GRACE :: Lung Cancer

Search cancerGRACE.org

adenocarcinoma

GRACE Video

Histology-Specific Regimens – Adenocarcinoma

Share
GRACE Cancer Video Library - Lung

GCVL_LU-F05_Histology_Specific_Regimens_Adenocarcinoma

 

Dr. Jack West, Swedish Cancer Institute, addresses the issue of choosing a first-line chemotherapy regimen based on an adenocarcinoma histology.

Download Transcript

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.

 

Transcript

There are several different subtypes of non-small cell lung cancer and these are broken down by what is called histology — how they appear under the microscope. The most common subtype of non-small cell lung cancer is known as adenocarcinoma and there may be specific recommendations about what chemotherapy to recommend for patients with an adenocarcinoma.

In general, we favor a two-drug so-called platinum-based doublet for the vast majority of patients with an advanced or stage IV lung cancer, but the exact chemotherapy combination we might favor can differ depending on whether a patient has one subtype, one histology, or another. So for patients with a lung adenocarcinoma it’s fair to say that any of the chemotherapy doublets widely used is an acceptable choice — cisplatin or carboplatin with a taxane such as Taxol, also known as paclitaxel, or docetaxel which is also known as Taxotere, you could consider Gemzar, also known as gemcitabine, but one that is often favored is called Alimta, or pemetrexed.

Why is that? Well, there was a study that was published years ago that looked at the combination of cisplatin and gemcitabine, or Gemzar, versus cisplatin and Alimta, and there were no major differences between the large groups of patients overall, but when they looked specifically at the subgroups based on whether they had a squamous or a non-squamous cancer, the patients who had a squamous cancer did better with cisplatin and gemcitabine, and the opposite was true for the patients with a non-squamous cancer — those patients did particularly well with cisplatin and Alimta. Since then there have been several other studies that have shown particularly favorable results with Alimta in patients with adenocarcinoma histology.

It’s fair to say that there are not great differences, but the tendency toward a more favorable efficacy in patients with adenocarcinoma and the good tolerability, lead many lung cancer specialists and general oncologists alike, to favor a combination of a platinum drug with Alimta for patients with a non-squamous, and especially, an adenocarcinoma histology.


GRACE Video

ALK Rearrangements: What Are They, and Who Has Them?

Share
GRACE Cancer Video Library - Lung

GCVL_LU-BA02_ALK_Rearrangements_What_Who

 

Dr. Ross Camidge, University of Colorado, describes ALK rearrangements and the characteristics of patients who most often have them.

[]

Download Transcript

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.

 

Transcript

ALK stands for anaplastic lymphoma kinase. This is a gene which is involved in the development when we’re a little tiny embryo, and then it gets turned off when we become an adult. As an embryo, it’s involved in the development of the gut and the nervous system and a few other things. It’s silenced in most adult tissues, but it can be turned on again by what’s called a gene rearrangement. What that means is it brings in the front part of another gene which drives the expression of the previously silenced ALK, then it actually functions as something so powerful that it can actually turn a normal cell into a cancer cell.

The absolute frequency is running somewhere between 3% and 7% of lung cancer. The people who tend to have these more often tend to be people with a kind of lung cancer called adenocarcinoma of the lung — that’s what it looks like in the microscope, comes from glandular tissue. It tends to be more common in never smokers, it’s slightly more common in people who are younger than the average age of people who develop lung cancer, maybe a decade or so.

You also need to understand that all of these factors which are associated with it are not exclusive. So you can be older, you can have a history of smoking, you can have non-adenocarcinoma and still have an ALK rearrangement that may respond very well to an ALK inhibitor. So you have to understand the difference between an enrichment factor, and an absolute — “you should never test”, or “always test.” For me, I test everybody unless they have a 0% chance, and that’s a very small group that has a 0% chance. Essentially I test everybody with non-small cell lung cancer.


GRACE Video

How Rate of Progression Can Affect Treatment Decisions

Share
GRACE Cancer Video Library - Lung

GCVL_LU-F03_Progression_Rate_Affect_Treatment_Decisions

 

Dr. Benjamin Levy, Mount Sinai Health Systems, explains how the rate of progression of a patient’s cancer may affect treatment choices.

Download Transcript

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.

 

Transcript

I think we know a lot now about how to treat patients with advanced stage lung cancer, and there are several things that we factor in when we treat patients. One is clearly the genetic makeup of their tumor — we tend to look at this when we’re trying to decide on a targeted drug for these patients. The other is perhaps histology, looking at a particular type of lung cancer whether it be adenocarcinoma or squamous cell, and deciding what type of chemotherapy we’re going to give. One that I would also like to mention that’s sometimes factored into treatment decisions is the variability of the aggressiveness of the tumor, meaning that some lung cancers can be very aggressive, and despite popular belief, some can be quite indolent.

Now while most lung cancers are thought to be more aggressive, I have come across many patients with lung cancers that tend to grow less rapidly, and the thought is: how do we factor this in when we’re making treatment decisions? I think the variability of progression plays out in two clinical scenarios.

One is a patient who is on chemotherapy or even on a targeted drug who’s doing well and tolerating the drug, and in which we are ordering scans every six to twelve weeks and we’re seeing that the tumor is growing but at a very limited pace, and the question is: if the patient is tolerating the chemotherapy or the targeted drug, should that limited pace of growth trigger a treatment change? I would say in our practice, not necessarily. Sometimes if growth is small, or growth is limited, or the pace is limited, sometimes we will keep patients on that particular therapy. My thought is they’re probably deriving some sort of benefit from that therapy if they’re tolerating it.

I think the other scenario where this plays out is for a patient who perhaps hasn’t been tolerating therapy and is on a treatment break. Sometimes not all patients tolerate chemotherapy and may need a treatment break, particularly when they get to maintenance, and the question becomes: if the cancer is growing on scans while they’re on a treatment break, should you reinstitute the drug or even reinstitute another drug? Again, I think that depends on how quickly things are moving along — for patients who may have not tolerated treatment well who are on a treatment break and their cancer is growing very, very slowly, I think it’s reasonable to continue to watch them as long as they understand that the cancer may grow rapidly at some point.

So I think these are important considerations when you’re treating a patient, not only to look at the genetic alterations in the tumor, not only to look at histology, but also to consider the natural evolution of this cancer and how it’s moving, and how quickly it’s growing when making treatment decisions.


GRACE Video

Platinum-Based Doublets As the Cornerstone of First Line Treatment

Share
GRACE Cancer Video Library - Lung

GCVL_LU-F02_Platinum_Doublets_First_Line_Treatment

 

Dr. Benjamin Levy, Mount Sinai Health Systems, discusses platinum-based chemotherapy as the standard of care for advanced NSCLC patients without targetable genetic mutations.

Download Transcript

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.

 

Transcript

I’m going to be talking about the role of platinum chemotherapy for patients with advanced stage non-small cell lung cancer. No doubt, there have been significant advances in the past ten years with the development of targeted drugs for those patients who have a particular genetic makeup of their tumor. Many of these drugs have shown to be quite effective for those patients that are susceptible to such treatments. I think what we know though is unfortunately many patients will not have the genetic alterations that make them eligible for targeted treatments, and we have to default to chemotherapy.

I think ‘default’ is a bit of a misnomer because platinum chemotherapy or platinum doublet chemotherapy remains a standard of care for patients with advanced stage lung cancer who don’t harbor particular genetic alterations in their lung cancer and that’s okay. I think what we know about chemotherapy, platinum chemotherapy specifically, is that this type of approach improves survival for patients and it also can have the potential to improve quality of life as well as control symptoms as they relate to the lung cancer. So all three of those measures can be achieved with platinum chemotherapy.

Now chemotherapy comes in a variety of different shapes and sizes — the chemotherapy that we tend to use sometimes is called histology-directed chemotherapy, so patients with a particular type of lung cancer called adenocarcinoma may get one type of platinum chemotherapy, whereas patients with a particular type of lung cancer called squamous cell may get a different type of chemotherapy.

I just want to speak briefly about maintenance chemotherapy for adenocarcinoma patients. This is the most common type of lung cancer we see, and again for those patients that don’t harbor genetic alterations that make them eligible for targeted drugs, we can offer a very effective chemotherapy that’s also very tolerable and that can also be given as a maintenance strategy. What I mean by that is that patients generally get four cycles of chemotherapy and for those patients that at least achieve stable disease after their four cycles and are tolerating treatment, I think that we have good data now that we can drop the platinum and continue one of the drugs called pemetrexed and provide a survival advantage for those patients. There are certain maintenance strategies that are also being looked at in the squamous cell population and there are studies ongoing for that.

I think, in some, that the chemotherapies we have now work very well, they can extend life, they can improve quality of life and they’re well tolerated, and I also think specifically for the subset of patients that come in with adenocarcinoma or non-squamous, that there should be a consideration for patients who are tolerating chemotherapy to be offered a maintenance approach.


GRACE Video

Different Lung Cancer Subtypes – Histology

Share
GRACE Cancer Video Library - Lung

GCVL_LU-A07_Different_Lung_Cancer_Subtypes_Histology

 

Dr. Edward S. Kim from the Levine Cancer Institute in Charlotte, NC defines the concept of cancer histology and gives examples of several lung cancer subtypes.

Download Transcript

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.

 

Transcript

Now we’re talking about histology. When you’ve identified a nodule on a chest x-ray, or a CAT scan, or maybe there’s something in the liver — as you know,  lung cancer likes to leave its home base and go to other places — we get a biopsy, and that biopsy is going to help us two ways. One: it’s going to tell us what the origin of the tissue is, and two is: what subtype of that tumor is it? So, in the case of lung cancer, we try to first, identify whether it’s a non-small cell, or small cell lung cancer, and then within the non-small cell lung cancer grouping, which consists of about 85% of all of lung cancer, there are multiple different histology subtypes. That means a pathologist looks at it under a microscope — is looking at it like you would look at artwork on the wall, and trying to identify whether it’s an impressionist period, or it’s a different period of time — and that’s how they’re doing it.

Sometimes, they’ll run some basic tests that they can do in their pathology lab to help further classify one or the other histology subtypes. The most common subtype is adenocarcinoma — again, this is just the name of a non-small cell lung cancer subtype. There are also subtypes called squamous cell cancer, and then — again, those are the two major types, there are then a whole host of others. You will hear terminology such as: large cell carcinoma, neuroendocrine carcinoma, there’s even a classification called NOS, meaning not otherwise specified, and about 10-15% of the time, we can see this.

What does that mean? Well, it still means it’s a lung cancer, and it usually means it’s non-small cell lung cancer, but there is not enough tissue, or the architecture was not preserved enough during the biopsy procedure, that the pathologist can completely classify this tumor. That’s problematic, because now we have therapies that are specifically tailored for some patients who have adenocarcinoma, or squamous cell carcinoma. There are not as many therapies out there tailored for the large cell or neuroendocrine tumors. Again, these just represent different cell types that exist in the lung, and those are the ones that decide to grow and become misbehaving, and they evolve into a cancer, and that’s why they have their particular names.


Ask Us, Q&A
Lung/Thoracic Cancer Expert Content

Archives

Share

GRACE Cancer Video Library - Lung Cancer Videos

 

2015_Immunotherapy_Forum_Videos

 

2015 Acquired Resistance in Lung Cancer Patient Forum Videos

Share

Join the GRACE Faculty

Breast Cancer Blog
Pancreatic Cancer Blog
Kidney Cancer Blog
Bladder Cancer Blog
Head/Neck Cancer Blog
Share

Subscribe to the GRACEcast Podcast on iTunes

Share

Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon

Subscribe to
GRACE Notes
   (Free Newsletter)

Other Resources

Share

ClinicalTrials.gov


Biomedical Learning Institute

peerview_institute_logo_243