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Dr. Mark A. Socinski

A drug already approved for the treatment of kidney cancer shows promise for the treatment of some lung cancers, too. That's according to research presented at the American Society of Clinical Oncology annual meeting held in Atlanta this past June.

Dr. Mark A. Socinski, an associate professor of medicine at the University of North Carolina at Chapel Hill, explains to Medical News that the oral drug sunitinib malate, already shown to inhibit a kidney tumor cell's ability to develop new blood vessels, offers the same avenue of hope for some patients with non-small cell lung cancer.

He says the initial research, for which he is the principal investigator, "was validation of the paradigm, if you will, that anti-angiogenic strategies are useful in the treatment of non-small cell lung cancer. That study really opens up the possibility that other ways to target anti-angiogenesis may be useful in non-small cell lung cancer." The word "angiogenic" means blood vessel growth.

Socinski's research initially involved 63 patients at several sites, including a site in Italy and one in Spain. The patients were of a difficult, very ill group whose advanced disease had been previously treated with chemotherapy. Thus, their options were limited. Of the 63, six showed progress, while in an additional 27, their disease stabilized. "So for about 50 percent of patients, we think that sunitinib had some level of clinical benefit or clinical activity," he says. Those patients received one 50-milligram pill daily for four weeks, followed by two weeks off the treatment. During the treatment, three patients died, two from pulmonary hemorrhage and one from a cerebral hemorrhage. Researchers suspect a complication of anti-angiogenic therapy in general in those three cases, Socinski says.

An anti-angiogenic therapy for lung cancer already exists in the drug Avastin®, which has been shown to keep new blood vessels from forming when delivered in conjunction with chemotherapy.

That's the next step for sunitinib, Socinski says. "We believe that probably the greatest benefit of anti-angiogenic therapy is to study sunitinib in combination with chemotherapy, and those trials are ongoing," he says. In addition, Socinski and his colleagues have enrolled an additional 47 patients, who are trying a lower dose of sunitinib (37.5 milligrams daily) on a continuous basis to see how that works.

One critical way sunitinib differs from Avastin is in its delivery system. Avastin is typically given intravenously every three weeks or so for lung-cancer patients, while sunitinib is an oral drug. Also, he says sunitinib "has its angiogenic effect by a different mechanism," which means it may be effective in patients who have had no luck with Avastin.

Socinski cautions that his phase 2 clinical trial was not randomized; nonetheless, "a number of phase 3 ideas are circulating around at this point, though no concrete decisions have been made."

Socinski acknowledges that lung cancer therapy is a frustrating arena, since most patients "present with more advanced disease, usually stage 3 or 4." Compare that to breast cancer, when the problem is usually discovered earlier. Also, most lung-cancer patients are in their late 60s or early 70s, and because of a smoking history, they suffer other co-morbid conditions such as heart disease, hypertension and emphysema. The good news is that the "nihilism associated with lung cancer," the belief that smokers prompted their disease, is fading, he says.

"We're in a different era nowadays," Socinski says. "The prevailing winds are that a majority of patients who are diagnosed with lung cancer are current nonsmokers who have kicked the habit, and about 10 to 12 percent of them were never smokers."

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