Frankly Speaking About Lung Cancer

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Frankly Speaking About Lung Cancer

• The Wellness Community provides a free program of
  emotional support, education and hope for people
  with cancer and their loved ones.

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Frankly Speaking About Lung Cancer

• The Wellness Community
• Patient Active Concept
• Cancer patients who participate in their fight
  for recovery along with their healthcare team
  will improve the quality of their lives and may
  enhance the possibility of recovery.

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Frankly Speaking About Lung Cancer

• The Wellness Community
• national non-profit organization
• 21 locations nationwide 2 international
• over 12,000 support group sessions
• 138,000 visits each year
• Research, publications
• The Virtual Wellness Community

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The Wellness Community Programs

• Nutritional education
• Stress reduction programs (Tai Chi, Yoga, etc.)
• Exercise programs
• Childrens programs
• Resource library
• Social activities

• Weekly patient support groups
• Weekly family support groups
• Diagnosis specific networking groups
• Bereavement groups
• Educational programs

All programs are free of charge!
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Frankly Speaking About Lung Cancer

• What You Need to
• Know About Lung Cancer
• Its Treatment

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Frankly Speaking About Lung Cancer

• Powerful facts
• 177,000 cases annually
• Lung cancer is the 1 cause of cancer-related
  deaths by far in the U.S.
• more than breast, prostate, and colon cancer
  combined.

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Frankly Speaking About Lung Cancer

• Risk Factors
• Smoking (90 of all cases)
• Second-hand smoke (25 of non-smoker cases)
• Occupational/environmental

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Frankly Speaking About Lung Cancer

• Non-Small Cell Lung Cancer (NSCLC)
• Comprises 85 of all lung cancers
• Types of NSCLC
• Adenocarcinoma (most common)
• Squamous cell
• Bronchoalveolar Carcinoma
• Large Cell Carcinoma
• Adenosquamous

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Frankly Speaking About Lung Cancer

• Small Cell Lung Cancer (SCLC)
• Comprises 15-20 of all lung cancers
• Spreads more aggressively than NSCLC
• Is more responsive to chemotherapy
• Frequently found in smokers or former smokers

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Frankly Speaking About Lung Cancer

• Stages of Non-Small Cell Lung Cancer
• Stage I confined to lung tissue alone
• Stage II lung tissue and lymph nodes in lung
• Stage III lung tissue and lymph nodes outside
  of the lung
• Stage IV distant spread (liver, adrenal
  glands, bone, brain, other sites)

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Frankly Speaking About Lung Cancer

• LUNG CANCER STAGING (TNM)
• T Primary tumor size (T1-T4)
• N Lymph node involvement (N1-N3)
• M Distant metastasis (M0-M1)

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Frankly Speaking About Lung Cancer

• Treatment of Stage I NSCLC
• Evaluate for surgery
• Surgery alone is the standard of care
• Pathologic stage I 67 cure
• Clinical trials are evaluating the value of
  adjuvant (after surgery) therapy

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Frankly Speaking About Lung Cancer

• Treatment of Stage II NSCLC
• Evaluate for type of surgery
• Surgery alone is the standard of care
• Pathologic stage II 40-50 cure
• Clinical trials are evaluating the value of
  adjuvant (after surgery) therapy

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Frankly Speaking About Lung Cancer

• Theoretical Advantages of Combining Different
  Types of Cancer Therapies
• Chemotherapy
• ?Controls micro-metastases that may be
  responsible for systemic recurrence after
  successful surgery
• ?Acts synergistically with XRT to downstage
  NSCLC and make tumor-free margin surgery more
  likely
• Radiation Therapy
• ? Sterilizes surgical margins making local
  recurrence less likely

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Frankly Speaking About Lung Cancer

• Summary Treatment Stage I II NSCLC
• Surgery is the standard of care
• Neoadjuvant (given before surgery) therapy is
  promising
• Adjuvant (given after surgery) chemotherapy or
  radiation therapy show no improvement

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Frankly Speaking About Lung Cancer

• Stage III Non-Small Cell Lung Cancer
• 2 types Stage IIIA and Stage IIIB
• Radiation alone was the standard care until
  1990s
• Chemotherapy radiation is the new standard
  based on results of clinical trials
• Newer radiation techniques minimize side effects
  of treatment

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Frankly Speaking About Lung Cancer

• Treatment of Stage III NSCLC
• Chemo radiation standard of care
• Role of surgery is undefined
• Unanswered questions
• -Which chemo is best? How does one decide?
• -When how should chemotherapy be given?
• -When how should radiation be given?

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Frankly Speaking About Lung Cancer

• Stage III A Non-Small Cell Lung Cancer
• Bulky vs. minimal disease
• Chemotherapy radiation
• Commonly used chemotherapy drugs
• Platinum-based
• Non-platinum based
• Role of surgery undefined

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Frankly Speaking About Lung Cancer

• Stage III B Non-Small Cell Lung Cancer
• Pleural effusion affects treatment plan
• Chemotherapy radiation or radiation alone
• Commonly used chemotherapy drugs
• Platinum-based
• Non-platinum based

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Frankly Speaking About Lung Cancer

• Treatment of Stage IIIB-IV NSCLC
• Reduce Chemotherapy Toxicity
• Recent study Combination of 2 drugs provide same
  benefit as 3, but with fewer side effects
• Less nausea/vomiting
• Less hair loss
• Less nerve damage
• Lower risk of infection
• Gemcitabine vinorelbine slightly less toxicity
  but equivalent response
• (Cancer, Vol. 95, No. 6, 2002)

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Frankly Speaking About Lung Cancer

• Stage IV NSCLC
• NCI Recommended First-Line Chemotherapy
• gemcitabine cisplatin
• paclitaxel carboplatin or cisplatin
• vinorelbine cisplatin
• docetaxel cisplatin
• Other drug combinations

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Frankly Speaking About Lung Cancer

• Treatment of Recurrent NSCLC
• Challenges of decision-making
• General health status of the patient
• Several treatment options with equivalent results
  but widely varying side effects
• Balancing quality of life with side effects
• Patients goals and wishes

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Frankly Speaking About Lung Cancer

• Treatment of Recurrent NSCLC
• NCI Recommended treatment options
• Chemotherapy
• vinorelbine cisplatin
• paclitaxel cisplatin or carboplatin
• gemcitabine cisplatin
• docetaxel cisplatin
• Other drug combinations
• Palliative radiation therapy to relieve symptoms

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Frankly Speaking About Lung Cancer

• Treatment of Small Cell Lung Cancer
• Limited stage chemo xrt standard of care
• etoposide cisplatin radiation
• cisplatin irinotecan
• Extensive stage first-line chemotherapy
• etoposide (VP-16) cisplatin (or carboplatin)
  radiation
• cisplatin irinotecan
• CAV, CAE in clinical trials

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Frankly Speaking About Lung Cancer

• Treatment of Recurrent Small Cell Lung Cancer
• Possible Chemotherapy Agents
• topotecan (Hycamtin) only FDA-approved drug for
  recurrent disease
• oral etoposide (VP-16)
• paclitaxel (Taxol)
• irinotecan/CPT-11 (Camptosar)
• CAV
• others in clinical trials
• Palliative radiation to relieve symptoms

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Frankly Speaking About Lung Cancer

• Newer Strategies Targeted Therapy
• Chemotherapy targets general features of cells,
  including both cancer cells and normal cells
• Normal cells usually recover, while cancer cells
  may not
• However, chemotherapy is associated with side
  effects

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Frankly Speaking About Lung Cancer
Examples of Lung Cancer Targeted Therapy in
Development

• Epidermal Growth Factor Receptors
• Angiogenesis
• Antisense
• Protein Kinase C
• C-kit

• PDGF-r
• Cox-2
• Ras inhibitors
• Raf inhibitors
• Map kinase
• Others

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Frankly Speaking About Lung Cancer

• Epidermal Growth Factor Receptors
• Iressa (AstraZeneca)
• Tarceva (Genentech)
• Erbitux (Imclone, BMS)
• Many others in development

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Frankly Speaking About Lung Cancer

• Angiogenesis Inhibitors
• Angioblood vessel, Genesisformation or
  beginning
• Many agents being tested to inhibit this process
• Anti-VEGF
• Thalidomide
• Angiostatin/Endostatin
• Anti-VEGF tyrosine kinase inhibitors
• Others

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Frankly Speaking About Lung Cancer

• Antisense Drugs
• Affinitac (Lilly)
• Antisense drug to protein kinase C
• Phase II studies completed combining with
  chemotherapy
• Evaluating effectiveness in recurrent lung cancer
• Phase III trials underway comparing chemotherapy
  drug

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Frankly Speaking About Lung Cancer

• What You Need to
• Know About Lung Cancer
• Its Treatment
• Questions and Discussion

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Frankly Speaking About Lung Cancer

• PATIENT ACTIVE BREAK

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Frankly Speaking About Lung Cancer

• Issues to Discuss With Your Doctor When Making
  Decisions About Lung Cancer Treatment
• A Patient Active Approach

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Frankly Speaking About Lung Cancer

• Making decisions about cancer treatment is a
  complex and sometimes overwhelming experience.
• You have choices. But you need to be informed
  you need to evaluate many aspects of your care.

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Frankly Speaking About Lung Cancer

• What is the goal of my cancer therapy?
• Is it prolongation of life?
• Is to control symptoms?
• Is it palliation?

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Frankly Speaking About Lung Cancer

• What is a clinical trial and would one be a
  reasonable treatment option for me?
• What are the risks and benefits?

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Frankly Speaking About Lung Cancer

• Clinical Trial Definitions
• Phase I-new drug/treatment well-tested in the lab
  now testing toxicity in people
• Phase II-new drug/treatment has given good
  preliminary results-test feasibility
• Phase III-compares new drug/treatment vs standard
  of care

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Frankly Speaking About Lung Cancer

• What are the risks of treatment?
• What are the risks of no treatment?
• Should I seek a second opinion?

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Frankly Speaking About Lung Cancer

• Are there some treatments that have equal
  benefit, but fewer or different
• side effects?
• Can we discuss which side effects I would be most
  concerned about having or preventing?

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Frankly Speaking About Lung Cancer

• How do we balance my quality of life with my need
  for effective treatment?
• How will we know that the treatment is working?
• What can I expect to happen to me as the cancer
  progresses?

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Frankly Speaking About Lung Cancer

• Can I continue to work or maintain my other daily
  activities during treatment?
• If I have pain, what should I do?
• Nausea vomiting?
• Fatigue?
• Risk of infection?

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Frankly Speaking About Lung Cancer

• Why do some people who smoke get lung cancer
  while others dont?
• Why did I get lung cancer if I never smoked?

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Frankly Speaking About Lung Cancer

• What kind of supportive resources are available
  to me and my family?
• What can I expect from an emotional perspective?

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Frankly Speaking About Lung Cancer

• Questions to Ask Yourself
• What can I do to be a stronger partner with my
  physician health care team?
• What is my goal of therapy and have I expressed
  that to my physician?

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Frankly Speaking About Lung Cancer

• Am I ready and willing to participate fully and
  actively in my treatment plan?
• Do I know what the potential side effects of
  therapy are and how best to prevent or manage
  them?
• Have I communicated with my physician what
  quality of life means to me?

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Frankly Speaking About Lung Cancer

• How will I (and my family) address the emotional
  issues of living with lung cancer?
• Is a support group right for me (and/or my
  family)?

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Frankly Speaking About Lung Cancer

• Making decisions about lung cancer and its
  treatment is never easy.
• By being informed partnering with your
  physician health care team, you can improve the
  quality of your life and may enhance the
  possibility of your recovery.

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Frankly Speaking About Lung Cancer

• Making Decisions About Lung Cancer Treatment
• Questions and Discussion