University of Texas
MD Anderson Cancer Center
Houston, Texas

Multidisciplinary Research on Lung Cancer and Head and Neck Cancer

Lung cancer is the leading cause of cancer-related death in both men and women. In 2011 in the United States, an estimated 221,130 new cases and 156,940 deaths from lung cancer are expected, which is a higher mortality rate than those predicted for breast, prostate, and colorectal cancers combined. The 5-year survival rate for all stages of lung cancer combined is only 16%, and there has been minimal progress in conventional treatments such as surgery, radiation and chemotherapy, reaching the ceiling in the cure of this disease. Therefore, new therapeutic approaches are desperately needed to improve patient survival with lung cancer.

Cancer that arises in the head or neck region, including that in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, and larynx [voice box], is categorized as head and neck cancer. Although compared to lung cancer, head and neck cancer affect fewer people. There is an estimated 49,260 new cases this year alone in America, and nearly 11,480 will die from it. Like lung cancer, head and neck cancer is also linked to tobacco use. In fact, 85% of head and neck cancers are linked to smoking and smokeless tobacco. These cancers are often curable when detected early. However, treatments can damage important functions including eating, speaking, or even breathing, severely affecting the quality of patients' lives.

NFCR Fellow Expertise

NFCR Fellow Waun Ki Hong, M.D., former president of the American Association for Cancer Research, is a world renowned scientist and the foremost authority on the treatment and prevention of lung and head and neck cancers. Dr. Hong has developed novel treatment approaches that have enabled thousands of laryngeal cancer patients to avoid radical surgery. Dr. Hong's approaches eradicate the cancer while preserving their ability to speak and swallow, allowing these patients to enjoy a better quality of life. Dr. Hong also showed for the first time that genetic damage to the airways can persist for many years after smoking cessation. His team also developed measurements to identify genetically the subgroup of former smokers who are at highest risk for lung cancer.

NFCR Research Overview

Dr. Hong is currently leading several multi-disciplinary cancer research programs in lung and head and cancers, focusing on prevention and treatment of these types of cancer. With support from NFCR and other organizations, these programs have made significant advancement over the past few years.

NFCR Research Findings

Risk model for cancer recurrence

Research has shown that lung or head and neck cancer patients with a history of smoking are at high risk for redeveloping these types of cancer (recurrent or second primary tumors (SPTs)) after surgical removal of the tumors. Unfortunately, there are no standard interventions that have been proven to help reduce the risk. Dr. Hong's team has initiated a program called Vanguard Trial of Investigational Therapeutics in Adjuvant Treatment of Lung Cancer (VITAL). The program aims to develop a risk model for cancer recurrence or smoking-related SPTs in this high risk population. The risk model is near completion and has provided insights into why only a subgroup of smokers are prone to have their DNA damaged by smoking and consequently develop lung cancer. Dr. Hong hopes that those who are deemed to be at high risk could take proactive measures early on that might prevent or delay lung cancer development again.

Chemoprevention

As one of the founders of chemoprevention, Dr. Hong and his team have also initiated clinical studies on curcumin and celecoxib for their potential roles in lung cancer prevention. Curcumin is a natural Indian curry spice, and celecoxib is an anti-inflammatory drug used for the treatment of arthritis. The results of these initial studies are encouraging and further research on these two agents may lead to their new applications in cancer chemoprevention, and may help to avoid or delay lung cancer initiation.

Identification of gene signatures and biomarkers in early lung cancer

Knowing the molecular events in early stage non-small cell lung cancer (NSCLC) will allow doctors to better predict the survival outcome of their patients. Patients will also benefit from a more personalized treatment option with agents that target the genes and their products-options that early-stage NSCLC patients greatly need after their initial surgery. Using a powerful tumor model comprised of various cancer cell lines, together with large databases of tumor tissues, the scientists in the Hong research team identified a robust six-gene signature that may be valuable in predicting survival of patients with a subtype of NSCLC. Importantly, Dr. Hong's research has unraveled a protein product of one of those genes, with potential to become a powerful biomarker for predicting progression and outcome of early stage NSCLC. Dr. Hong's research is leading the exploration of the progressive molecular changes in lung cancer that can be translated into chemoprevention and treatment of lung cancer-at the earliest stage-when patients need it the most.

Historical first steps towards personalized medicine for lung cancer patients

Individualized targeted therapies are considered as the new paradigm for cancer treatment. By targeting specific molecular abnormalities in individual patients, it holds high hope for more effective treatments with fewer side effects compared to traditional radiation and chemotherapy. Toward this goal, Dr. Hong has initiated the BATTLE program, or Biomarker-Based Approaches of Targeted Therapy for Lung Cancer Elimination, to develop individualized targeted therapies for patients with advanced NSCLC that is resistant to chemotherapy. Recently, Dr. Hong's team presented very encouraging results of four (4) clinical trials that tested personalized medicine protocols in lung cancer patients. In these trials, patients were assigned to the treatment drug which they were most likely to respond based on their personal biomarker profile identified through tumor biopsies. BATTLE is an important step toward personalized medicine and marks a paradigm shift for clinical trials by demonstrating the feasibility of a biopsy-based, biomarker trial. These initiatives will move personalized medicine forward and improve treatment efficacy to individual patients.

In addition, Dr. Hong has facilitated the development of a unique computer game-like education program called "TALK", aimed at enhancing public knowledge on cancer-related information.

Future Research Goals

Having established a solid foundation for lung cancer and head and neck cancer research, Dr. Hong and his team will continue their efforts in conducting the multidisciplinary research programs in the areas of cancer prevention and treatment. Their work holds promise for more effective preventative measurements and personalized therapies for the patients, and may lead to significant improvements in their survival and quality of life.