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The Lancet Oncology

Saturday, May 2, 2009

European specialists are joining forces to improve lung cancer treatment

Prevention, personalized therapies and closer collaborations between surgeons, medical oncologists and radiation oncologists will result in better outcomes for lung cancer patients and those at risk, a leading European expert says.

“Lung cancer is a complex disease. It is one of the most complex cancers, and the more we learn about the biology of the disease, the more we realize that improved cancer care will result from multidisciplinary treatment,” said Prof Robert Pirker, from the Medical University of Vienna, Austria (Spitalgasse 231090 Wien 9., Alsergrund, Wien, Austria). Prof Pirker is co-chair of the scientific committee of a new medical conference, the European Multidisciplinary Conference in Thoracic Oncology (EMCTO), being held for the first time this year, 1-3 May, at the Palazzo dei Congressi in Lugano, Switzerland.

The conference aims to further clinical and scientific cooperation between disciplines to help in the fight against lung cancer. Designed as a regular multidisciplinary, educational meeting, the organizers feel that the meeting may help strengthening general knowledge and providing an updated overview of prevention, screening, diagnosis, treatment modalities and results of translational research. One of the goals of the organizers is to facilitate interaction between the specialties in order to promote an integrated approach to diagnosis and treatment of chest tumors and to strengthen European cooperation and scientific exchange in multidisciplinary management of lung cancer.

A common cancer
Lung cancer is the most common cancer in the world. In men, the highest incidence rates are seen in Europe (especially eastern Europe) and North America. In women, high incidence rates are found in North America and in Europe, particularly in northern and western Europe.

Role of tobacco and smoking
Tobacco smoking is well established as the main cause of lung cancer and about 90% of cases are thought to be tobacco related. There is a clear dose-response relation between lung-cancer risk and the number of cigarettes smoked per day, degree of inhalation, and age at initiation of smoking. Researchers have noted that someone who has smoked all his life has a 20 -30 times greater risk of getting lung-cancer than a non-smoker. The link between tobacco-use and smoking is further emphasized by the fact that the risk of lung cancer decreases with time since smoking cessation.

Research has also shown that while the incidence of lung cancer among men in many Western European countries has been decreasing since the 1980s, the age-adjusted rate for men in other European countries increased at least until the 1990s. Among women this peak in incidence had not been reached in the 1990s. At the same time, the proportion of adenocarcinoma in both men and women has been increasing over time. The most likely explanation for this trend is the shift to low-tar filter cigarettes.

Screening Emphasized
Since the early 2000’s there has been renewed interest in screening because spiral computerized tomography (CT) can detect small asymptomatic lesions more effectively than conventional radiography. Although cure rates for such lesions are very good, there is to date no evidence for effectiveness of mass-screening strategies.

Targeted therapies
Over the past 5 years, researchers have established that for patients with operable cancer, surgery followed by chemotherapy can result in good outcomes. Now, large clinical trials are beginning to evaluate that adding molecular targeted therapies can further improve the chance of a successful outcome for some patients. In addition, doctors are now attempting to refine their treatments based on the clinical characteristics of individual patients, and based on the molecular profile of their tumor.

“More sophisticated and complex treatments require more cooperation,” Prof Pirker says. “That is one of the reasons why we have organized this conference. We believe the result will be better outcomes for lung cancer patients.”

For patients with metastatic disease, targeted therapies have already entered clinical practice or have shown survival benefit in clinical trials. Combinations of chemotherapy and radiotherapy are also improving outcomes of loco-regional non-small-cell lung cancer. “Cure is now possible in about 15% to 20% of patients whose disease can be treated in this way,” adds Prof Jean-Paul Sculier, from Institut Jules Bordet in Brussels, Belgium. (121 Boulevard de Waterloolaan, Bruxelles 1000 Brussel 121 Boulevard de Waterloolaan, Bruxelles 1000 Brussel, telephone +32 254 1311). Prof Sculier will chair a session on treating advanced disease at the conference.

During the European Multidisciplinary Conference in Thoracic Oncology Research groups will present new data that reflect these developments, including:

  • A study comparing radiotherapy alone to sequential chemotherapy and radiation in locally advanced non-small-cell lung cancer, plus a correlation of gene expression level with survival (UK).
  • Promising results from a study of accelerated hypofractionated three-dimensional conformal radiotherapy (3D-CRT) with dose-per-fraction escalation for treatment of stage III non-small-cell lung cancer (Poland).
  • Confirmation that EGFR mutations (deletion in exon 19, missense L858R) are the most important predictors of sensitivity to tyrosine-kinase inhibitor targeted therapies (Italy)

Barbara Zolty from the World Health Organization (Avenue Appia 20 1211 Geneva 27 Switzerland telephone +4122791211) will also highlight the importance of preventing lung cancer as the first and foremost weapon against lung cancer. Ms Zolty will speak about the WHO Tobacco-Free Initiative with an enlightening keynote lecture entitled “A thousand seconds, a thousand lives.”

The EMCTO Conference is co-organized by the European Society for Medical Oncology (ESMO), the European Society for Therapeutic Radiology and Oncology (ESTRO), the European Society of Thoracic Surgeons (ESTS) and the European Respiratory Society (ERS)

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