The enclosed results from a survey of 150 randomly selected US-based medical oncologists and 21 lung cancer clinical investigators illustrate the current integration of clinical research findings into daily patient care.

As with all studies of this type, one can tease out interesting variations in how physicians approach common and not-so-common management scenarios.

Clearly there have been a number of major recent changes in the treatment of non-small cell lung cancer, most notably the evolution of adjuvant chemotherapy and the new role of biologics — specifically bevacizumab and erlotinib — in the management of advanced disease.

Even better, as we have seen in many other major solid tumor types, ongoing clinical trials are attempting to evaluate these and other targeted interventions at earlier stages of disease with the hope that other therapeutic home runs on par with adjuvant trastuzumab in breast cancer are on the horizon for lung cancer.

Unfortunately, an equally valid view of lung cancer practice patterns is that our available interventions are woefully inadequate in the face of this brutal disease.

It is almost impossible to comprehend that in spite of these and other therapies, almost 160,000 people die of lung cancer every year in the US alone. (See figure below).

Comparing this apocalyptic statistic to breast cancer — where incidence rates are almost identical, but 42,000 lives are lost each year — we must acknowledge that our current diagnostic, therapeutic and technologic advances have pretty much failed to meaningfully address this profound public health disaster.

Have we become desensitized to what is going on here? Has the smoking connection made it OK to blame the patients and therefore ignore the human toll of this disease? I am tired of hearing the whining about smoking. Yes, most lung cancers are theoretically preventable — just like heart disease — but let’s get real here.

The ads and PR campaigns targeting teenagers to prevent this addiction are critical, long overdue and inadequately funded, but tens of millions of people have already quit smoking and remain at high risk to die of this disease in the next few years.

At our recent lung cancer think tank, my co-chair, Tom Lynch, voiced concern that our current understanding of lung cancer is prerudimentary at best and concluded that available resources should be poured into the laboratory to go back to the basics to figure out what this disease is all about.

Tom’s suggestion couldn’t be more apropos because the truth is that a therapeutic platform in which 75 percent of patients are dead in a couple of years reflects patterns of care that just don’t work.

Neil Love, MD
NLove@ResearchToPractice.com
October 11, 2007

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