Continued Gains in Non-small Cell Lung Cancer Therapy

With approximately 1.3 million cases and 1.1 million deaths per year worldwide, lung cancer represents a very common and highly lethal cancer. Certainly, the ultimate goal of managing this disease is prevention, and we have the advantage that the primary causative factor is identified, well known, and above all, modifiable. In parts of the world such as the United States and northern and western Europe, the efforts of education and smoking cessation programs have had an impact on the incidence of smoking with a resulting decrease in the incidence of lung cancer. Lung cancer is far from eradicated, and trends of decreasing incidence in women lag behind those of men, ensuring decades more of unacceptably high incidence rates. In other geographical areas, however, such as southern and eastern Europe, the incidence continues to rise even in men. We are thus faced with the continuing need to develop better management of this cancer. By far the most common type of lung cancer is non-small cell lung cancer (NSCLC), and this supplement was created to apprise the practising clinician of the latest research on this disease. It is, however, no longer sufficient simply to stay abreast of new developments in the treatment of NSCLC. On the contrary, we must advance a step further by changing our way of thinking about the disease and embrace new treatment paradigms. This supplement to the Journal of Thoracic Oncology reviews the recent advances in clinical and translational research and perspectives on the treatment of NSCLC. These articles represent, in part, presentations of key thought leaders in lung cancer research and treatment that were given during the Interactive Lung Cancer Conference 2006 in Lisbon, Portugal. This unique international conference provided the opportunity for oncologists to engage in discussions about their experiences with treating NSCLC around the globe. You will find that the authors and investigators reach beyond the current standards of care, and challenge the reader to accept the possibility of incorporating new treatment paradigms as research advances and new technologies become available. To make rational treatment choices based on available data, clinical trial endpoints must be critically examined, particularly in the context of their practicality and applicability to daily practice. Richard Gralla and Frank Griesinger provide a critical interpretation of clinical trial endpoints used in recent studies and present compelling data supporting the evaluation of quality of life measures, especially if there is a gain in survival. They further argue that measuring quality of life must not remain the sole domain of clinical trials, but should be incorporated into routine day-to-day clinical practice. The underlying biology of NSCLC tumors is of key interest in order to identify patients who might respond to specific therapy and to make a proper selection of patients for currently available molecularly targeted agents. Frances Shepherd and Rafael Rosell review clinical data with targeted agents, particularly those that target the epidermal growth factor receptor (EGFR). The story on EGFR gene mutations, gene amplification