Thus far, we’ve examined the two most oft-diagnosed cancer types: prostate cancer and breast cancer. This week we’ll be shifting our focus to lung cancer — a type of cancer with a much grimmer prognosis in terms of survival rates than prostate or breast cancer.
The skinny on lung cancer
This year, an estimated 228,190 people are going to be diagnosed with some form of lung or bronchus cancer. I wish I could say that advancements have been swift in treating this disease, but abstinence and awareness as to the effects of cigarette smoking have been front and center in helping to reduce instances of lung cancer over the past two decades. Between 2005 and 2009, the incidence of lung cancer in men has decreased by an average of 1.9% annually. For women, this trend only recently began to reverse, with diagnoses falling by just 0.3% annually between 2005 and 2009.
However, the sad reality is that five-year survival rates for lung cancer have improved from just 12% in 1975-1977 to 17% in 2002-2008, according to the American Cancer Society (link opens PDF). Lung cancer is an effective and swift killer, accounting for more deaths among men and women than any other cancer, and has left patients and physicians scrambling for solutions for the better part of 40 years.
Source: Centers for Disease Control and Prevention.
This relates back to the fact that only 15% of all lung cancer diagnoses come with the cancer in a localized stage, and advanced-stage lung cancer carries only a 4% survival rate of five years or beyond. The majority of diagnoses are for non-small-cell lung cancer (about 84%) with the remainder being small-cell lung cancer. The typical treatment for localized lung cancer is surgery often followed by chemotherapy. In advanced stages of the disease, surgery isn’t typically an option, and rounds of chemotherapy or radiation are often prescribed by physicians.
Where investment dollars are headed
Unlike prostate or breast cancer, which have growing five-year survival rates and hormonal therapies that keep the disease at bay, lung cancer has few tools that slow down the progression of the disease for a meaningful amount of time. In short, investment dollars are streaming into lung cancer research from both an early- and late-stage perspective, and physicians couldn’t be happier to have so many companies focused on the next revolutionary lung cancer treatments.
The National Cancer Institute alone lists 29 drugs currently approved by the FDA to fight non-small-cell lung cancer, or NSCLC. I’ll cover the most pertinent ones below. I should also note that I’m going to focus almost entirely on NSCLC treatments as opposed to small cell lung cancer, or SCLC, as SCLC has a considerably better response rate to standard chemotherapy and radiation than does NSCLC.
Avastin: Developed by Roche (OTCBB:RHHBY), Avastin is a multi-cancer wonder drug. It’s approved to treat metastatic colorectal and kidney cancer, glioblastomas (an aggressive brain cancer), and metastatic lung cancer where surgery has been ruled out. Avastin was approved in 2006 in combination with chemotherapy agents Paclitaxel and carboplatin following a clinical trial in which the Avastin arm’s median overall survival improved to 12.3 months from just 10.3 months in the Paclitaxel and Carboplatin-only control arm. However, Avastin may also be losing some of its allure. In 2011, the FDA revoked its approval for its use in breast cancer after it discovered that its risks outweighed its benefits. In addition, a study conducted by researchers at the Stony Brook University School of Medicine found that death risk actually rose for patients when Avastin was combined with chemotherapy agents.
Tarceva: Owned by Roche and Astellas Pharma, Tarceva is a pill designed as a second or third-line treatment for NSCLC. Patients receiving Tarceva have either gone through a round of chemotherapy that’s kept the disease at the same level, or it has progressed. Tarceva was first approved by the FDA in 2004, but received the additional indication of “maintenance treatment” in April 2010. For its 2004 approval, Tarceva demonstrated median overall survival of 6.7 months as compared to just 4.7 months for the control arm.
Xalkori: Developed by Pfizer Inc. (NYSE:PFE) (yes, we broke the Roche streak dating back to last week), Xalkori is a twice-daily pill dedicated to patients with metastatic NSCLC that’s caused by a defect in a gene called anaplastic lymphoma kinase, or ALK. Xalkori was granted an accelerated approval by the FDA in August 2011 after two arms of the same clinical trial demonstrated objective response rates of 50% and 61%. Keep in mind, however, that this trial was not designed to measure overall survival, and Pfizer Inc. (NYSE:PFE) even states on the Xalkori webpage that “It is not known whether Xalkori will improve symptoms or help patients with this disease live longer.”
Abraxane: Celgene Corporation (NASDAQ:CELG)‘s Abraxane is used as a first-line treatment in metastatic cases of NSCLC where neither surgery or radiation are a viable option. It received approval from the FDA just last October after clinical trials showed an 8% increase in overall response rate and a 0.9-month median response duration improvement with the Abraxane patient pool as compared to those just taking Paclitaxel.
