Lung Cancer.pdf

Molecular Events in Lung Cancer 297
KEY PRACTICE POINTS
• Lung cancer development involves a multistep process occurring throughout
a field of tissue exposed to carcinogens. Molecular changes can be found
throughout the exposed lung, and the extent of change may be associated
with lung cancer risk.
• Individuals differ in their susceptibility to tobacco smoking because of individual
differences in carcinogen activation, detoxification, DNA repair, and tissue
response to chronic exposure to carcinogens.
• Smokers who quit continue to have an increased risk of lung cancer development.
More than 50% of new lung cancer cases involve former smokers.
• Prevention and early detection provide the greatest chance for reducing the
morbidity and mortality of lung cancer.
• The molecular characteristics of a patient’s lung tumor have prognostic implications
and may help to identify the most efficacious treatment approach.
• Molecular characterization of lung tumors has led to the identification of new
targets for prevention and therapy. Clinical trials are ongoing involving the
use of monoclonal antibodies against growth factor receptors and angiogenesis
stimulators, the use of small peptide inhibitors of dysregulated signaling
pathways, and gene replacement strategies.
• Targeted molecular therapies are now being combined with surgery, radiation
therapy, and chemotherapy to augment and extend treatment response.
Suggested Readings
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Hanahan D, Weinberg RA. The hallmarks of cancer. Cell 2000;100:57–70.
Hirsch FR, Franklin WA, Gazdar AF, et al. Early detection of lung cancer: clinical
perspectives of recent advances in biology and radiology. Clin Cancer Res
2001;7:5–22.
Hittelman WN. Genetic instability assessments in the lung cancerization field. In:
Brambilla C, Brambilla E, eds. Lung Tumors: Fundamental Biology and Clinical
Management. New York, NY: Marcel Dekker; 1999:255–267.
Hittelman WN. Molecular cytogenetic evidence for multistep tumorigenesis: implications
for risk assessment and early detection. In: Srivastava S, Hensen DE,
Gazdar A, eds. Molecular Pathology of Early Cancer. Washington, DC: IOS Press;
1999:385– 404.
Hong WK, Spitz MR, Lippman SM. Cancer chemoprevention in the 21st century:
genetics, risk modeling, and molecular targets. J Clin Oncol 2000;18(21
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