Recent Advances in the Treatment of Lung Cancer

By David Jones, MD  |  Monday, February 10, 2014

With the aging of the United States population, the number of lung cancer cases is expected to rise by 50 percent during the next two decades. In addition, with the 2013 U.S. Preventive Task Force recommendation that CT screening for lung cancer be performed for high-risk individuals, we can expect an associated increase in identification of early-stage lung cancers.

At Memorial Sloan Kettering, we have one of the busiest thoracic surgical oncology programs in the country, and as such, we perform a significant number of lung cancer resections each year. We increasingly perform advanced minimally invasive resections for lung cancer, including video-assisted thoracic surgery (VATS) and robotic procedures. Given our expertise with these highly innovative and minimally invasive procedures, we are able to perform increasingly complicated resections without the need for a thoracotomy. In fact, several of our surgeons were early adopters and pioneers in the development of VATS lobectomies and other minimally invasive procedures for the resection of lung cancer.

We currently perform more than half of our procedures using a minimally invasive approach. The average hospital stay for these patients is two to three days. We have had one death in the last 800 consecutive VATS lobectomies—a mortality rate of 0.1%.

Many of our patients have more advanced stage disease and larger tumors and have undergone previous treatments, including chemotherapy and radiation. For several of these patients, open surgery is the optimal approach. We have extensive experience handling these cases, with expertise in the surgical management of superior sulcus (Pancoast) tumors and tumors invading the chest wall, for example.

Genomic Analyses of Lung Cancers

Given our singular focus on cancer, our surgeons and our multidisciplinary team have long appreciated that lung cancers are not all the same. Beginning in January 2014, MSK will perform a Clinical Laboratory Improvement Amendments–certified genomic analysis of all lung cancers (surgically resected and biopsied). This will include an analysis of more than 350 genes, looking for known driver mutations and important gene amplifications that we can ultimately target.

This effort represents a significant extension of the eight genes that we have been examining since 2003. The knowledge gained from this new initiative will help to design future clinical trials and, more immediately, to shape personalized care plans for each patient.

Second Opinions

We are seeing an increased number of patients who are requesting a second opinion, frequently at the behest of their referring physician. While a second opinion is not always indicated, it does play a role in selected cases. Frequently, patients are denied surgery for their lung cancer because of poor pulmonary function, advanced age, or concerns that the tumor cannot be removed completely with surgery. We have significant experience with these types of patients, and in many cases a complete surgical resection of their cancer is possible, with little morbidity.

The surgeons at our institution are committed to advancing the care of patients with lung cancer. We remain focused on providing a multidisciplinary, cutting-edge approach that involves novel, personalized therapy, while embracing innovative minimally invasive surgical techniques.

Figure 1. Surgical treatment of lung cancer at Memorial Sloan Kettering, 2011 to 2013 Enlarge Image Figure 1. Surgical treatment of lung cancer at Memorial Sloan Kettering, 2011 to 2013

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