Download Lung Cancer Fact Sheet

Lung Cancer
Fact Sheet
Lung cancer, a cancer that forms in tissues of the lung, usually in the cells lining air passages,1 has
traditionally been classified into two major types: non-small cell lung cancer (NSCLC) and small cell lung
cancer (SCLC).1 About 85 percent of all lung cancers are identified as non-small cell, and approximately 75
percent of these are metastatic, or advanced, at diagnosis. 2 NSCLC can be further categorized into distinct
subsets that are classified by a number of factors, including histology and the molecular makeup of the tumor.
Facts and Figures
 Worldwide in 2012, an estimated 1.8 million new cases of lung cancer were expected to be diagnosed,3
accounting for approximately 13 percent of total cancer diagnoses. 4 In the United States, an estimated
221,200 new cases of lung cancer are expected to be diagnosed in 2015, accounting for approximately 13
percent of total cancer diagnoses.5
 Lung cancer is the leading cause of cancer death worldwide 6 with an estimated 1.6 million deaths each
year.3 An estimated 158,040 deaths from lung cancer are expected to occur in the U.S. in 2015,
accounting for about 27 percent of all cancer deaths.5
 Globally, lung cancer is the most common cause of cancer-related deaths in men and the second most
common in women.7 More people die of lung cancer in the U.S. than of colon, breast and prostate cancers
combined.5
 Since 1987, more women in the U.S. have died each year from lung cancer than from breast cancer. 5
Risk Factors
 Lung cancer affects a diverse group of people, including the young and non-smokers.
 Some lung cancer risk factors may include:8
o Smoking cigarettes or cigars
o Exposure to second-hand smoke, asbestos, radon, chromium, arsenic, soot or tar
o Treatment with radiation therapy to the breast or chest
o Personal or family history of the disease
 Historically, smoking was seen as the major risk factor in developing lung cancer. While smoking is a
significant factor, about 10 to 15 percent of lung cancers in the U.S. are unrelated to smoking.9
 Most lung cancers do not cause any symptoms until the disease has already reached an advanced stage.
Even when symptoms do appear, they are often mistaken for other health problems.
Non-Small Cell Lung Cancer
 NSCLC is a disease in which malignant cells form in the tissues of the lung. NSCLC is a difficult disease to
treat, particularly in the metastatic or advanced setting (Stage IIIB/IV). In these patients, the five-year
survival rate is only 5 percent.7
 Historically, NSCLC has been categorized by histology to include adenocarcinoma, squamous cell
carcinoma and large cell carcinoma. 7
o Adenocarcinoma, which accounts for about 40 percent of NSCLC cases, is usually found in the
outer region of the lung.7
o Squamous cell carcinoma, which accounts for about 25 to 30 percent of all NSCLC cases, tends to
be located in the middle of the lungs, and is more often linked to a history of smoking. 7
o Large cell carcinoma, which accounts for about 10 to 15 percent of NSCLC cases, may appear in
any part of the lung and tends to grow and spread quickly. 7
 Previously thought of as one disease, doctors now understand that there are different types of lung cancer,
which can be driven by different biomarker profiles. Biomarker testing, which is usually determined by
testing tumor samples, can help doctors diagnose patients more accurately and guide their treatment
decisions.
 The National Comprehensive Cancer Network (NCCN) Guidelines® recommend (category 1) that
metastatic NSCLC that is determined by histology to be adenocarcinoma or not otherwise specified (NOS)
undergo biomarker testing for EGFR mutations and ALK gene rearrangements.*
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NCCN Guidelines also recommend consideration of EGFR and ALK testing in patients with squamous cell
carcinoma, especially in patients who have never smoked, when small biopsy specimens were used to
assess histology, or in mixed-histology tumors.10
EGFR mutations occur in 10 to 20 percent of NSCLC tumors11 and as high as 60 percent in NSCLC
tumors in Asian populations.12
Epidemiology studies suggest that approximately 3 to 5 percent of NSCLC tumors are ALK-positive.13
Pfizer supports testing for all clinically relevant biomarkers during treatment planning, as testing is
increasingly important to patients with metastatic NSCLC and will help guide treatment decisions that may
lead to improved patient care.
o In April 2013, an evidence based guideline issued by the College of American Pathologists (CAP),
International Association for the Study of Lung Cancer (IASLC) and Association for Molecular
Pathology (AMP) emphasized the importance of routine molecular testing in metastatic NSCLC
adenocarcinoma diagnosis and treatment.
o According to the guideline, doctors should order EGFR mutation and ALK rearrangement testing at
the time of adenocarcinoma diagnosis for patients who present with metastatic NSCLC, regardless
of their clinical history.14
NSCLC Treatment
Current treatment options for NSCLC include surgery, radiofrequency ablation, radiation therapy,
chemotherapy, biomarker-driven therapy and immunotherapy. In some cases, more than one kind of treatment
is used.7
 With the identification and increased understanding of molecular abnormalities in lung cancer, research
efforts have focused on identifying biomarker targets and using this knowledge to develop biomarkerdriven therapies and guide treatment decisions.2,12 At the same time, the oncology community is continuing
to better understand how tumor histology plays a role in treatment outcomes and how each of these
factors must be considered in order to choose the most appropriate therapy for each individual.
 Targets currently being used or investigated in the treatment of NSCLC include the human epidermal
growth factor (HER) family of receptors, EGFR, ERCC1, KRAS, ALK, BRAF, PI3KA, IGF-1R, c-MET,
ROS-1 and RET.15,16,17,18,19,20,21
* Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
1
National Cancer Institute at the National Institute of Health website. Lung Cancer. 2009. http://www.cancer.gov/cancertopics/types/lung.
Accessed March 25, 2015.
2
Reade CA, Ganti AK. EGFR targeted therapy in non-small cell lung cancer: potential role of cetuximab. Biologics. 2009; 3: 215–224.
3
World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence,
Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. (Select Lung from drop down
menu). Accessed March 25, 2015.
4
World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence,
Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. (Select All Cancers from drop down
menu). Accessed March 25, 2015.
5
American Cancer Society website. Cancer Facts and Figures 2015. Available at:
http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf. Accessed on March 27, 2015.
6
World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2008: Estimated Cancer Incidence,
Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx (select ‘World’ from the drop
down menu under ‘Fact Sheets’). Accessed March 25, 2015.
7
American Cancer Society website. Global Cancer Facts and Figures 2011. Available at:
http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf
8
American Cancer Society website. Detailed Guide: Lung Cancer (Non-Small Cell).
http://www.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf. Accessed March 31, 2015.
9
Samet, J, Avila-Tang, E, Boffetta, A, et al. Lung Cancer in Never Smokers: Clinical Epidemiology and Environmental Risk
Factors. Clinical Cancer Research. 2009; 15: 5626.
10
National Comprehensive Cancer Network website. NCCN Clinical Practice Guidelines in Oncology: Lung Cancer Screening Version
1.2013. http://www.nccn.org/professionals/physician_gls/pdf/lung_screening.pdf Accessed August 7, 2013.
11
Pao W, Miller VA. Epidermal growth factor receptor mutations, small-molecule kinase inhibitors, and non-small-cell lung cancer: current
knowledge and future directions. J Clin Onc. 2005; 23:2556-2568.
12
Mok T, Thongprasert S, Yang C, et al. Gefitinib or Carboplatin–Paclitaxel in Pulmonary Adenocarcinoma. N Engl J Med, 2009; 361:947957.
13
Garber K. ALK, lung cancer, and personalized therapy: portent of the future? J Natl Cancer Inst. 2010; 102:672-675.
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May 2015
14
Association for Molecular Pathologists website. Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK
Tyrosine Kinase Inhibitors. Lung Biomarker Guideline Released April 2013 by CAP, IASLC, and AMP.
http://www.amp.org/committees/clinical_practice/LungBiomarkerGuideline.cfm. Accessed March 25, 2015.
15
Janku F et al. Targeted therapy in non-small-cell lung cancer- is it becoming a reality? Nature Reviews Clinical Oncology. 2010; 7:401414.
16
Vilmar, A, Santoni-Rugiu, E, Sorensen J. ERCC1 and histopathology in advanced NSCLC patients randomized in a large multicenter
phase III trial. Annals of Oncology. 2010; 21:1817 – 824.
17
Eberhard, DA, Johnson, BE, Amler, L, et al. Mutations in the Epidermal Growth Factor Receptor and in KRAS Are Predictive and
Prognostic Indicators in Patients With Non–Small-Cell Lung Cancer Treated With Chemotherapy Alone and in Combination With
Erlotinib. Journal of Clinical Oncology. 2005; 23:5900 – 5909.
18
Marchetti A, Felicioni L, Malatesta, S, et al. Clinical Features and Outcome of Patients With Non–Small-Cell Lung Cancer Harboring
BRAF Mutations. Journal of Clinical Oncology. 2011; 29:3574 – 3579.
19
Metastatic Non-Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances. Hematology & Oncology Journal
Online. http://www.hematologyandoncology.net/index.php/archives/april-2012/metastatic-non-small-cell-lung-cancer-managementnovel-targets-and-recent-clinical-advances/# Accessed August 7, 2013.
20
Dziadziuszko R, Camidge D, Hirsch F. The Insulin-Like Growth Factor Pathway in Lung Cancer. Journal of Thoracic Oncology. 2008;
3:815 – 818.
21
Bergethon K, Shaw A, Ou S, et al. ROS1 Rearrangements Define a Unique Molecular Class of Lung Cancers. J Clin Oncol.
2012;30:863-870.
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