Fas the most common type of lung cancer among Americans, deaths fall faster than new cases, a new one to study reports, suggesting – but not proving – that new therapies targeting genetic mutations have a large format on survival.
Mortality rates for patients with non-small cell lung cancer, which accounts for three-quarters of lung cancers, decreased for men by 3.2% per year from 2006 to 2013. The decline accelerated to 6, 3% per year from 2013 to 2016, when targeted therapies were introduced. The decline in both periods exceeded the drop in new cases. Biennial survival jumped from 26% for men diagnosed in 2001 to 35% in 2014.
For women, the slope is not very steep, but it moves in the same direction. Incidence was flat from 2001 to 2006 and then decreased by 1.5% annually from 2006 to 2016. Deaths decreased by 2.3% in the year from 2006 to 2014, but then faster, and fell by 5.9% the year from 2014 to 2016. Biennial survival rose from 35% to 44% in that decade.
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Notably, the improvement was consistent among all racial and ethnic groups surveyed: non-Hispanic Asian and Pacific Islander, non-Hispanic white, Hispanic, and non-Hispanic Black.
Small cell lung cancer, which accounts for 13% of diagnoses, was a different story. During the time period examined, deaths were downward, but almost in lockstep with less diagnosed cases. There was no improvement in survival rates. Researchers from the National Cancer Institute extracted their figures from the NCI’s SEER registry and their report appeared Wednesday in the New England Journal of Medicine.
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Nadia Howlader, co-author of a study and a mathematical statistician in surveillance research at NCI, said recent treatments advancing non-small cell lung cancer are likely primarily responsible for the sharp decline in deaths. “Decreasing smoke rates will affect incident rates and subsequent death rates downstream, but the type of abrupt and sharp fall we see for non-small cell lung cancer and the extent and timing of that fall in death rates lead us to believe that it has something to do with the approval of the new drugs in 2013. “
These drugs include two targeted therapies: the tyrosine kinase inhibitor erlotinib which promotes EGFR mutations and the ALK inhibitor crizotinib.
Arrival of lung cancer has improved at a population level for about 40 years for men and 30 years for women. The study adds a new hypothesis based on SEER subtype data that targeted therapies are responsible for the uptick in the survival of non-minor lung cancer. SEER data do not include information about the medications patients are receiving.
The authors emphasize that the effects of targeted drugs, specifically those that target mutations of the EGFR and ALK genes, are lowering death rates. Although only 15% of patients with non-cell lung cancer have defective EGFR genes and only 5% have ALK gene translocations, their survival is measured in years, not the months typical of chemotherapy. That dramatic benefit accounts for the lower death toll system, the researchers say.
Immunotherapies, known as checkpoint inhibitors – medicines that release the brakes of the immune system after cancer breaks out – were first approved in 2015, near the end of the study period. Howlader said future projects will control these drugs, as well as newer therapies targeting other genetic mutations besides EGFR and ALK.
Grace Dy, head of thoracic medicine at Roswell Park Comprehensive Cancer Center, expects future reports to show continuous improvement, especially as genomic tests become more available as new drugs are developed and approved to attack mutations in ROS1, BRAF, MET exon 14 , and others. She also thinks there may be more to the story. She was not involved in the investigation.
‘It’s a combination of many things. There were additional improvements to chemotherapy, “she said.” It’s essentially a new standard of care that has been introduced that incrementally improves survival. “
David Jones, head of thoracic surgery at Memorial Sloan Kettering Cancer Center, also said that other factors may contribute to the clearer picture for a disease that is the leading cause of cancer death in the US, with indications of better radiation oncology and greater use of minimally invasive surgery as care of patients for lung cancer has become more multidisciplinary. Jones, who was not involved in the study, was encouraged that the survival gains extended to all races and ethnicities.
“If it is thanks to more widespread use of these targeted therapies, then they should reach those we have historically thought may be suffering from some differences in health care,” he said.
Jones fixed at 30% the stake of patients who have a mutation or genomic change in their tumors that a physician can now treat. And it turns out that most patients who do not have EGFR and ALK mutations are candidates for immunotherapy.
“As we learn more about inhibitors of immune checkpoints and related compounds, we begin to look at data that first appear for non-small cell lung cancer and even for small cell lung cancer, a survival benefit that is very important,” he said. . “I expect that if this article comes out again in five years’ time, we will see further improvements in lung cancer mortality. And I think a lot of that can be attributed to the immunotherapies. ”
SEER data do not say if patients smoke, but 70% of lung cancers are still attributed to smoking, generations after the habit and the disease were first linked. As smoking rates fall, doctors have seen an increase in cases of lung cancer among non-smokers with possible risk factors such as exposure to radon, asbestos, secondhand smoke, or air pollution. Although those non-small cell lung cancers have completely different biology and disease processes than cancer-related lung cancers, the tumors are more likely with EGFR mutations. That means nonsmokers may have more options in terms of genomically targeted treatment, Jones said.
Whand he began his career in thoracic oncology 40 years ago, there was a sense of nihilism about lung cancer, he said. Considered a death sentence, it also made the stigma of smoking a common choice (although cigarettes are very addictive and difficult to quit). There has been a sea change in the last 10 years.
“You see, an article is now appearing in the New England Journal of Medicine that is praised in terms of progress being made – it’s still a very serious disease, [but] I am encouraged by the fact that it is a positive report, with the emphasis on the benefits of all ethnicities and genders. ”
