Chemoprevention of lung cancer: soon daily practice?

The statistics on lung cancer survival remain disappointing and form a powerful argument to develop new methods to control this most deadly form of cancer in both men and women. Chemoprevention is one of these new approaches. While carcinogens from cigarette smoke form an essential link between nicotine addiction and lung cancer, several investigations confirm that dietary and genetically determined factors play an important role in modulating the individual susceptibility and are linked to the chemoprevention approach. In spite of a large abundance of positive preclinical observations, most experiences with potential chemopreventive agents, such as retinoids and antioxidants in individuals at risk for lung cancer have been so far negative. Moreover, beta-carotene was associated with an increased lung cancer incidence in two large randomized studies, as a consequence of a negative interaction with smoking. On the other hand, recent progress in molecular biology has led to the discovery of specific approaches to chemoprevention and there considerable optimism regarding the potential of molecules and antibodies that target specific receptors or mutations. Epidermal growth factor receptor blocking agents, farnesyltransferase and cyclooxygenase inhibitors and 9-cis retinoic acid have been identified as promising candidates for studies in high risk populations. After more than 20 years of worldwide research, the prospects for effective lung cancer treatment are better than ever.