The majority of patients who are diagnosed with lung cancer (40%) are diagnosed at advanced stages. Non-small cell lung cancer (NSCLC), the most common form of lung cancer, is very difficult to treat. It is most common to provide both chemotherapy and radiation therapy, but scientists do not yet agree on what is the best form of treatment. Usually, the care team around the patient will use their personal experience to decide which type of treatment is best. This is particularly true in those who have NSCLC as a result of asbestos exposure, which is perhaps even harder to treat.

Understanding NSCLC

Lung cancer is believed to be the deadliest and most common form of cancer. Some 1.3 million people per year die from cancer. Eight five percent of these cancers are NSCLC, and around 40% receive a diagnosis when they are in stage 3 or later. Unfortunately, this means that a cure is unlikely. Even if chemotherapy and radiation therapy are offered, the 3 year survival rate is just 27%. If caught early enough, however, the survival rates are much better, including a 51% five year survival rate.

Forty percent of NSCLC patients are diagnosed at advanced stages, and a third have stage 3 cancer. For many years, radiotherapy was the only available treatment, despite this having very poor positive results. The average survival rate was just nine to 11 months.

Stage 3 NSCLC Treatment

Usually, treatment includes chemotherapy, radiation therapy, and surgery. Because of this, a care team has to be made up of a thoracic surgeon, radiation oncologist, and medical oncologist. They will work together to determine the size and location of the tumor, its spread, the patient’s overall health, and how well they will respond to treatment.

If the cancer has spread to the lymph nodes, or to other structures in the chest, it can no longer be surgically removed. Chemotherapy and radiation therapy may be offered if the patient is in reasonable overall health. There have been some rare cases of people even being cured through this. However, the majority of people will simply be offered palliative care at this point.

For all lung cancer patients, the opportunity to take part in clinical trials if they want to.

The Role of Vinorelbine

As NSCLC patients, and particularly those who have asbestos-related lung cancer, regularly take part in clinical trials, new treatment options are being developed. One particular treatment option that is gathering a lot of attention is vinorelbine.

Towards the middle of the 1980s, chemotherapy treatment was the only available form of treatment. However, in 1995, 3,033 patients were studied, and this demonstrated that combining chemotherapy and radiation therapy provided a significant difference. Since then, various other clinical trials have taken place to determine whether other forms of treatment were even more beneficial. Below are examples:

• A study by the Cancer and Leukemia Group B showed significant improvements in patients who were provided chemotherapy with cisplatin-vinblastine before being given radiotherapy. The survival rate at three years was 23% instead of 11%, and at five years was 19% instead of 7%.
• The Radiation Therapy Oncology Group, ECOG, and Southwest Oncology Group, worked together on a similar study, and they noted similar results in terms of better survival rates.
Le Chevalier et al. also completed a similar study, although more in depth by testing different types of chemotherapy drugs, as well as more cycles. They also noted that survival rates were significantly improved.

Unfortunately, it is known that chemotherapy and radiotherapy will reach a plateau at some stage, particularly in those who have stage 3 NSCLC. As such, the median survival rates, even in the best studies, is still only between 18 and 23 months. Hence, third generation drugs are being studied to see whether they could potentially benefit patients.

One of the most promising drugs, so far is vinorelbine, which is an oral cytostatic. It has a number of features that enable it to be used concomitant with radiotherapy. The biggest benefit is that it is an oral drug. Studies have shown that 75% of patients would prefer an oral tablet. The same study showed a number of other benefits, including the fact that:

• It combines well with cisplatin, and is therefore able to treat locally metastatic and advanced lung cancer
• Its safety profile is good
• It is quick to absorb, with a 40 hour elimination half life
• It has a 13% better binding profile to plasma proteins
• Its metabolism is hepatic-gallbladder
• It has a 40% bioavailability, which means it can be as effective as endovenous doses
• It is not affected by food
• If administered after a light meal, patients experience less vomiting and even nausea
• If patients do vomit soon after ingesting it, its bioavailability remains unaffected.
• The drug does not interact with cyclophosphamide, gemcitabine, capecitabine, paclitaxel, docetaxel, or cisplatin.

Unfortunately, the prognosis for those who are diagnosed with lung cancer, whether caused by asbestos or not, remains very poor. This is because the disease has a very long latency period and, in early stages, is almost asymptomatic. When symptoms do start to appear, they are often mistaken for respiratory infections such as a cold, flu, or bronchitis. As a result, once the cancer is finally discovered, it has often spread and has become more difficult to treat. While surgery, combined with chemotherapy and radiotherapy, has shown some promising results, many patients are too physically weak to go through the surgery. As such, developments such as the vinorelbine one, and other clinic trials, are vital to increase overall survival rates.