Chemoprevention of Lung Cancer

Department of Medicine, VA Eastern Colorado Healthcare System, University of Colorado at Denver Health Sciences Center, Denver, Colorado 80220, USA.
Proceedings of the American Thoracic Society 05/2009; 6(2):187-93. DOI: 10.1513/pats.200807-067LC
Source: PubMed


Lung cancer is the leading cause of cancer death in the United States, and the majority of diagnoses are made in former smokers. While avoidance of tobacco abuse and smoking cessation clearly will have the greatest impact on lung cancer development, effective chemoprevention could prove to be more effective than treatment of established disease. Chemoprevention is the use of dietary or pharmaceutical agents to reverse or inhibit the carcinogenic process and has been successfully applied to common malignancies other than lung. Despite previous studies in lung cancer chemoprevention failing to identify effective agents, our ability to determine higher risk populations and the understanding of lung tumor and pre-malignant biology continues to advance. Additional biomarkers of risk continue to be investigated and validated. The World Health Organization/International Association for the Study of Lung Cancer classification for lung cancer now recognizes distinct histologic lesions that can be reproducibly graded as precursors of non-small cell lung cancer. For example, carcinogenesis in the bronchial epithelium starts with normal epithelium and progresses through hyperplasia, metaplasia, dysplasia, and carcinoma in situ to invasive squamous cell cancer. Similar precursor lesions exist for adenocarcinoma, and these pre-malignant lesions are targeted by chemopreventive agents in current and future trials. At this time, chemopreventive agents can only be recommended as part of well-designed clinical trials, and multiple trials are currently in progress and additional trials are in the planning stages. This review will discuss the principles of chemoprevention, summarize the completed trials, and discuss ongoing and potential future trials with a focus on targeted pathways.

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    • "Although lung cancers often present late, there are many possible avenues for intervention within both a surgical and chemopreventive context. Primary chemoprevention focuses on preventing the development of precancerous lesions particularly in high-risk populations, such as smokers; secondary prevention aims to prevent progression of preneoplasia to cancer; and tertiary prevention is concerned with prevention of spread or recurrence of primary disease (Keith, 2009). Early disease can be classified into papillomas (squamous, glandular, or mixed) and adenomas (alveolar, papillary, salivarygland-type ). "
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