Easy to understand Cancer and the treatment options of Lung Cancer

1. TREATMENT OPTIONS OF
LUNG CANCER
Presented By:
Faruk Hossain
Beacon Pharmaceuticals Ltd
+88 01717 678894
faruk@beaconpharma.com.b
d
shadhin1008@live.com

2. LUNG CANCER
Lung cancer is the uncontrolled growth of abnormal cells that start
off in one or both lungs; usually in the cells that line the air passages.
The abnormal cells do not develop into healthy lung tissue, they
divide rapidly and form tumors.

3. TYPES OF LUNG
CANCER
40%
25%
10%
15%
4%
Adenocarcinoma
Squamous Cell
Carcinoma
Large Cell Carcinoma
NSCLC
SCLC
1.NSCLC-85% of
LCs
2.SCLC-15% of LCs

4. NSCLC:
Non-small cell lung cancer accounts for about 85 percent of lung
cancers and includes:
Adenocarcinoma(often found in an outer area of the lung) , the most
common form of lung cancer in the United States among both men
and women;
Squamous cell carcinoma(often found by center of the lung by an air
tube), which accounts for 25 percent of all lung cancers;
Large cell carcinoma(any part of the lung & grow faster), which
accounts for about 10 percent of NSCLC tumors.

5. STAGES OF NON-SMALL CELL LUNG
CANCER
Stage 0: Abnormal cells are found in the innermost lining of the lung.
Stage I: The cancer is located only in the lungs and has not spread to any
lymph nodes.
Stage II: The cancer is in the lung and nearby lymph nodes.
Stage III: Cancer is found in the lung and in the lymph nodes in the middle of
the chest, also described as locally advanced disease. Stage III has two
subtypes:
If the cancer has spread only to lymph nodes on the same side of the chest
where the cancer started, it is called stage IIIA.
If the cancer has spread to the lymph nodes on the opposite side of the
chest, or above the collar bone, it is called stage IIIB.
Stage IV: This is the most advanced stage of lung cancer, and is also
described as advanced disease. This is when the cancer has spread to both
lungs, to fluid in the area around the lungs, or to another part of the body,
such as the liver, Heart, Brain or other organs.

6. SMALL CELL LUNG CANCER
Small cell lung cancer accounts for the remaining 15 percent of lung
cancers in the United States. They tend to grow more quickly than
NSCLC tumors. Usually, SCLC is more responsive to chemotherapy
than NSCLC.

7. STAGES OF SMALL CELL LUNG
CANCER
Limited stage: In this stage, cancer is found on one side of the chest,
involving just one part of the lung and nearby lymph nodes.
Extensive stage: In this stage, cancer has spread to other regions of
the chest or other parts of the body.

8. TREATMENT OPTIONS OF LUNG
CANCER:
1. Surgery

9. 2. Radiotherapy

10. 3. Chemotherapy

11. 4. Targeted Therapy

12. 5. Palliative Care.

13. STAGE WISE TREATMENT OF
NSCLC
Treating stage 0 NSCLC
Because stage 0 NSCLC is limited to the lining layer of airways and
has not invaded deeper into the lung tissue or other areas, it is
usually curable by surgery alone. No chemotherapy or radiation
therapy is needed.
If Patient is healthy enough for surgery, Patient can usually be treated
by segmentectomy or wedge resection (removal of part of the lobe of
the lung).
Cancers in some locations (such as where the windpipe divides into
the left and right main bronchi) may be treated with a sleeve
resection, but in some cases they may be hard to remove completely
without removing a lobe (lobectomy) or even an entire lung
(pneumonectomy).

14. Lung
Cancer
Surgeries

15. TREATING STAGE I NSCLC
If Patient have stage I NSCLC, surgery may be the only treatment.
Segmentectomy or wedge resection is generally an option only for very small stage I
cancers and for patients with other health problems that make removing the entire
lobe dangerous. Still, most surgeons believe it is better to do a lobectomy if the
patient can tolerate it, as it offers the best chance for cure.
For patients with stage I NSCLC that has a higher risk of coming back (based on
size, location, or other factors), adjuvant chemotherapy after surgery may lower the
risk that cancer will return. But doctors aren’t always sure how to determine which
people are likely to be helped by chemo.
After surgery, the removed tissue is checked to see if there are cancer cells at the
edges of the surgery specimen (called positive margins). If some cancer has been
left behind, a second surgery might be done to try to ensure that all the cancer cells
has been removed. (This might be followed by chemotherapy as well.) Another
option might be to use radiation therapy after surgery.

16. TREATING STAGE II NSCLC
Patients who have stage II NSCLC and are healthy enough
for surgery usually have the cancer removed by lobectomy or sleeve
resection. Sometimes removing the whole lung (pneumonectomy) is
needed.
Any lymph nodes likely to have cancer in them are also removed.
In some cases, chemotherapy (often along with radiation) may be
recommend before surgery to try to shrink the tumor to make the
operation easier.
After surgery, the removed tissue is checked to see if there are cancer
cells at the edges of the surgery specimen (called positive margins).
This might mean that some cancer has been left behind, so a second
surgery might be done to try to remove any remaining cancer. This
may be followed by chemotherapy (chemo). Another option is to treat

17. TREATING STAGE IIIA NSCLC
Treatment for stage IIIA NSCLC may include some combination of
radiation therapy, chemotherapy (chemo), and/or surgery.
For this reason, planning treatment for stage IIIA NSCLC often requires input
from a medical oncologist, radiation oncologist, and a thoracic surgeon.
Treatment options depend on the size of the tumor, Position in lung, which
lymph nodes it has spread to, overall health, and how well patient tolerating
treatment.

18. TREATING STAGE IIIB NSCLC
Stage IIIB NSCLC has spread to lymph nodes that are near the other lung or in
the neck, and may also have grown into important structures in the chest.
These cancers can’t be removed completely by surgery. As with other stages
of lung cancer, treatment depends on the patient’s overall health.
If Patient are in fairly good health patient may be helped
by chemotherapy(chemo) combined with radiation therapy. Some people can
even be cured with this treatment. Patients who are not healthy enough for
this combination are often treated with radiation therapy alone, or, less often,
chemo alone.
These cancers can be hard to treat, so taking part in a clinical trial of newer
treatments may be a good option for some patients.

19. TREATING STAGE IV NSCLC
Stage IV NSCLC is widespread when it is diagnosed. Because these cancers
have spread to distant sites, they are very hard to cure. Treatment options
depend on where the cancer has spread, the number of tumors, and
Patients overall health.
If Patients are in otherwise good health, treatments such
as surgery, chemotherapy (chemo), targeted therapy, immunotherapy,
and radiation therapy may help Patients live longer and make feel better by
relieving symptoms, even though they aren’t likely to cure.
End of NSCLC Treatment.

20. TREATMENT CHOICES BY STAGE
OF SCLC
For practical reasons, small cell lung cancer (SCLC) is usually staged
as either limited or extensive. In most cases, SCLC has already spread
by the time it is found (even if the spread is not seen on imaging
tests), so chemotherapy (chemo) is usually part of treatment if a
patient is healthy enough.
If patient smokes, one of the most important things Patient can do to
be ready for treatment is to try to quit.
Studies have shown that patients who stop smoking after a diagnosis
of lung cancer tend to have better outcomes than those who don’t.

21. TREATMENT OF LIMITED STAGE SCLC
For most patients with limited stage SCLC, surgery is not an option
because the tumor is too large, it’s in a place that can’t be removed
easily, or it has spread to nearby lymph nodes or other places in the
lung.
If Patents who are in good health, the standard treatment
is chemo plus radiation to the chest given at the same time
(called concurrent chemoradiation). The chemo drugs used are
usually etoposide plus either cisplatin or carboplatin.

22. TREATMENT OF EXTENSIVE STAGE
SCLC
Extensive stage SCLC has spread too far for surgery or radiation
therapy to be useful as the initial treatment. If Patient have extensive
SCLC and are in fairly good health, chemotherapy(chemo) can often
shrink the cancer, treat symptoms, and help live longer.
The most common chemo combination is etoposide plus either
cisplatin or carboplatin. Most people will have their cancer shrink
significantly with chemo, and in some the cancer may no longer be
seen on imaging tests. Unfortunately, the cancer will still return at
some point in almost all patients with extensive stage SCLC.
End of SCLC treatment.

23. WHAT ARE THE
CHEMOTHERAPEUTIC AGENTS
USED?
Cisplati
n
Gemcitabin
e
Etoposid
e
Docetaxel
Paclitaxe
l

24. NOW, WHAT IS TARGETED
THERAPY IN NSCLC?
Targeted therapy of lung cancer refers to using agents specifically
designed to selectively target molecular pathways responsible for
the malignant phenotype of lung cancer cells.

25. DRUGS THAT TARGET TUMOR BLOOD
VESSEL GROWTH (ANGIOGENESIS)
For tumors to grow, they need to form new blood vessels to keep
them nourished. This process is called angiogenesis. Some targeted
drugs, called angiogenesis inhibitors, block this new blood vessel
growth:
1. BEVASTIM (Bevacizumab) is used to treat advanced NSCLC. It is a
monoclonal antibody (a man-made version of a specific immune
system protein) that targets vascular endothelial growth factor (VEGF).
2. Ramucirumab.

26. DRUGS THAT TARGET CELLS WITH
EGFR CHANGES
Epidermal growth factor receptor (EGFR) is a protein on the surface of
cells. It normally helps the cells grow and divide. Some NSCLC cells
have too much EGFR, which makes them grow faster. Drugs
called EGFR inhibitors can block the signal from EGFR that tells the
cells to grow. Some of these drugs can be used to treat NSCLC.
EGFR inhibitors used in NSCLC with EGFR gene mutations
Erlotinib
(Tarceva)
Afatinib (Gilotrif)

27. EGFR INHIBITORS THAT ALSO TARGET
CELLS WITH THE T790M MUTATION
EGFR inhibitors can often shrink tumors for several months or more.
But eventually these drugs develop resistance for most patients,
usually because the cancer cells develop another mutation in
the EGFR gene. One such mutation is known as T790M. But some
newer EGFR inhibitors also work against cells with the T790M
mutation, including Osimertinib (Tagrisso).

28. DRUGS THAT TARGET CELLS WITH ALK
GENE CHANGES
About 5% of NSCLCs have a rearrangement in a gene called ALK. This
change is most often seen in non-smokers (or light smokers) who
have the adenocarcinoma subtype of NSCLC. The ALK gene
rearrangement produces an abnormal ALK protein that causes the
cells to grow and spread. Drugs that target the abnormal ALK protein
include:
Crizotinib (Xalkori)
Ceritinib (Zykadia)
Alectinib (Alecensa)–Now in Beacon’s rich Pipeline
Brigatinib (Alunbrig)- Now in Beacon’s rich Pipeline

29. DRUGS THAT TARGET CELLS WITH
BRAF GENE CHANGES
The BRAF gene provides instructions for making a protein that helps
transmit chemical signals from outside the cell to the cell's nucleus.
In some NSCLCs, the cells have changes in the BRAF gene. Cells with
these changes make an altered BRAF protein that helps them grow.
Some drugs target this and related proteins:
Dabrafenib (Tafinlar) is a type of drug known as a BRAF inhibitor,
which attacks the BRAF protein directly.
Trametinib (Mekinist) is known as a MEK inhibitor, because it attacks
the related MEK proteins. -- Now in Beacon’s rich Pipeline.

30. WHAT IS PALLIATIVE CARE ?
Palliative care is an approach that improves the quality of life of patients and their
families facing the problem associated with life-threatening illness, through the
prevention and relief of suffering by means of early identification and impeccable
assessment and treatment of pain and other problems, physical, psychosocial and
spiritual.
Palliative care:
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
will enhance quality of life, and may also positively influence the course of illness;

31. THANK
YOU