Frankly Speaking About Lung Cancer

2. 2

3. 3 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.”

4. 4 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

5. 5 The Wellness Community Programs Weekly patient support groups Weekly family support groups Diagnosis specific networking groups Bereavement groups Educational programs Nutritional education Stress reduction programs (Tai Chi, Yoga, etc.) Exercise programs Children’s programs Resource library Social activities

6. 6 Frankly Speaking About Lung Cancer “What You Need to Know About Lung Cancer & Its Treatment”

7. 7 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.

8. 8 Frankly Speaking About Lung Cancer Risk Factors: Smoking (90% of all cases) Second-hand smoke (25% of non-smoker cases) Occupational/environmental

9. 9 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

10. 10 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

11. 11 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)

12. 12 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)

13. 13 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

14. 14 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

15. 15 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

16. 16 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

17. 17 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 1990’s Chemotherapy + radiation is the new standard based on results of clinical trials Newer radiation techniques minimize side effects of treatment

18. 18 Frankly Speaking About Lung Cancer

19. 19 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

20. 20 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

21. 21 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)

22. 22 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

23. 23 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 Patient’s goals and wishes

24. 24 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

25. 25 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

26. 26 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

27. 27 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

28. 28 Frankly Speaking About Lung Cancer Epidermal Growth Factor Receptors Angiogenesis Antisense Protein Kinase C C-kit PDGF-r Cox-2 Ras inhibitors Raf inhibitors Map kinase Others

29. 29 Frankly Speaking About Lung Cancer Epidermal Growth Factor Receptors Iressa (AstraZeneca) Tarceva (Genentech) Erbitux (Imclone, BMS) Many others in development

30. 30 Frankly Speaking About Lung Cancer Angiogenesis Inhibitors “Angio”=blood vessel, “Genesis”=formation or beginning Many agents being tested to inhibit this process: Anti-VEGF Thalidomide Angiostatin/Endostatin Anti-VEGF tyrosine kinase inhibitors Others

31. 31 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

32. 32 Frankly Speaking About Lung Cancer “What You Need to Know About Lung Cancer & Its Treatment” Questions and Discussion

33. 33 Frankly Speaking About Lung Cancer PATIENT ACTIVE BREAK

34. 34 Frankly Speaking About Lung Cancer “Issues to Discuss With Your Doctor When Making Decisions About Lung Cancer Treatment: A Patient Active Approach”

35. 35 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.

36. 36 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?

37. 37 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?

38. 38 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

39. 39 Frankly Speaking About Lung Cancer What are the risks of treatment? What are the risks of no treatment? Should I seek a second opinion?

40. 40 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?

41. 41 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?

42. 42 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?

43. 43 Frankly Speaking About Lung Cancer Why do some people who smoke get lung cancer while others don’t? Why did I get lung cancer if I never smoked?

44. 44 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?

45. 45 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?

46. 46 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?

47. 47 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)?

48. 48 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.

49. 49 Frankly Speaking About Lung Cancer Making Decisions About Lung Cancer Treatment Questions and Discussion