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Dr. Jared Weiss is an Associate Professor of Clinical Research for Hematology/Oncology at the University of North Carolina School of Medicine in Chapel Hill, NC. He completed fellowship in Hematology and Oncology at the University of Pennsylvania and residency in Internal Medicine at Beth Israel Deaconess Medical Center in Boston, MA. He received his Doctor of Medicine at Yale University School of Medicine in New Haven, CT and his B.S. in neuroscience at Brown University, in Providence, RI.

New Year, New Stats
Mon, 01/11/2010 - 05:38
Jared Weiss, MD, Associate Professor Clinical Research Hematology/Oncology

Happy new year, GRACErs! The change in the calendar brings out contemplation. Most of the year, the gym in my building is quiet and hardly used so I can calmly read my journals on the exercise bike. The exercise hopefully compensates for my otherwise sedentary, nerdy lifestyle and I find that I do good thinking there. Now, after the new year, as in every year, the gym has been briefly very busy. During an otherwise not so impressive workout, I read an article that I think may be of interest to some in this community. The Journal of Clinical Oncology rang in the new year with a review of our advances and failures entitled: “Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, And Screening—A Report From the American Society of Clinical Oncology”. The statistics are a bit depressing so for those who prefer to avoid these numbers, please stop reading. I promise not to be offended and will write more stuff without stats for you. For those who find these statistics interesting and useful for advocacy, feel free to read on.

The first table in the JCO article looked at cancer incidence and mortality in 2009. Select cancers (lung, the next four biggest killers, and head and neck tumors included for comparison) are shown below.

table-of-cancer-incidence-and-death-rates-2010(click on table to enlarge)

Lung cancer causes more death than any other cancer. If you add up the next four killers, colon, breast, pancreas and prostate, you get to 153,130 deaths, still less than lung cancer.

Five year survival rates improved dramatically for certain cancers, but little for lung and head/neck cancer (really consider skipping this chart if you’re bothered by depressing stats). I’ve included a few select other cancers for comparison, including a few of the most improved. five-year-cancer-survivals-over-time As you can see, for all comers, we’ve made advances over the years—better surveillance, better imaging, better surgery, better radiation and better chemotherapy have improved overall outcomes over the past several decades. For five year survival, much of the advance is confined to a few cancers. However, five year survival in lung, unlike more indolent cancers, mostly reflects cure; while we may not be curing much more lung cancer than we were, we have made real gains in survival for metastatic disease that is not be reflected in these statistics. Textbooks still quote 8-9 month survival with best chemotherapy, yet the newest trials reach the 13-15 month mark and there are numerous approaches in development that seek to push these numbers further. The first table addressed number of new cases and number of deaths and the second table addressed 5 year survival once a patient already has cancer. Another revealing way to look at these statistics is to look at deaths per population—in this analysis, a cancer only counts when it causes death. Age-adjusted cancer death rates by site in the US from 1930 to 2005 are shown below. death-rates-by-ca If this were a New Year’s Eve party, the thoracic oncologists in attendance might be more inclined towards a shot of vodka than a glass of champagne. Nonetheless, there are real reasons for celebration and optimism and the authors found something legitimate to toast for every cancer. The first two lung cancer items were noted as “major advances” and the third as a “notable advance.” Each of these advances have been covered extensively on GRACE as they were announced. Maintenance pemetrexed therapy improves survival for certain subtypes of advanced NSCLC · NCCN Guidelines for NSCLC Now Include Reference to Maintenance Therapy · Debating maintenance therapy for advanced NSCLC: Not accepted as the standard of care · Maintenance by any other name is still as sweet Tumor mutation status predicts response to therapy · Moving to Molecular Defined Lung Cancer Treatment: The IPASS Trial · Iressa vs. Standard Chemo in Asian Never- or Light Ex-Smokers: Results of the IPASS Trial Translocations of the EML4-ALK gene predict treatment response to an oral receptor kinase inhibitor targeting ALK · Like Gleevec for Lung Cancer: A Novel Treatment for EML4-ALK Lung Cancer · The EML4-ALK Mutation Enters the Lung Cancer Clinic Personally, I think that the EML4-ALK story is one of the most promising developments in lung cancer ever. Although only about 4% of lung cancer patients have this mutation, the development of the Pfizer compound happened through an advance in understanding mechanisms of disease and the drug’s development from advance in basic science to phase III trial was incredibly fast. While the overall number of patients affected may be small, the benefit to these patients seems like it will be huge and the story gives me hope for future drug development. I’m done thinking about the last three decades. I think that it’s useful to understand where we are and we’re we’ve been. For me, these statistics are useful in advocacy and motivate me to work harder on research. And on that note, I’m moving on to my next project of the day--continuing work on a grant proposal and protocol for a trial for extensive-stage small cell lung cancer patients.

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