Lung Cancer – Should it be Treated?

One of the hot topics at the annual Medical Oncology Group and Faculty of Radiation Oncology Group meeting was lung cancer.

In the Barossa Valley, the annual cancer specialist meeting took place at the Novotel resort. This meeting included some of the nation’s top chemotherapy specialists and radiotherapy specialists, and featured highlights from a number of international experts in their fields.

Of the four main types of lung cancer, it has long been thought that the three commonest types have not been sensitive to chemotherapy. This negative attitude towards treatment was seen as being outdated. It was acknowledged by many of the doctors present that therapeutic nihilism is a very real obstacle that has to be overcome.

There is a significant challenge to get the message to doctors from outside the oncology field that there have been many rapid advances in treatment of a number of different cancers. The general public are likewise poorly informed of the latest advances in cancer care.

In the conference session on elderly people with lung cancer, the evidence was assessed for the activity of different chemotherapy drugs used alone and in combination.

Does chemotherapy work metastatic lung cancer?
One of the more aggressive types of lung cancer, small cell lung cancer, as always been known to respond well to chemotherapy and radiotherapy. Some doctors have had a very negative view about how well the other forms of lung cancer respond to chemotherapy. Over the last few years, there have been considerable advances in the development of new treatments against this disease. The general conclusion from the conference, was that this attitude is now outdated – i.e. that non – small cell lung cancer (the other types of lung cancer apart from small cell lung cancer) does respond to treatment with chemotherapy and this is a very worthwhile treatment modality.

Chemotherapy versus best supportive care.

The evidence from a number of trials in metastatic lung cancer was reviewed. Those patients treated with chemotherapy, in general, had a 10% improvement in one year survival and a 50% increase in average survival time compared to those patients who did not have treatment. In the ‘Big Lung Trial’, twice as many people survived two years in the group that had treatment compared to the group that had no treatment.

Most importantly, there was no difference in quality of life. What this means is that having chemotherapy did not produce a deterioration in overall quality of life i.e. there was an improvement in survival without quality of life penalty.

What about side-effects?

Many patients worry about side-effects on treatment and ask about the relative benefits of treatment compared to side-effects. The ELVIS trial looked at treatment with a well-tolerated single agent (i.e. single drug treatment). This trial showed that the chemotherapy drug produced an improvement in patients’ pain levels and shortness of breath. This illustrates that having treatment can produce a positive benefit. Some minor side-effects were reported, including constipation and some nausea. Both of these side-effects were easy to control with conventional constipation and nausea treatment.