{"id":26286,"date":"2020-08-18T13:31:38","date_gmt":"2020-08-18T13:31:38","guid":{"rendered":"https:\/\/scienceblog.cancerresearchuk.org\/?p=17890"},"modified":"2024-11-03T15:16:20","modified_gmt":"2024-11-03T15:16:20","slug":"us-lung-cancer-data-points-to-the-power-of-cancer-research","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/us-lung-cancer-data-points-to-the-power-of-cancer-research\/","title":{"rendered":"US lung cancer data points to the power of cancer research"},"content":{"rendered":"
<\/p>\n

Lung cancer cell. Credit: LRI EM Unit<\/span><\/p>\n<\/div>\n

Whether it\u2019s exams, a COVID-19 test or a mid-treatment scan, waiting for results <\/span>can be<\/span> nerve-wracking. The <\/span>anxiety<\/span>. The unknowns. The <\/span>implications for the<\/span> future. The <\/span>growing <\/span>sense of <\/span>anticipation<\/span> as the day looms. <\/span>Will it be good news, or bad?<\/span> <\/span><\/p>\n

This week, the whole of cancer research got some long-awaited results \u2013 and <\/span>they\u2019re<\/span> a <\/span>tentative<\/span> thumbs-up. <\/span>New data <\/span>from the US<\/span> National Cancer Institute<\/span> (NCI)<\/span>, published in the <\/span>New England Journal of Medicine<\/a>,<\/span> show the clearest signs yet that <\/span>one of the most promising concepts in modern cancer medicine <\/span>\u2013<\/span> <\/span>targeted<\/span> <\/span>therapy<\/span> \u2013 <\/span>seems to be<\/span> having a<\/span>n<\/span> impact on one of the hardest cancers to treat: lung cancer.<\/span> <\/span><\/p>\n

Long-term trends<\/span> <\/span><\/h2>\n

Lung cancer<\/span> is the biggest cancer killer, claiming an estimated <\/span>1.76m<\/span> lives <\/span>each year around the globe. Thankfully, in many countries,<\/span> <\/span>the rate of people dying from the disease in the population<\/span> h<\/span>as<\/span> been <\/span>gradually <\/span>falling<\/span> for <\/span>several years. <\/span>And although <\/span>there have been some big <\/span>changes <\/span>in<\/span> how the disease is diagnosed and treated <\/span>over this time<\/span>,<\/span> <\/span>the <\/span>main <\/span>thing driving<\/span> th<\/span>e<\/span> drop <\/span>is <\/span>the decline in<\/span> <\/span>smoking rates <\/span>across the developed world<\/span>, meaning fewer people are getting lung cancer.<\/span> <\/span><\/p>\n

This is of course, extremely good news. But the huge <\/span>influence<\/span> <\/span>smoking <\/span>has <\/span>on cancer rates <\/span>has <\/span>made it harder to <\/span>unpick<\/span> <\/span>any underlying<\/span> impact of <\/span>treatment <\/span>changes<\/span>. A large US analysis <\/span>looked at this back<\/span> in January<\/span>, and appeared to<\/span> <\/span>show a big drop in death rates<\/span> from all cancers \u2013 which was initially <\/span>lauded as proof that treatment was improving. But a closer look at the data revealed that other factors were at play \u2013 including the <\/span>drop in<\/span> smoking. <\/span> <\/span><\/p>\n

The question of whether <\/span>specific <\/span>changes in treatment lead to<\/span> population-level<\/span> improvements in <\/span>cancer outcomes<\/span> is, of course, <\/span>much <\/span>more than an academic <\/span>one<\/span>. Over the decades, billions <\/span>of pounds, dollars and euros have<\/span> been invested in understanding cancer<\/span> <\/span>and<\/span> develop<\/span>ing<\/span> new treatments. In the case of lung cancer,<\/span> this has led to<\/span> a whole slew of new therapies <\/span>being<\/span> approved in the last 5-10 years, and <\/span>making<\/span> their way into routine use \u2013 including in the UK<\/span>. <\/span> <\/span><\/p>\n

Most prominent of these are the so-called \u2018targeted\u2019 therapies<\/span>, designed to treat patients whose cancers are caused by <\/span>particular <\/span>DNA<\/span> errors<\/span>.<\/span> <\/span>After being proven <\/span>effective<\/span> in clinical trials, these drugs <\/span>began to enter<\/span> routine<\/span> use<\/span> <\/span>in the early 2010s<\/span>. <\/span> <\/span><\/p>\n

As a result, many researchers and organisations <\/span>\u2013 including Cancer Research UK \u2013 <\/span>have<\/span> <\/span>been keeping a keen eye on national and international cancer trends, looking for signs that <\/span>this collective effort is<\/span> having the<\/span> \u2018big picture\u2019<\/span> impact that the <\/span>positive <\/span>trial results suggest<\/span>ed<\/span> <\/span>they <\/span>should<\/span>.<\/span> <\/span> <\/span> <\/span><\/p>\n

A not inconsiderable number of fingers have been crossed.<\/span> <\/span><\/p>\n

Hitting the target?<\/span> <\/span><\/h2>\n

We\u2019ve written before about <\/span>the promise and challenges of targeted therapies<\/a> <\/span>\u2013 also referred to as \u2018personalised\u2019 or \u2018precision\u2019 medicines. Unlike conventional chemo drugs, they<\/span>\u2019<\/span>re designed to interfere with specific processes within cancer cells, with the aim of more precisely targeting <\/span>the<\/span> disease<\/span>. <\/span> <\/span><\/p>\n

T<\/span>hanks to the help of our supporters, <\/span>we<\/span>\u2019ve been able to play a key role in accelerating the development of these drugs. O<\/span>ur <\/span>researchers have been at the forefront of tracking down <\/span>molecular faults in cancer cells, and finding ways to target them. <\/span>W<\/span>e\u2019ve worked closely with pharma companies to <\/span>help <\/span>test <\/span>experimental therapies<\/span>, <\/span>to<\/span> bring those that are safe and effective to patients as swiftly as possible. <\/span>And w<\/span>e\u2019ve worked closely with the NHS<\/span>,<\/span> to ensure the necessary testing <\/span>is available to patients<\/span>,<\/span> <\/span>\u2013<\/span>and<\/span> <\/span>regulators, to <\/span>make sure their approval happens <\/span>smoothly<\/span>. <\/span> <\/span><\/p>\n

And yet, despite <\/span>th<\/span>e<\/span> hope and promise, lingering doubts remain. <\/span> <\/span><\/p>\n

In trial settings, these drugs <\/span>can <\/span>offer <\/span>only <\/span>modest benefits<\/span> \u2013<\/span> months rather than years<\/span>. <\/span>They <\/span>are<\/span> extremely expensive<\/span>. So too<\/span> is the testing infrastructure needed to use them effectively<\/span>, and only about <\/span>1<\/span> in <\/span>5<\/span> patients <\/span>has<\/span> a relevant marker suggesting the drugs will work. <\/span>As with chemotherapy, <\/span>tumours can develop resistance to them. <\/span>They cause side-effects \u2013 different side-effects to chemo <\/span>for sure <\/span>but<\/span>,<\/span> <\/span>for many patients, no less <\/span>debilitating. <\/span>Many commentators have written about <\/span>the \u2018hype\u2019 around these drugs<\/a><\/span>, and wondered whether they <\/span>might be<\/span> a false<\/span>, expensive<\/span> dawn in the <\/span>quest to beat cancer. <\/span> <\/span><\/p>\n

The new analysis<\/span> <\/span>from the NCI <\/span>begins to suggest otherwise. <\/span> <\/span><\/p>\n

Promising n<\/span>ew data<\/span> <\/span><\/h2>\n

T<\/span>his week<\/span>\u2019s new analysis<\/span> <\/span>draws<\/span> on data from<\/span> lung cancer<\/span> patients diagnosed in the US<\/span> <\/span>between 2006 and 2016<\/span>, and <\/span>relies on the fact that <\/span>the disease<\/span> exists in <\/span>several <\/span>distinct<\/span> forms. Two thirds are what\u2019s known as \u2018<\/span>non<\/span> <\/span>small<\/span> <\/span>cell<\/span>\u2019 lung cancers, while <\/span>just over<\/span> a <\/span>tenth<\/span> are termed \u2018small<\/span> <\/span>cell\u2019 lung cancers. Both <\/span>can be<\/span> caused by smoking, but<\/span> \u2013 crucially \u2013 <\/span>targeted<\/span> <\/span>drugs <\/span>have only been widely introduced<\/span> for the former. <\/span> <\/span><\/p>\n

Th<\/span>ese facts<\/span> allowed<\/span> <\/span>the NCI\u2019s <\/span>researchers to compare<\/span> <\/span>lung cancer incidence and mortality <\/span>for both <\/span>forms<\/span>, using data from the organisation\u2019s massive <\/span>national <\/span>Surveillance, Epidemiology, and End Results (SEER) cancer registry<\/span>. Any difference in trends, the <\/span>researchers<\/span> reasoned, <\/span>would likely <\/span>to be due to <\/span>factors like treatment changes<\/span>, rather than other \u2018bigger picture\u2019 factors like smoking<\/span> or improved diagnosis<\/span>.<\/span> <\/span><\/p>\n

As expected, the<\/span> analysis revealed that <\/span>from<\/span> <\/span>2006<\/span> <\/span>mortality rates declin<\/span>ed <\/span>for both forms<\/span>. But from 2013, the researchers spotted a<\/span> big <\/span>increase<\/span> in the downward<\/span> <\/span>trend for <\/span>patients with <\/span>non-small cell lung cancer<\/span>, which wasn\u2019t apparent <\/span>for those with small cell cancers. <\/span> <\/span><\/p>\n

2013, of course, is when targeted therapies began to be used for <\/span>non<\/span> <\/span>small<\/span> cell lung cancer. <\/span> <\/span><\/p>\n

The <\/span>drop in<\/span> mortality seemed to double, from 3% a year, to 6% a year. <\/span>And w<\/span>hen the<\/span> researchers<\/span> looked at 2-year survival data <\/span>(<\/span>the proportion of patients still alive two years after their diagnosis<\/span>)<\/span> <\/span>this<\/span> appeared to <\/span>rise from about a quarter to over a third<\/span>.<\/span> <\/span> <\/span><\/p>\n

That\u2019s a big improvement, for a notoriously hard-to-treat cancer. <\/span>And it\u2019s wonderful news.<\/span> <\/span><\/p>\n

But <\/span>there<\/span> <\/span>a<\/span>re a<\/span> few caveats. I<\/span>t\u2019s not <\/span>absolute<\/span> \u2018smoking gun\u2019 proof that targeted therapies are <\/span>behind the improvement<\/span> \u2013 the SEER database doesn\u2019t record which treatments a patient received, making the link <\/span>an indirect one<\/span>.<\/span> Over the same time, there have <\/span>also <\/span>been <\/span>incremental <\/span>improvements in chemotherapy, <\/span>radiotherapy <\/span>and surgery<\/span>.<\/span> But <\/span>many of these <\/span>applied <\/span>to<\/span> both diseases, and <\/span>the researchers were able to rule out many other factors<\/span>,<\/span> such as improvements in diagnosis leading to more cancers being diagnosed earlier<\/span>,<\/span> <\/span>mak<\/span>ing their case<\/span> <\/span>extremely <\/span>compelling. <\/span> <\/span><\/p>\n

No room for complacency<\/span> <\/span><\/h2>\n

Despite this <\/span>welcome<\/span> news<\/span> \u2013 in <\/span>a<\/span> type of cancer<\/span> where progress has historically been slow<\/span> \u2013 <\/span>the<\/span> <\/span>study also <\/span>highlights<\/span> how much further we <\/span>have to<\/span> go to <\/span>keep <\/span>improv<\/span>ing<\/span> things for <\/span>all<\/span><\/em> patients<\/span>, <\/span>including<\/span> <\/span>those with <\/span>non<\/span> <\/span>small<\/span> cell lung cancers<\/span>. <\/span> <\/span><\/p>\n

These drugs may be good \u2013 but they\u2019re not good enough:<\/span> they\u2019re not cures, and they\u2019re not suitable for everyone. <\/span>C<\/span>ancer<\/span>, and lung cancer in particular, <\/span>is a <\/span>complex<\/span>, rapidly evolving<\/span> disease<\/span><\/a> \u2013 <\/span>so <\/span>finding <\/span>suitable<\/span> drugs for <\/span>more types <\/span>(and subtypes) <\/span>of cancer<\/span> is going to be a long slog<\/span>. <\/span>A<\/span>nd<\/span>,<\/span> as our National Lung Matrix Trial <\/span>results <\/span>suggested <\/span>last month<\/span><\/a>,<\/span> <\/span>non<\/span> <\/span>small<\/span> cell lung cancer<\/span>\u2019s<\/span> <\/span>\u2018<\/span>low-hanging fruit<\/span>\u2019<\/span> <\/span>may already have been plucked<\/span>. <\/span> <\/span><\/p>\n

It will <\/span>also <\/span>be important to make sure that <\/span>any <\/span>new<\/span> drugs are <\/span>made <\/span>available, and affordable, to all patients who need them. <\/span>And just focusing on drugs certainly won\u2019t be enough. <\/span>Lung cancer <\/span>can be<\/span> curable in its early stages <\/span>\u2013<\/span> <\/span>we <\/span>urgently <\/span>need better ways to <\/span>diagnose the disease early, to give people the best chance of long-term survival. <\/span> <\/span><\/p>\n

<\/p>\n

Copy this link and share our graphic.<\/a> Credit: Cancer Research UK<\/span><\/p>\n<\/div>\n

We know <\/span>how much work is still to do, despite this week\u2019s good news.<\/span> <\/span><\/p>\n

But <\/span>there is<\/span> reason to be <\/span>incredibly <\/span>proud of your support for us<\/span>.<\/span> <\/span>Th<\/span>ose<\/span> key <\/span>lung cancer <\/span>drugs <\/span>introduced in 2013 <\/span>are designed to <\/span>target a<\/span> molecule <\/span>known as the epidermal growth factor receptor, or <\/span>EGFR<\/span>. <\/span>This<\/span> <\/span>crucial molecule <\/span>was <\/span>discovered in the 1980s<\/span><\/a>, by <\/span>researchers<\/span> at our London Research Institute \u2013 now <\/span>part of<\/span> the Francis Crick Institute<\/span>. <\/span> <\/span><\/p>\n

None of <\/span>this week\u2019s<\/span> good news would have been possible without that <\/span>breakthrough<\/span>. <\/span> <\/span><\/p>\n

And t<\/span>oday, hundreds of researchers at the Crick, and around the country<\/span>, are continuing to make discoveries that, we hope, will <\/span>keep improving things for <\/span>all <\/span>people affected by cancer. <\/span> <\/span><\/p>\n

And with<\/span> COVID-19 having had such a big impact <\/span>on charities like ours, your support has never been more <\/span>valuable<\/span>, nor more appreciated. <\/span> <\/span><\/p>\n

Henry Scowcroft is C<\/span><\/span>ancer <\/span><\/span>R<\/span><\/span>esearch <\/span><\/span>UK\u2019s communications strategy lead <\/span><\/span> <\/span><\/em><\/p>\n

More on this topic<\/h3>\n<\/p>\n

Source<\/a><\/p>","protected":false},"excerpt":{"rendered":"

Lung cancer cell. Credit: LRI EM Unit Whether it\u2019s exams, a COVID-19 test or a mid-treatment scan, waiting for results can be nerve-wracking. The anxiety. The unknowns. The implications for the future. The growing sense of anticipation as the day looms. Will it be good news, or bad?  This week, the whole of cancer research got some long-awaited results \u2013 and they\u2019re a tentative thumbs-up. New data from the US National Cancer […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-26286","post","type-post","status-publish","format-standard","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26286","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=26286"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26286\/revisions"}],"predecessor-version":[{"id":44188,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26286\/revisions\/44188"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=26286"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=26286"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=26286"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}