10 issues to consider during National Lung Cancer Awareness Month

Accounting for more annual deaths than colon, breast and prostate cancers combined in the United States, lung cancer is the leading cause of cancer-related deaths in both men and women. More than 200,000 cases of lung cancer are diagnosed each year, and according to the American Cancer Society, over 150,000 patients will die from this disease – an estimated 28% of all cancer deaths this year.

With the month of November designated as National Lung Cancer Awareness Month, HemOnc Today highlights 10 issues for oncologists to consider for their patients, as well as the new guideline revisions and research regarding the identification, treatment and management of patients with lung cancer.

1. CMS supports Medicare coverage of lung cancer screening

The CMS issued draft guidance that supports Medicare coverage of annual lung cancer screening with low-dose CT for individuals who meet specific criteria.

The guidance applies to individuals aged 55 to 74 years who are asymptomatic for lung cancer, have at least a 30 pack-year smoking history, either currently smoke or have quit in the past 15 years, and receive a written order from a physician or qualified non-physician practitioner. Read more

2. Lung cancer screening would cost $81,000 per quality-adjusted life-year gained

The cost-effectiveness of lung cancer screening with low-dose CT — estimated to cost $81,000 for each quality-adjusted life-year gained — is highly variable based on patient characteristics and how screening is implemented, according to a cost analysis of the National Lung Screening Trial.

Screening with low-dose CT was associated with a 20% (95% CI, 6.8-26.7) reduction in lung cancer mortality in the National Lung Screening Trial. However, the cost-effectiveness of screening has been a matter of debate, particularly as CMS considers whether to cover low-dose CT screening among at-risk Medicare beneficiaries. Read more

3. Lung cancer clinical trials routinely exclude cancer survivors

Many patients are automatically excluded from lung cancer clinical trials due to previous cancer, according to findings.

Additionally, this criterion appears to be used in trials with a variety of characteristics, including more than two-thirds of trials with non-survival endpoints, the researchers wrote. Read more

4. Longer course of first-line therapy provided no survival benefit in NSCLC

Patients with advanced non–small cell lung cancer treated with six cycles of platinum-based therapy demonstrated no survival advantage compared with those who underwent three or four cycles of therapy, according to results of a systematic review and meta-analysis. Read more

5. Medicare reimbursement policy failed to significantly reduce chemotherapy cost

The Medicare Prescription Drug, Improvement and Modernization Act of 2003, intended to slow the skyrocketing costs of drugs the federal government must pay for to treat Medicare patients, does not appear to have significantly affected the cost of chemotherapy.

“Economists expected a sharp decline in the use of the most expensive drugs targeted by the law, because reimbursement to oncologists for these drugs was reduced, but that did not happen,” Mark C. Hornbrook, PhD, of Kaiser Permanente Northwest, said. Read more

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6. ASCO: Offer EGFR, ALK testing to all patients with lung adenocarcinoma

ASCO endorsed a joint clinical practice guideline from three other entities that addresses questions about the appropriate use of EGFR-mutation and ALK-rearrangement testing in patients with lung cancer.

A key recommendation from the guideline — developed by the College of American Pathologists, the International Association for the Study of Lung Cancer and the Association for Molecular Pathology — states that clinicians should offer EGFR and ALK testing to all patients with lung adenocarcinoma, as well as those with mixed lung cancer with an adenocarcinoma component. Read more

7. Targeted treatments for lung cancer likely to drive field forward

WASHINGTON — Recent progress in the use of genomics to treat lung cancer is likely to advance the field of cancer treatment, according to Mark G. Kris, MD, the Ruane Chair in Thoracic Oncology at Memorial Sloan Kettering Cancer Center.

“It’s not one-size fits all anymore,” Kris said during his presentation at the U.S. News & World Report’s Hospital of Tomorrow Forum. “The difference is, we now have a better knowledge of biology, and an ability to test for these concepts that we’ve discovered; and we have these targeted therapies.” Read more

9. E-cigarettes unhelpful for smoking cessation among patients with cancer

A study of patients with cancer who smoke showed those who used electronic cigarettes were more nicotine-dependent than nonusers.

Those who used e-cigarettes also were equally or less likely to have quit smoking traditional cigarettes than nonusers. Read more

9. Physician tumor board participation linked to clinical trial enrollment

Patients with lung or colorectal cancers whose physicians attended weekly multidisciplinary tumor board meetings were more likely to enroll in clinical trials, according to study results presented at the ASCO Quality Care Symposium. Read more

10. Two novel mutations linked to ALK inhibitor resistance in NSCLC

Two novel ALK mutations, V1180L and I1171T, were associated with resistance to crizotinib and alectinib but were sensitive to other next-generation ALK tyrosine kinase inhibitors for non–small-cell lung cancer, according to study results. Read more