Lung cancer is the deadliest form of cancer, each year claiming more lives than breast, colon and prostate cancers combined. The National Cancer Institute (NCI) wants to change that.

The NCI recently announced an integrated effort to eliminate the suffering and death due to lung cancer by 2015. Implementation of this plan has three strategies:

1. Reducing the risk for lung cancer by achieving more effective tobacco control.
2. Improving the likelihood of a cure through earlier detection and treatment of lung cancer and pre-cancer.
3. Introduction of novel targeted therapies through cohesive partnerships with ongoing or planned biology initiatives.

This puts the responsibility on NCI designated comprehensive cancer centers like the Siteman Cancer Center to play a major role in this initiative. Community efforts such as the annual "Siteman Smokeout for Life" and continued efforts with smoking cessation classes have helped Siteman work on the first strategy. However the second and third strategies are actively being pursed in both clinical and research venues.

"We have made significant advances in treating lung cancer," says Ramaswamy Govindan, MD, oncologist at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. "For example, fifteen years ago we asked if it''s really worth treating patients with chemotherapy and today we use chemotherapy for patients with lung cancer regularly."

Advances in chemotherapy are only one example of Siteman''s work in improving cancer treatment as part of the NCI strategy. The latest research shows that a new generation of chemotherapy drugs improves the survival of patients by 15 percent. The number of patients that survive beyond five years is now 69 percent, compared to 54 percent before.

Dr. Govindan and his colleagues at the Siteman Cancer Center have played a major role in reducing lung cancer deaths. As a NCI Comprehensive Cancer Center – the only one within a 240-mile radius of St. Louis – Siteman researchers have had access to clinical trials not available at other cancer centers. In turn, those trials have led to FDA approval of drugs that have made therapy easier for patients.

"In the past we used chemotherapy drugs that killed both normal and abnormal cells, but right now the focus is more on how to turn off the bad genes and that is the basis of targeted chemotherapies," says Dr. Govindnan.

Targeted chemotherapies such as Iressa and Tarceba turn off cancer cells, essentially killing them. "I have patients who came in four and half years ago and there was no hope," says Dr. Govindan. "But thanks to these drugs they are still alive.

"The fact you could take a pill by mouth and you can slow down this horrible cancer – this thought was unthinkable some years back, but today it happens routinely," he says.

Dr. Govindan says the ultimate goal is to convert deadly cancers like lung cancer into chronic diseases like diabetes or high blood pressure. "We still have a long way to go, but I think it''s more a possibility now."

Adding to those possibilities is research led by Howard McLeod, PharmD, director of the pharmacology core at the Siteman Cancer Center and associate professor of medicine of genetics and molecular biology and pharmacology at the School of Medicine. He is pioneering a process of targeted therapy called pharmecogenetics that could revolutionize cancer treatment.

"We envision a world where a patient would come in with a cancer diagnosis and gets a series of tests that allow us to pick the right medicines for them," says Dr. McLeod.

He says doctors select chemotherapy for patients based on what works for a wide patient population, not necessarily what is best for the individual patient. However with pharmecogenetics, by looking at a patient''s DNA, doctors will be able to determine what course of therapy is best for that individual patient. That leads to not only shrinking the tumor, but also getting reducing or eliminating side effects.

"In the old days, pain and nausea were part of the course of treatment, but with modern therapy that''s not true," says Dr. McLeod. "We''re entering a world where someone not only knows their diagnosis, but also knows that based on their DNA there are certain medicines right for them as an individual."

"And all we have to do is obtain a simple blood test and send it to a central laboratory and determine the best course of therapy," says Dr. McLeod.

Over 70 colon cancer patients in clinical trials have been successfully treated using pharmecogenetics at the Siteman Cancer Center. Dr. McLeod says that success allows them to use those treatments for other diseases such as lung cancer.

"Having a comprehensive NCI designation allows us to push the envelope and make treatments better in the future," says Dr. McLeod. "It''s just one way we try to build a better future for the treatment of cancer."

That future is the present when it comes to radiation therapy. Overall, 75 percent of lung cancer patients eventually receive radiation. Radiation therapy is necessary when the cancer is not treatable with surgery or it may be used after surgery.

In the past radiation therapy was a difficult treatment for lung cancer patients. Treatments would burn surrounding tissue as well as the cancer itself, however stereotactic radiation therapy aims away from other organs and patients receive highly precise radiation therapy to the targeted tumor.

"The nice thing about stereotactic therapy is it''s not invasive and doesn''t require a needle or incision," says Jeff Bradley, MD, radiation oncologist at the Siteman Cancer Center.

This procedure is limited to a small patient population. "Most of these patients have other small peripheral lung lesions or cancers away from critical structures," says Dr. Bradley. "This provides a good option for patients who normally would have surgery but can''t for other reasons and provides an option to cure their lung cancer without surgery."

Currently around two patients a week are treated at Siteman with this course of therapy. "And the advent of high resolution CT imaging allows us to treat patients non-invasively with these stereotactic techniques," says Dr. Bradley.

High resolution CT scanning now allows radiologists to spot lung cancer and other lung lesions as small as a grain of rice, and that''s become the focus of a major study at the Siteman Cancer Center. The National Lung Screening Trial is a multi-center study with over 50,000 volunteers participating at more than 30 screening centers around the country. The study''s goal is to determine whether screening with low radiation dose CT results in fewer deaths from lung cancer than screening by chest x-ray in individuals with a heavy smoking history.

"We know that CT can reveal lung cancer at smaller sizes than with other methods currently available, says David Gierada, MD, radiologist at Mallinckrodt Institute of Radiology. "But we''re not sure whether this earlier detection will reduce deaths from lung cancer."

Oftentimes, lung CT scans may lead to management dilemmas as small lung lesions are found in many patients. Though few of such incidental lesions are cancerous, it is often impossible to tell for certain that a lesion is not cancer.

With over 90 percent of lung cancer caused by cigarette smoking, the best way to reduce deaths from lung cancer is relatively obvious.

"If we were to write reasons of why lung cancer was happening up on a chalkboard, smoking would take up the whole thing and the other factors would be in tiny type," says Alec Patterson, MD, chief of cardiothoracic surgery at Barnes-Jewish Hospital and Washington University School of Medicine.

While advances are being made in lung cancer treatment, doctors agree that "kicking the habit" should be at the top of any smoker''s agenda.

For more information about joining a smoking cessation class at the Siteman Cancer Center, call 800-600-3606.