Lung cancer: some progress, but still a lot more to do

In a report, State of Lung Cancer, released on Nov 12, the American Lung Association shows that 5-year survival for US patients with lung cancer has improved from a dismal 17·2% 10 years ago, to 21·7% now. This improvement is attributed to a combination of personalised, biomarker-driven treatment, screening of people at high risk and, therefore, diagnosis at earlier stages, and advancements in research and drug development. Yet progress is uneven by states and by populations. For example, the incidence is 27·1 per 100 000 people in Utah compared with 92·6 per 100 000 in Kentucky. Medicaid programmes are not required to cover lung cancer screening, which has been in place for high-risk populations in the USA since 2013. And the average national rate of screening is low, at 4·2%, in those eligible. The progress made in survival by using biomarker-targeted treatments over the past 5 years or so, although scientifically interesting, is still modest, and whether such expensive treatment will be widely available is questionable. For example, the CASPIAN trial in this week's issue reported an improved survival by 2·7 months when durvalumab was added to conventional chemotherapy in patients with extensive-stage small-cell lung cancer—admittedly, a group with poor prognosis and few options overall. Lung cancer remains the most common cancer (11·6% of all cancers) and the leading cause of cancer deaths, with over 1·7 million deaths worldwide in 2018. Most patients are diagnosed at an advanced stage. Tobacco use is still the most important risk factor, with other risk factors emerging, such as air pollution, which was declared to cause lung cancer by the International Agency for Research on Cancer in 2013. Cancer Research UK estimates that approximately 10% of lung cancers in the UK are due to air pollution. With both pollution and tobacco use increasing in many low-income and middle-income countries, there is a worrying potential for an increase in lung cancer burden in places that can ill afford screening tools or expensive treatments. Durvalumab plus platinum–etoposide versus platinum–etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trialFirst-line durvalumab plus platinum–etoposide significantly improved overall survival in patients with ES-SCLC versus a clinically relevant control group. Safety findings were consistent with the known safety profiles of all drugs received. Full-Text PDF