Lung Cancer: Beyond the Guidelines

This issue of JNCCN contains the clinical practice guidelines for both small cell (SCLC) and non-small cell lung cancer (NSCLC). Over the past few years, the therapeutic options for patients with lung cancer, particularly NSCLC, have increased dramatically. For patients with potentially curable disease, combined-modality therapy has been fully integrated into care and has shown benefits as adjuvant chemotherapy for patients with completely resected stage II or III NSCLC and as concurrent chemoradiotherapy for those with unresectable stage III NSCLC and limited-stage SCLC. For patients with advanced disease, broader recognition of the benefits of various palliative care options, including the rational use of chemotherapy and targeted therapy, have improved both the quality and length of life. As a realistic clinician, however, I must acknowledge that the gains achieved thus far have been modest. Lung cancer remains an enormous public health problem. In the United States, lung cancer accounts for more deaths every year than colon, breast, prostate, and pancreatic cancers combined. Few people realize that nearly twice as many women in the United States die each year of lung cancer than of breast cancer. The personal and societal toll of this disease is staggering. So how can we favorably impact these dismal statistics? Theoretically, prevention is the best hope, but the prevalence of smoking has hit a plateau in the United States and is rising at an alarming rate in the developing world. Practically, further progress can not be made on preventing lung cancer until we, as a society, recognize...

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Gregory P. Kalemkerian, MD, is a professor of internal medicine at the University of Michigan Medical School and Co-Director of thoracic oncology at the University of Michigan Comprehensive Cancer Center. Dr. Kalemkerian completed medical school and an internal medicine residency at Northwestern University in Chicago, followed by a fellowship in medical oncology at Johns Hopkins Oncology Center in Baltimore. He is currently coordinating the Multidisciplinary Lung Cancer Clinic and the lung cancer research clinical program. He is also chair of the NCCN Small Cell Lung Cancer Panel and a member of the NCCN Non-Small Cell Lung Cancer Disease-Specific Executive Committee.

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