lung cancer Archives - NFCR

lung cancer

Lung Cancers Can Differ by Race

According to Clinical Cancer Research, a journal of the American Association for Cancer Research, recently discovered genetic differences in non-small cell lung cancers (NSCLCs) between some African-Americans and European-Americans suggest that there are racial differences in the biology of the disease. These findings could have a clinical impact on personalized cancer therapies in the future.

“We are entering the age of ‘precision medicine’ in which diagnosis and therapy decisions for each cancer patient will be based on detailed molecular and chemical fingerprints,” said researcher Bríd M. Ryan, a researcher at the National Cancer Institute’s Center for Cancer Research and the study’s author.

“Much of the revolutionary work that underpins precision medicine has been conducted on populations of European descent, with limited work in minority populations,” she added. “We want to make sure that all populations can benefit from this approach. Studying the biology of lung cancer in African-Americans is one step toward that goal.”

Dr. Ryan and her team analyzed normal and NSCLC tissue obtained from 64 African-Americans and 74 European-Americans. Tissue from 22 African-Americans and 19 European-Americans was analyzed for mRNA expression, which provides information about gene expression, and tissue from the remaining patients was analyzed for microRNA expression. These two different kinds of RNA have related, but different, roles inside the cell.

The researchers found that expression of 2,210 genes was more than two-fold increased or decreased in NSCLC from African-Americans compared with matched normal tissue. For European-American samples, 2,921 genes were differentially expressed by more than two-fold. Many of the genes were differentially expressed between NSCLC and normal tissue in both African-Americans and European-Americans, but 637 and 1,844 were differentially expressed only in African-Americans and European-Americans, respectively.

The genes differentially expressed only in the African-American NSCLC samples were enriched for those involved in stem cell biology and invasive behavior. The genes differentially expressed only in European-Americans were enriched for those involved in cell cycle, mitosis, and proliferation.

In addition, the genes differentially expressed only in African-Americans or European-Americans were analyzed using a drug-response prediction model. The two gene subsets predicted similar resistance/sensitivity for NSCLC from African-Americans and European-Americans to some drugs. For other drugs, the predictions varied by race, with NSCLC from African-Americans predicted to be resistant to 53 drugs to which NSCLC from European-Americans was sensitive. Among these drugs was irinotecan, used for treating certain types of cancer.

“This study helps close a gap in our knowledge of which genes are expressed in lung cancers from African-Americans, revealing clear differences in lung cancer biology between African- Americans and European-Americans,” said Mitchell. “By understanding these racial differences in gene expression, we can account for how they may contribute to disease progression and treatment response and, ultimately, help reduce some health outcome disparities.”

The study parallels a recent publication in Theranostics, one of whose authors is NFCR-sponsored scientist, Dr. Wei Zhang, of Wake Forest Baptist Medical Center. That team’s precision oncology study of racial differences in genetic alterations in smoking-related cancers revealed that African-Americans had a significantly increased mutation rate in the TP53 gene (tumor suppressor gene), and five genes were significantly amplified in this population. The researchers also found that a number of genes—including those that repair DNA damage—mutated at higher frequencies in African-American cancer patients versus European-Americans. 

Dr. Zhang stated, “These results provide strong evidence that genomic instability is a fundamental hallmark of cancer, and the events underlying the regulation of genome stability are centered on interactions with environmental factors and lifestyle, such as smoking.”

Too, the study points to genetic mutations common to African-Americans as a factor contributing to cancer outcome disparities. This latter discovery may lead to the development of novel diagnostic and improved therapeutic options for patients. 


Kytola V, Topaloglu U, Miller LD, Bitting RL, Goodman MM, D`Agostino RB Jr, Desnoyers RJ, Albright C, Yacoub G, Qasem SA, DeYoung B, Thorsson V, Shmulevich I, Yang M, Shcherban A, Pagni M, Liu L, Nykter M, Chen K, Hawkins GA, Grant SC, Petty WJ, Alistar AT, Levine EA, Staren ED, Langefeld CD, Miller V, Singal G, Petro RM, Robinson M, Blackstock W, Powell BL, Wagner LI, Foley KL, Abraham E, Pasche B, Zhang W. Mutational Landscapes of Smoking-Related Cancers in Caucasians and African Americans: Precision Oncology Perspectives at Wake Forest Baptist Comprehensive Cancer Center, Theranostics. 2017; 7(11):2914-2923. doi:10.7150/thno.20355

Ryan, Bríd  M. Comparative Transcriptome Profiling Reveals Coding and Noncoding RNA Differences in NSCLC from African Americans and European Americans, Clinical Cancer Research. (December 2017).




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7 Facts You Need to Know About Lung Cancer

With lung cancer continuing to affect the lives of so many people, it’s important to understand the disease and what we can do to improve our chances of beating it.


  • In the United States, an estimated 222,500 people will be diagnosed with lung cancer this year.
  • Lung cancer is the second most common cancer in both men and women.
  • More people die of lung cancer than of colon, breast and prostate cancers combined, as it claims nearly 160,000 lives every year.

Here’s a list of seven facts you need to know about lung cancer. (And make sure you read about related work by NFCR-funded scientists Dr. Daniel Haber and Dr. Alice Shaw)

1. Targeted therapies are showing great promise in treating lung cancer.

If you’ve been diagnosed with lung cancer, talk to your doctor about comprehensive genomic tumor testing. It is best to have this discussion before the initial biopsy, but it is never too late to discuss this with your doctor.

2. CT screenings can save lives.

Get screened using a low-dose CT scan- it’s the only proven effective way to screen for lung cancer.  X-rays do not detect lung cancer at it’s earliest of stages.

3. Smoking is the #1 risk factor….

Cigarette smoking is the #1 risk factor for lung cancer.  Smoking cigars, pipes and hooka also increases your risk.  If you are a current or former smoker, your risk of developing lung may be up to 25 times higher than someone who never smoked. Quitting reduces your risk, even if you’ve smoked for years.

In addition to causing cancer, smoking damages nearly every organ and organ system in your body.  Consider taking part in the Great American Smokeout on Thursday, November 16, 2017.  Talk to your doctor about strategies or stop-smoking aids that can help you quit.

4. …But, be aware, nonsmokers can get lung cancer too.

Roughly 10 to 15 percent of lung cancer cases occur in non-smokers.  Risk factors include:  exposure to radon gas, secondhand smoke, carcinogens like asbestos or diesel exhaust, air pollution and even gene mutations.

5. There are identifiable warning signs that can lead to early diagnosis.

Only 16% of people with lung cancer will be diagnosed when at the earliest stage, when the disease is most treatable.  If you are experiencing a chronic cough, coughing up blood, hoarseness, wheezing, frequent shortness of breath, chest pain, bone pain, or unexplained weight loss, talk to your doctor right away.

Also talk to your doctor if you have a family history of lung cancer – especially a parent or sibling.

6. There are different types of lung cancer. 

Non-Small Cell Lung Cancer (NSCLC) is the most common type of lung cancer, making up 80-85% of all cases.   Adenocarcinoma, squamous cell carcinoma, large cell carcinoma and large cell neuroendocrine tumors are considered to be part of this group.

Small Cell Lung Cancer (SCLC) makes up 15-20% of all lung cancer cases.  This is a fast-growing cancer that spreads rapidly to other parts of the body.

Mesothelioma is a cancer of the lining of organs and can originate in the lungs or the abdomen, heart, and chest.  It is associated with exposure to asbestos.

Carcinoid tumors are a type of neuroendocrine tumor that can originate in the lungs or small intestine.

7. Cutting-Edge research helps us attack lung cancer head on.

NFCR-funded scientists are working around-the-clock on projects that can help us attack lung cancer. For example, in July, the FDA approved the drug Iressa® as front-line treatment for patients with non-small cell lung cancer (NSCLC). The approval is extended to only those patients whose tumors contain specific mutations, which were originally identified by NFCR scientist Dr. Daniel Haber. 

Also, thanks to NFCR-funded research by Dr. Alice Shaw, a new and better way to treat resistant cancers is emerging. By successfully identifying drug combinations that halted the growth of resistant cells in tumor models, her research will hopefully lead to the development of effective therapeutic strategies for patients with ALK-positive NSCLC (mutations in the ALK gene), which could be clinically tested within one to two years.

Read about NFCR supporters that help fund Dr. Shaw’s research projects.

This blog was originally published on November17, 2016

Please show your support by spreading awareness AND by taking action against the disease.

Support cancer research.  Without funding, we are not able to sustain our efforts to find a cure for lung cancer and all cancers.

Supporters’ Story

The Hillsberg Lung Cancer Translational Research Grant

Each year, about 8,000 patients in the United States and 40,000 worldwide are diagnosed with ALK-positive non-small cell lung cancer (NSCLC). And while patients typically respond well initially to targeted ALK-inhibitor therapy, unfortunately, almost all patients eventually develop resistance to these drugs and their disease progresses.

The lack of clinical development to address this issue caught the attention of two NFCR donors, Sanford and Penny Hillsberg, who are long-time supporters of cancer research.  They were determined to take action to solve this particular drug resistance problem. They turned to NFCR and established a donor-initiated research fund in 2013 to support promising research in this critical field.  Their biggest hope is that their partnership with NFCR will help accelerate the clinical development of new and effective treatments for those who have already run out of options for their resistant lung cancer.

“We are so happy to be part of this important research effort,” said Mr. Hillsberg.  “We have worked with NFCR for years, and we know their excellent track record of supporting high-quality science. That’s why we were excited to participate in their donor-initiated research model, which matched our interest in translational lung cancer research with some of the best scientists in the world. We know these efforts will benefit patients fighting cancer, and we are fully committed to continuing our support of the excellent translational lung cancer projects at NFCR.”

If you, too, are interested in establishing a donor-initiated research fund at NFCR, call us at 1-800-321-CURE (2873).

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Non-Invasive Liquid Biopsy Uncovers Key Information to Treat Cancer

A liquid biopsy can provide valuable insight into how to best fight cancer. This noninvasive diagnostic is particularly helpful for patients who cannot undergo a surgical biopsy or whose tumor sample has been exhausted. In the not-too-distant future, liquid biopsies may be used to guide cancer treatment decisions and even screen for tumors that are not yet visible through imaging.

Liquid biopsies are a non-invasive alternative to surgical biopsies which enables doctors to discover a range of information about a tumor through a simple blood sample. In addition to providing a current picture of a patient’s cancer, liquid biopsies can be used for early detection of cancer, to monitor responses to treatment, give an early warning about possible recurrence and help explain why some cancers are resistant to treatment.

New study released by Dr. Wei Zhang

NFCR-funded scientist Dr. Wei Zhang of the Precision Oncology Center of Wake Forest Baptist Comprehensive Cancer Center (WFBCCC) just released the latest results of his study using liquid biopsies in a paper entitled “Circulating mutational portrait of cancer: manifestation of aggressive clonal events in both early and late stages” which was published in the Journal of Hematology & Oncology.

In this study, Dr. Zhang and his team isolated circulating tumor DNA (ctDNA) from the plasma of 177 patients diagnosed with cancer at both early and advanced stages. The majority of these patients (103 patients) had lung cancer, while the remaining 74 patients had been diagnosed with other solid tumor cancers including head and neck, colorectal, pancreatic, gastric and other cancer types. The team then performed next generation DNA sequencing to identify mutations in a panel of key cancer-causing genes from the plasma samples.  Key findings include:

  • Mutations in TP53, EGFR, and KRAS genes were most prevalent in this study, and mutations in BRCA1, BRCA2, and ATM were found in 18.1% of cases.
  • Mutation rates (number of mutations) of ctDNA were similar in early (I and II) and late stage (III and IV) cancers.
  • Patients with higher mutation rates had significantly higher mortality rates.
  • Lung cancer of never smokers exhibited significantly higher ctDNA mutation rates as well as higher EGFRand ERBB2 mutations than ever smokers.
  • Mutations of key genes found in the tumor tissue could remain in circulation even after frontline radiotherapy and chemotherapy, suggesting these mutations represented resistance mechanisms.
  • Five lung cancer patients known to have EGFR mutations in their tumor were monitored through multiple plasma sampling and ctDNA tests over time. Results showed distinct changes in ctDNA mutation portraits that are consistent with cancer progression or response to EGFR drug treatment.  This experiment further substantiated the benefits of repeated liquid biopsy as a substitute of invasive tumor biopsy for continued disease monitoring and treatment adjustment based on changes in gene mutations of the tumor.

    Bench to bedside: Integrating research into today’s treatments

    Wei ZhangDr. Zhang’s research demonstrates that liquid biopsy can be an effective, non-invasive, pain-free tool to identify driver mutations or mutations that sensitize or resist treatments as well as monitor cancer progression. Detection of ctDNA (circulating tumor DNA) in a liquid biopsy can also be a non-invasive early detection method for screening high risk populations such as smokers leading to real-time changes in treatment.

    In certain instances, such as with many lung cancers, new gene mutations occur as the cancer is treated or even progresses. To assess these changes, new tumor sample is needed, but repeated surgical biopsies are risky, painful and often times, simply not feasible to obtain. On the other hand, a liquid biopsy would allow doctors to obtain multiple samplings over a period of time easily and without harm to the patient.

    Liquid biopsy will become a powerful next generation tool that may lead to a brighter future in patient care‑  one where early diagnosis  and the delivery of more effective treatments could be managed with a simple blood draw.


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9 Must-Know Facts About Colorectal Cancer

Colorectal cancer (cancer of the colon and rectum) continues to affect millions of men and women worldwide, and understanding the disease and what we can do to prevent it is the first step toward a cure.

Quick stats:

  • Colorectal cancer is the third most common cancer diagnosed in both men and women in the U.S.
  • Although the death rate from colorectal cancer has been dropping for the past 30 years, it is still the second leading cause of cancer death in the U.S.
  • The overall lifetime risk of developing colorectal cancer is: 1 in 21 for men and 1 in 23 for women.[i]
  • There are currently more than one million colorectal cancer survivors in the U.S.[ii]

Here’s a list of nine facts you need to know about colorectal cancer. And make sure you read about related work by NFCR-funded scientists Dr. Wei Zhang, Dr. Daniel Von Hoff, Dr. Laurence Hurley and Dr. Yung-Chi Cheng.

1. With regular screenings, colorectal cancer is preventable.

Colorectal cancer screening saves lives. In many cases, a screening can prevent colorectal cancer by finding and removing polyps before they turn into cancer. Screening also helps find colorectal cancer at an early stage, when treatment is most effective.

Studies show that regular screening could prevent 1/3 of colorectal cancer deaths in the U.S. The five-year survival rate is 90% if detected early.[iii]

2. Age is the #1 risk factor for colorectal cancer.

90% of colorectal cancer cases appear in men and women 50 years old or older, and the risk for developing this cancer increases with age. Yet, like most disease trends, this isn’t absolute – younger people can get colorectal cancer too.

3. There are warning signs, but not EARLY warning signs.

Like lung cancer and cervical cancer, colorectal cancer can be hard to detect in its earliest stage. Symptoms can include a change in bowel habits; blood in the stool; diarrhea, constipation or feeling that the bowel does not empty all the way; frequent gas pains, bloating, fullness or cramps; weight loss for no known reason; nausea, tiredness and vomiting.[iv] If you experience any of these symptoms, contact your doctor right away.

4. Lifestyle choices impact colorectal cancer risk.

Many lifestyle-related factors are directly linked to colorectal cancer risk. Obesity not only increases your risk of having colorectal cancer by 30%,[v] but it also increases the likelihood of poor treatment outcomes and complications.[vi] Smoking also increases your risk of developing and dying from this type of cancer. One recent study reported that patients with colon cancer who smoke were 14% more likely to die from their colon cancer within five years than patients who had never smoked.[vii]

Other risk factors include heavy alcohol use, lack of exercise and diets high in red and processed meats. Additionally, cooking meats at a very high temperature can create chemicals on your food that may increase your cancer risk.

5. Family history matters.

People with a first-degree relative (parent, sibling, offspring) who has colorectal cancer have two to three times risk of developing this disease.[viii] A personal or family history of polyps (adenomas) also puts you at higher risk – especially if the polyps are large or if there are many of them.

6. Health conditions can increase your risk.

Your risk of colorectal cancer increases if you have the following conditions: Type 2 diabetes; inflammatory bowel disease (IBD), including either ulcerative colitis or Crohn’s disease; and having an inherited syndrome like Familial adenomatous polyposis (FAP) or Lynch Syndrome.[ix]

7. Regular colorectal cancer screenings typically begin at age 50.

Because polyps tend to be seen most often in people 50 years of age and older, experts recommend universal screening for colorectal cancer beginning at this age. If you are under 50 and have a family history of colorectal cancer or other risk factors, talk to your doctor about when you should start regular screening.

8. There are different screening options.

Screening tests can include: colonoscopy; sigmoidoscopy; barium enema; CT colonography or virtual colonoscopy; and at-home tests like the fecal occult blood test, fecal immune testing or stool gene testing.[x] Talk to your doctor to see what screenings are most appropriate for you given your family history, age and lifestyle choices. For more information on cancer screenings, please refer to our.

9. Research helps us attack colorectal cancer – and all types of cancer.

NFCR has distinguished itself from other organizations by emphasizing long-term, transformative research that has the potential to save lives. Our scientists are conducting a wide range of cutting-edge research focused on improving diagnosis and treatment of colorectal cancer – and all types of cancer.

Studying the system of genes that form colorectal cancer

NFCR Fellow Dr. Wei Zhang

NFCR-funded scientist, Dr. Wei Zhang, is the Director of the Wake Forest Baptist Comprehensive Cancer Center’s Precision Oncology Initiative. Dr. Zhang has vast experience identifying biomarkers and genes in colorectal cancer. His current research team is studying how gene expression, gene amplification and mutations relate to and regulate each other. Using data from next-generation sequencing, Dr. Zhang’s team is identifying the genetic drivers or growth-promoting genes of a patient’s cancer.

Dr. Zhang has previously identified microRNAs (miRNAs) as biomarkers to improve colorectal cancer prognosis and predict treatment response. He used blood samples from healthy donors and patients with stage I through IV colorectal cancer, and confirmed that one microRNA molecule – miR-141 – may predict the outcome for stage IV colorectal cancer patients.

Chinese herbal medicine curbs colorectal cancer treatment side effects

NFCR Fellow Dr. Yung-Chi Cheng

For approximately 20 years, with NFCR support, Dr. Yung-Chi Cheng, of Yale University’s School of Medicine, has explored the therapeutic properties of PHY906, a Chinese herbal medicine formula. Dr. Cheng and his laboratory team have discovered that cancer treatment with PHY906, combined with chemotherapy, alleviates
the unpleasant gastrointestinal side effects of chemotherapy for colon and rectal cancer patients. Moreover, their research demonstrated that PHY906 also has its own, solo anti-tumor attributes. If there is continued success in clinical trials, PHY906 could become one of the first FDA-approved oral herbal medicines for anti-cancer treatment.

Targeted drug treatment and key colorectal cancer gene

(Left to Right) NFCR Center for Targeted Cancer Therapies Co-Directors Dr. Daniel Von Hoff and Dr. Laurence Hurley

The c-Myc gene is a cancer-causing gene (or oncogene) that is amplified in colorectal cancer and is a tough molecule in terms of finding targets for drug development. NFCR-sponsored scientists Dr. Daniel Von Hoff and Dr. Laurence Hurley are creating drugs to block large clusters of DNA called “super enhancers,” which control the expression of a network of genes – including the critical and seemingly-undruggable c-Myc gene.

Shutting down colorectal cancer through the blood stream

Dr. Harold F. Dvorak

Dr. Harold Dvorak received funding from NFCR for over 30 year and is responsible for the discovery of the vascular endothelial growth factor (VEGF). His discovery fostered the entire field of vascular biology and led to the development of VEGF-targeting anti-angiogenic drugs. Unlike other anti-cancer drugs that aim to directly kill tumor cells, drugs that target VEGF cut off the blood supply that tumors need to survive.
In 2004, the VEGF-targeting drug Avastin® was approved by the FDA for the treatment of colorectal cancer. More than 280 clinical trials are currently investigating the use of Avastin® in over 50 tumor types.











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