROM BAYER AND
ONYX
Nexavar (sorafenib) is being
investigated in several ongoing
trials in a variety of tumor types,
among them lung cancer.

MOTESANIB
Motesanib (AMG 706)  for
Non-Small Cell Lung Cancer made
by Amgen, Takeda and Millennium
is tested  in Phase 3.

In order for a tumor to grow and
spread to other parts of the body, it
needs to have a blood supply.
Certain proteins in the body, called
cytokines or growth factors, have
been shown to cause the growth of
new blood vessels that supply
tumors and therefore help the tumor
to grow and spread. Motesanib
(AMG 706) prevents these proteins
from working, and may help to
prevent the growth of tumors.


VACCINES
The next big target for cancer
vaccines may be lung cancer.

Therapeutic vaccines are designed
to help the body's immune system
to attack the cancer cells.
The trouble is that cancer cells
produce substances that make
them invisible to the immune
system. The key to success here is
to find substances that make the
cancer cells "visible" for the body's
immune system.  

After many failures,  there are  two
late stage lung cancer vaccine trials
that could remove any remaining
uncertainty about the potential
future of cancer vaccines.

Success in lung cancer would be
impressive, because unlike
melanoma (which is targeted by
Bristol-Myers Squibb's ipilimumab
drug), this tumor has not been
viewed as "immunogenic". In other
words, it has not been clear that the
immune system can recognize and
attack lung tumors.


GLAXO VACCINE  GSK1572932A

This  vaccine, from   
GlaxoSmithKline, uses a protein
called MAGE-A3 found on lung
cancer cells.

According to some this is one of
the best cancer vaccines out there
now.

In a second stage trial in lung
cancer patients who had had
surgery to remove their tumors, it
slashed the risk of relapse after 28
months by 27%. The reduction
wasn't statistically significant as
there were only 182 patients in the
trial, but was a clear trend in the
right direction.
Now Glaxo is conducting a giant
final-stage trial in over 2000
early-stage lung cancer patients.

STIMUVAX

The second vaccine to watch  
comes from biotech Oncothyreon of
Seattle, which is collaborating with
Merck KgaA of Germany. The
vaccine, called Stimuvax, aims to
stimulate the immune system to
attack a protein fragment called
MUC-1 found on lung, breast,
prostate and colon tumors.
The vaccine showed a trend
towards higher survival in its initial
trial, is now in a final stage trial in
1300 patients with inoperable lung
cancer.

Merck KGaA got the green light
from the FDA to restart its
late-stage lung cancer program for  
Stimuvax, which had been halted
after a patient in a multiple
myeloma trial contracted
encephalitis in March 2010.


LUCANIX
The vaccine Lucanix is produced by
a San Diego-based
biopharmaceutical company,
NovaRx Corporation.

Nova Rx   identified  the molecule
transforming growth factor beta  
(TGF-beta) as one of the most
potent immunosuppressive
molecules produced by tumor cells.

The company's technology blocks
that molecule and this way the
immune system is able to "see"
and fight the cancer.

TGF-beta is often elevated in
patients with non-small cell lung
cancer (NSCLC), which causes the
immune system to become
suppressed and not attack the
cancer.

Lucanix is made up of four types of
(dead) lung cancer cells that have
been genetically modified to inhibit
the secretion of TGF-beta, ideally
increasing the ability of the patient's
body to identify the cancer as an
invader and fight it off.

In phase II clinical trials, patients
with advanced NSCLC lived an
average of 16 months longer with
Lucanix.

The NovaRx  has become the first
to demonstrate that inhibiting
TGF-beta can increase the body's
immune response to a tumor, which
may result in longer survival.

This approach could potentially be
applied to other cancers.

Although no unusual negative side
effects have been reported, caution
must be used.

TGF-beta has other key roles in the
body  such as preventing cells from
growing out of control. Care must
be taken to ensure that other
functions are not undesirably
disrupted.

Lucanix is just starting phase III
clinical trials for treating non-small
cell lung cancer.

While Lucanix is not a cancer cure,
it may be a relatively significant
step in the right direction for
improving the lives of patients with
lung cancer.

TRANSGENE TG4010
French biotech firm Transgene  to
start  phase 2b/3   trials.
MUC1 is a tumor-associated
antigen that provides a viable target
for the TG4010 as it has the
potential to generate an immune
response to 'attack' the cancer.
Around 80% of all lung cancers are
NSCLC, with roughly 60% of this
group over-expressing MUC1.

TG4010 has a similar mechanism
of action as Merck's cancer vaccine
Stimuvax, currently in phase 3 trials
for a sub-type of NSCLC.

Current treatments for NSCLC are
limited and include AstraZeneca's
Iressa and Roche's Tarceva and
Avastin.

Novartis is Trangene's marketing
partner.

EARLY DETECTION

EBUS

EBUS stands for: endobronchial
ultrasound. It is a  new tool in the
fight against lung cancer.

Under local or general anaesthesia,
a thin flexible telescope
(bronchoscope) is inserted via the
patient's mouth into the lungs.
Images of the region between the
two lungs  are obtained using an
ultrasound probe attached to the
bronchoscope. These images help
to guide the operator when taking
samples of cells from masses
suspected of disease.

The aim of the procedure is to  
reach a diagnosis and, in patients
with lung cancer, to establish
whether the disease has spread
beyond the lung.

Before EBUS, biopsies performed
in these areas were made by a
calculated guess on their location
based on landmarks within the
body to find the lymph nodes and
masses that are oftentimes close to
large blood vessels and other
important structures.

EBUS helps to visualize in real time
while the procedure is being done
these lymph nodes and tumors.This
new technology also helps to
biopsy masses and tumors deep
within the lung.


PWS
A new diagnostic tool that looks for
signs of early stage lung cancer in
the lining of the cheek.
It is called partial wave
spectroscopic (PWS) microscopy.
It makes use of the fact that cells
located far from the site of an actual
tumor undergo specific tell-tale
changes in their molecular
composition.

The basic idea is that smoking not
only affects the lungs but the entire
airway tract.
There are currently no screening
methods uncovering the disease at
an early stage.
That means that the majority of lung
cancer patients -- 90 percent of
whom are smokers -- are
diagnosed at a late stage,
contributing to a low survival rate of
just 15 percent at five years. In fact,
in the United States, lung cancer is
the leading cause of cancer
fatalities.

Enter so-called "biophotonics"
technology tools, such as PWS.
Developed by a Northwestern
University  researcher, PWS has  
already been tested in a successful
effort to screen for colon cancer
and pancreatic cancer.

In this test 135 patients were
screened, nearly half of whom were
lung cancer patients with a history
of smoking. Among the others, just
over one-quarter were smokers
diagnosed with chronic obstructive
pulmonary disease, and the rest
were a mix of healthy smokers and
nonsmokers.
After swabbing each patient's
mouth, cheek cells were optically
scanned.
The team found that PWS was
successful at accurately
distinguishing between cancer
patients and individuals without
cancer more than 80 percent of the
time -- a rate that the authors said
is equivalent to that of screening
methods used for other cancers.
All this is preliminary and not yet
ready for use in the clinic.