Lung cancerLung cancerGilda’s Club of Metro DetroitGilda’s Club of Metro Detroit

June 14, 2006.June 14, 2006.

Harmesh Naik, MD.Harmesh Naik, MD.Hope Cancer ClinicHope Cancer Clinic

Brief overview of lung cancerBrief overview of lung cancer

•• 174,000 new cases in 2006174,000 new cases in 2006•• 13% off all new cancers13% off all new cancers•• Estimated 162,000 deaths in 2006Estimated 162,000 deaths in 2006•• 28% of all cancer deaths28% of all cancer deaths•• Over Over 300,000300,000 survivorssurvivors

ACS: Cancer.org-2006

What is newWhat is new

•• Some of the exciting developments (may Some of the exciting developments (may or may not be available today)or may not be available today)

Steps on road to cure….Steps on road to cure….

•• DiagnosisDiagnosis•• StagingStaging•• TreatmentTreatment•• ReRe--assessmentassessment•• Long term follow upLong term follow up•• Preventive measuresPreventive measures•• Final destination: CureFinal destination: Cure

What is new in diagnosisWhat is new in diagnosis

•• PET scanPET scan•• Pathology: better stainsPathology: better stains•• Molecular markers (targets)Molecular markers (targets)

What is new in stagingWhat is new in staging

•• PET/CT fusionPET/CT fusion•• MedistionoscopyMedistionoscopy•• ThoracoscopyThoracoscopy

What is new in treatmentWhat is new in treatment

•• Summary:Summary:•• More More precisionprecision

What is new in treatmentWhat is new in treatment

•• Surgery:Surgery:•• Thoracoscopic surgeryThoracoscopic surgery•• Robotic surgeryRobotic surgery•• Outpatient chest drainage tubes (effusion Outpatient chest drainage tubes (effusion

drainage)drainage)

What is new in treatmentWhat is new in treatment

•• Radiation:Radiation:•• Better method to deliver radiation (less Better method to deliver radiation (less

damage to normal tissue, more dose to damage to normal tissue, more dose to cancer)cancer)

•• Radiation sensitizersRadiation sensitizers•• Radiation protectantsRadiation protectants

What is new in treatmentWhat is new in treatment

•• Chemotherapy:Chemotherapy:•• ManyMany new drugsnew drugs•• ManyMany new combinationsnew combinations•• ManyMany new schedulesnew schedules•• ManyMany different ways to combine with different ways to combine with

radiation and surgeryradiation and surgery

MultiMulti--modality therapymodality therapy

•• Neoadjuvant chemotherapy Neoadjuvant chemotherapy surgerysurgery•• Combined chemotherapy and radiation Combined chemotherapy and radiation

(concurrent)(concurrent)•• ChemoChemo--RTRTchemochemo•• SurgerySurgery adjuvant chemoadjuvant chemo•• Have improved outlook significantlyHave improved outlook significantly•• ????curecure some patientssome patients

Targeted therapyTargeted therapy

•• To save normal tissue from damage while To save normal tissue from damage while focusing on cancer cell deathfocusing on cancer cell death

•• To select candidates for specific drugs To select candidates for specific drugs (e.g.. Gene mutations helping select (e.g.. Gene mutations helping select specific oral drugs)specific oral drugs)

•• To select appropriate chemotherapy (who To select appropriate chemotherapy (who is at risk of what side effect is at risk of what side effect –– avoid avoid certain drugs in certain patients)certain drugs in certain patients)

What will work for this patient?What will work for this patient?

•• Prediction of response for an individual is Prediction of response for an individual is quite difficult at present time.quite difficult at present time.

•• We do not know characteristics of We do not know characteristics of individual cancer individual cancer adequatelyadequately enough to enough to accuratelyaccurately predict response to any therapypredict response to any therapy

•• Lack of technologyLack of technology

Personalized therapy (Near future)Personalized therapy (Near future)

•• Individualized therapy based on molecular Individualized therapy based on molecular markers or targets (various proteins) on markers or targets (various proteins) on the cancer cell of an individual cancerthe cancer cell of an individual cancer

•• Save the healthy cellsSave the healthy cells--kill the cancer cellskill the cancer cells•• Future of medicineFuture of medicine

How to choseHow to chose

•• Known therapy versus experimental Known therapy versus experimental therapytherapy

•• No one therapy works No one therapy works foreverforever and and for allfor all..•• Therapy that may do wonders for one Therapy that may do wonders for one

person, may not do anything for other or person, may not do anything for other or it may even hurt by causing side effects it may even hurt by causing side effects (quality of life issue).(quality of life issue).

Supportive care advancesSupportive care advances

•• Transfusion medicineTransfusion medicine•• growth factorsgrowth factors•• Infection treatments: antibiotics.Infection treatments: antibiotics.•• Laser therapy to relieve blocked airwayLaser therapy to relieve blocked airway•• RadioRadio--ablation of lung tumorsablation of lung tumors

What is new in follow upWhat is new in follow up

•• Risk of new cancerRisk of new cancer•• Risk of brain metastasesRisk of brain metastases•• Newer medications to prevent new Newer medications to prevent new

cancerscancers•• Newer smoking cessation methods / Newer smoking cessation methods /

medications (e.g.. varenicline )medications (e.g.. varenicline )

Time tested………Time tested………

••KnowledgeKnowledge

••Positive attitudePositive attitude

••HopeHope