Improving lung cancer survival: Time to move on

Abstract

In 1761, lung cancer was first described as a distinct disease based on autopsies by Giovanni Morgagni. In 1810, Gaspard Laurent Bayle described lung cancer in more detail in his book entitled Recherches sur la phthisie pulmonaire. At that time it was an extremely rare disease; in 1878, malignant lung tumors included only one percent of all cancers discovered during autopsies at the Institute of Pathology of the University of Dresden in Germany. Nowadays lung cancer is the major cause of cancer deaths worldwide. There are two major groups of lung cancer: non-smallcell lung cancer (NSCLC) and small-cell lung cancer, accounting for approximately 85% and 15% of lung cancer cases, respectively. NSCLC can be divided into four histological subtypes: squamous cell carcinoma, adenocarcinoma, large cell lung carcinoma and undifferentiated NSCLC. Squamous cell carcinoma mostly develops from bronchial epithelial cells in the central airway, while most tumors that are not related to smoking, like adenocarcinoma, develop from basal bronchial cells and type II pneumocytes and arise in the more peripheral parts of the lung. Although the subdivision of NSCLC has no direct treatment consequences in limited disease, in advanced disease treatment choices depend on these histological differences. The 5-year survival of lung cancer is 73% for localized NSCLC and only 13% for metastasized disease. One of the reasons for this extremely poor survival is that most lung cancer cases are diagnosed at an advanced stage due to the relative lack of clinical symptoms during early stages. Metastatic NSCLC is currently an incurable disease for which standard chemotherapy provides only minor improvement in overall survival. Less than 30% of unselected patients with advanced-stage NSCLC have a clinical response to platinum-based chemotherapy, which is in general considered to be the most effective first line treatment at this stage of the disease.