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Chemoprevention of lung cancer: current status and future prospects
1Department of Bioimmunotherapy, The University of Texas M.D. Anderson Cancer Center; Houston, TX, USA.
Abstract:
Lung cancer is the leading cause of cancer death in the United States. The current mainstays of lung cancer therapy are surgery, radiation and chemotherapy. These interventions have produced slight declines in mortality rates in the last 5 years however, it appears unlikely that marked improvements will occur in the near future. This grim overview argues strongly for new, emerging approaches for controlling this disease. Chemoprevention is the use of specific natural or synthetic substances with the objective of reversing, suppressing or preventing carcinogenic progression to invasive cancer. Whether primary, secondary or tertiary settings, prevention has the highest potential to improve the dismal statistics associated with this cancer. Several randomized clinical or translational chemoprevention trials have been conducted. All have so far produced either neutral or harmful primary endpoint results showing that lung cancer was not prevented by alpha-tocopheral, beta-carotene, retinal, retinyl palmitate, N-acetylcysteine or isotretinoin in smokers. Secondary results supporting treatment with isotretinoin in 'never' and former smokers and data from prevention trials involving selenium and vitamin E however, are encouraging and offer a promising direction for future clinical study. Other areas of promise for future lung cancer chemoprevention study include the study of molecular markers of risk and drug activity, molecular targeting study, improved imaging techniques and new drug delivery systems.
Insights
Lung cancer chemoprevention trials have yielded disappointing results, failing to prevent cancer in smokers. However, promising secondary findings suggest future research directions for lung cancer prevention.
Area of Science:
- Oncology
- Preventive Medicine
- Cancer Research
Background:
- Lung cancer remains a leading cause of cancer death, with current treatments offering limited improvement.
- Emerging strategies like chemoprevention are crucial for better lung cancer control.
- Chemoprevention aims to reverse, suppress, or prevent cancer progression using natural or synthetic substances.
Purpose of the Study:
- To evaluate the effectiveness of chemoprevention in reducing lung cancer incidence.
- To identify promising agents and strategies for future lung cancer prevention trials.
Main Methods:
- Review of randomized clinical and translational chemoprevention trials.
- Analysis of primary and secondary endpoint results from trials involving various agents (e.g., alpha-tocopherol, beta-carotene, isotretinoin, selenium, vitamin E).
Main Results:
- Most trials showed neutral or harmful primary endpoint results, indicating no prevention of lung cancer in smokers.
- Secondary results suggested potential benefits of isotretinoin in never-smokers and former smokers.
- Encouraging data emerged from prevention trials involving selenium and vitamin E.
Conclusions:
- Current chemoprevention strategies have largely failed to prevent lung cancer in smokers.
- Further research into isotretinoin, selenium, and vitamin E is warranted for specific populations.
- Future directions include studying molecular markers, targeted therapies, imaging, and drug delivery systems for lung cancer chemoprevention.