For the last twenty years Oncologists have been stuck with how to improve the therapy for small cell lung cancer — that deadliest form of lung cancer affecting about 20% of newly diagnosed patients, and that form most closely linked to cigarette smoking. Chemotherapy seems to have stalled out, with cures still about 1% of newly diagnosed patients. Attempts, led by researchers at the Dana Farber Cancer Institute, to improve the cure rate by intensifying the dose of chemotherapy given, ran into two problems: patients with small cell tender to be older and sicker than the best “experimental” subjects leading to unacceptable toxicity; and even in those patients who could tolerate mega doses of chemo, improvements in outcome were miniscule.
Several years ago, researchers thought up a new approach. Small cell lung cancers have heightened sensitivity to Vascular Endothelial Growth Factor (VEGF), a protein circulating in the blood that increases the blood supply to cancers and promotes their growth. Why not try one of the new VEGF blockers that had been developed to treat other cancers such as kidney and liver cancer? It turns out that if you add a VEGF blocker like Sutent to best available chemo, the cocktail is too toxic. So a group of Oncologists led by a team at Duke with others from across the country added Sutent after the chemo was done. Their results are reported in the Journal of Clinical Oncology and show a modest improvement in outcome. Dr. Stark comments. “The absolute improvement in remission duration is short, but this is the first time in 20-25 years that anyone has made a dent in survivorship for this disease. I hope this is a first step in a string of improvements. It is proof of principle that VEGF matters in small cell.”