HOLLYWOOD, Fla., March 9 (UPI) -- Doctors from the nation's top hospitals added expensive molecular agents to guidelines aimed at treatment of patients with advanced lung cancer.
The long-term goal, experts say, is to eventually make cancer a chronic, but manageable disease on the order of a condition like diabetes.
"We made a number of changes in the guidelines for lung cancer," David Ettinger, professor of oncology and medicine at Johns Hopkins University School of Medicine in Baltimore, Md., "but the most important change involved adding bevacizumab (Avastin) and erlotinib (Tarceva)."
The drugs, know as targeted agents, attack specific processes of the cancer cell inhibiting growth of the malignancies. Although use of neither drug offers patients a cure, they do prolong survival, Ettinger told United Press International.
"A few years ago, the idea that we could have a two-year survival for patients with Stage 4 non-small cell lung cancer was not in the picture," Ettinger said Thursday at the 11th annual conference of the National Comprehensive Cancer Network in Hollywood, Florida. "But now we are seeing that 22 percent of these patients are surviving two years and longer."
Overall, said Mark Kris, chief of the thoracic oncology service at Memorial Sloan-Kettering Cancer Center in New York, the use of the targeted therapies extend overall survival about four months over treatments that don't include the small molecule drugs.
While four months may not seem clinically significant, Ettinger said that the difference continues to push survival further along in the right direction. "I can see the time that we will be able to treat advanced lung cancer much the way we treat people with diabetes - as a chronic disease," he said.
The NCCN, a consortium of 19 major cancer hospitals, including both Johns Hopkins and Memorial Sloan-Kettering, had been writing algorithm for treatment of virtually all known forms of cancer since 1996. The guidelines are now used as a standard-of-care in government demonstration projects and have gained national and international acceptance.
In updating the guidelines for lung cancer, Ettinger slated use of Avastin as a first-line treatment for patients with an acceptable performance status - that is, they were otherwise in good physical condition. Avastin should be used with standard chemotherapy for lung cancer, according to the guidelines.
Tarceva is slotted in the guidelines as one of three choices for second-line therapy and for third-line treatment if not used as a second line treatment. Second and third-line treatments are used if first-line therapy fails to control the disease.
Kris noted that while Avastin therapy appears to extend survival, it is not without side effects, some of which can prove fatal in some patients.
He also said that while the guidelines are not specific on long-term use of Tarceva, most doctors continue to deliver the drug as long as patients do not appear to have disease progression.
Ettinger said that oversight in how long patients should be treated would likely be addressed in the 2007 update in the guidelines.
