What is Lung Cancer?

Cancer occurs when there is an uncontrolled growth of cells in an area of the body. Lung cancer starts in the cells that make up the surfaces and lining of the lungs, which are called epithelial cells. Epithelial cells are also found throughout the body.

Normal cells in the body have a specific function, eventually die, and may be replaced by new cells. Cancerous cells no longer carry out a specific function, continue to live, and increase in number without stopping. These cancerous cells can spread to nearby tissues (group of similar cells in an area) or other organs inside the body. Cancer means to grow and spread in an uncontrolled manner. When cancer cells spread from their original location into other tissues or organs, this is known as metastasis. Cancer cells can develop into a mass or growth of new tissue, which is known as a malignant tumor.

The most common cause of lung cancer is long-term, direct contact with tobacco smoke or through indirect contact (passive or second-hand smoking). Other causes of lung cancer are prolonged contact with radon gas, asbestos, and other pollutants in the environment. In rarer cases, some people have been found to have a genetic (inherited via family) tendency to develop lung cancer.

The main forms of lung cancer are small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC collectively refers to three of the four possible types of lung cancer, specifically, squamous, adenocarcinoma, and large cell. SCLC is the fourth type of cancer. The treatments for NSCLC and SCLC differ greatly.

What are Signs and Symptoms of NSCLC?

The signs and symptoms of NSCLC depend upon where the cancer is located. There may not be any indication of NSCLC initially. The most common signs and symptoms of NSCLC are:

• Shortness of breath or difficulty breathing (dyspnea)
• Chronic coughing, and sometimes coughing up blood (hemoptysis)
• Lung or chest pain
• Weight loss
• Loss of appetite
• Lack of energy and/or weakness

How is it Diagnosed?

NSCLC often is found through a chest x-ray and/or other similar tools that look internally (inside the body), such as Computerized Axial Tomography (CT scan) or Magnetic Resonance Imaging (MRI). A CT scan is a type of x-ray that takes multiple "pictures" internally and can be used to locate cancer in specific parts of the body. A MRI is similar to a CT scanner but uses radio waves and a strong magnet to take pictures internally.

When NSCLC is suspected on a chest x-ray, CT scan, and/or MRI, a diagnosis (identification) is made by obtaining and reviewing cells or tissue from the suspected area. The removal of cells/tissues for review under a microscope (a tool to view objects too small to see with the eyes) is called a biopsy. A positive biopsy means that the reviewed cells or tissues contain cancerous cells or tissues.

How is it Treated?

The treatment of lung cancer, and NSCLC in particular, depends upon many factors, including but not limited to:

• How far the cancerous cells have spread (metastasized)
• Size and location of the cancer
• The current health of the patient

The most common treatment methods for NSCLC are surgery, radiation therapy, and chemical treatments that target and kill cancerous cells (chemotherapy). In some cases surgery, radiation therapy and chemotherapy will be used together to treat NSCLC.

Surgery may be used to treat early or localized lung cancer. It may involve the removal of a specific section of cancerous tissue in the lung. When a large portion of the lung (or lobe) is taken out surgically to remove cancerous tissue or tumor, this is called a lobectomy. If the NSCLC is advanced and has spread to other areas, surgery may no longer be an option. In that case, radiation therapy and medications may be used to treat the advanced NSCLC.

There are a number of medications available to treat advanced NSCLC, and generally, such cancer therapies will include more than one type or class of a chemical drug. Chemotherapy drugs work by destroying cells that multiply rapidly. However, chemotherapy drugs cannot distinguish between normal (healthy) cells and cancerous ones, causing the destruction of healthy cells along with the cancerous cells. This can lead to unwanted side (health) effects in patients, such as diarrhea, mouth sores, etc. This usually requires patients to receive multiple rounds of chemotherapy in order to fully destroy the cancer.

Because of the above-mentioned limitations with chemotherapy, there has been a need to develop more effective therapies. One approach is the use of targeted therapies, which selectively target the cancer rather than the normal cells. One type of targeted therapy called anti-angiogenic therapy, can prevent the creation of new tumor blood vessels that cancerous cells need in order to grow and spread, rather than targeting the cancerous cells directly. Stopping the formation of new blood vessels in a cancerous tumor can prevent further growth of the tumor and lead to shrinkage and eventually, the death of cancer cells. Anti-angiogenic drugs may be combined with chemotherapy drugs to treat advanced cancers that are otherwise difficult to treat. The combination of carboplatin plus paclitaxel plus bevacizumab has been proven to be effective in treating patients with advanced NSCLC by improving their survival. The Food and Drug Administration has approved this treatment combination for use in advanced NSCLC.

Some of the commercially-approved chemotherapy drugs and targeted therapies, including anti-angiogenic therapies used to treat advanced NSCLC are as follows (includes helpful links):

Chemotherapies:

• cisplatin
• carboplatin
• paclitaxel
• gemcitabine
• erlotinib
• pemetrexed

Anti-Angiogenic:

• bevacizumab

Check with your doctor and visit the above links for more information on these approved cancer therapies and others that are currently available.

Fosbretabulin (CA4P) is a tumor vascular disrupting agent (VDA), which is a drug compound that targets existing abnormal blood vessel networks in a tumor. Tumor VDAs differ from anti-angiogenics, which prevent the formation of new blood vessels. Tumor VDAs cause already-present tumor blood vessels to collapse and die, essentially "starving" a tumor and preventing its further growth. CA4P used in combination with an anti-angiogenic agent such as bevacizumab, is intended to work in a complimentary manner by disrupting the existing tumor blood vessels and prevent the development of new tumor vessels. The addition of chemotherapy agents to this combination may be even more effective in a particularly resistant or aggressive cancer. Tumor VDAs are not currently approved by the Food and Drug Administration (FDA) for use in the treatment of cancer.

OXiGENE is presently conducting clinical trials to test the investigational new drug, fosbretabulin (CA4P), for the treatment of advanced NSCLC and other types of cancer. An investigational new drug is one that is still being tested for safety and effectiveness and has not been approved for use outside of a clinical trial. Read on further for more information on clinical trials and specifics on the FALCON Trial. CA4P has shown anti-tumor activity in early clinical trials when combined with chemotherapy or anti-angiogenic therapy. CA4P is being combined with the standard, approved therapy of carboplatin, paclitaxel, and bevacizumab in advanced NSCLC.