Grand Rounds Review: NSCLC

Incredible talk on lung cancer today by Dr. Joan Schiller, Chief of the Division of Hematology-Oncology at UT Southwestern Medical Center and Deputy Director of Simmons Cancer Center. She is founder and president of Free to Breathe, a partnership for lung cancer survival.
Dr. Schiller presented five important facts for every internist, including:
  1. The changing face of lung cancer – about 15% of all lung cancers are in never smokers, and new risk factors, such as genetic factors or radon exposure, are being identified. The rate of NSCLC in never smokers appears to be on the rise.  
  2. Screening for lung cancer – the National Lung Cancer Screening Trial compared CXR and low-dose CT in patients considered to be at risk for lung cancer (age 55-74, 30 pack-year smoking history, etc.). The study found that low-dose CT scanning was associated with a 20% relative risk reduction in lung cancer mortality and a 6.7% reduction in all cause mortality. The findings of this study led to the USPSTF guidelines for lung cancer screening (which has since been approved for reimbursement by Medicare).
  3. People are living longer and better lives, with less side effects due to current treatments for NSCLC – Through advances such as VATS, stereotactic radiation therapy, and more effective chemotherapy regimens. Current chemotherapy regimens include platinum a combined with paclitaxel, docetaxel, gemcitabine, vinorelbine, and pemetrexed.
  4. Targeted therapy – systemic therapy with biologic or non-cytotoxic agents aimed at specific mutations, such as K-ras, EGFR, ALK, and HER-2. Novel agents, like erlotinib, afatinib, crizotinib, etc. are revolutionizing the care of these patients. Additionally, UTSW cancer researchers have identified irreversible inhibitors of the KRAS gene mutation. 
  5. The important of understanding biology to identify new treatments….activating the immune system – phase 2 clinical trials are underway to test immune checkpoint inhibitors. Dr. Philip Thorpe here at UTSW developed a first-in-class phoshatidylserine-targeting monoclonal antibody, Bavituximab. This drug is currently in phase 3 clinical trials as a second line therapy in NSCLC. 

To learn more about this exciting topic and the new advances in the field, check out the following article by Dr. David Johnson and Dr. Schiller!