2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

LUNG CANCER IN CHINA
Fig 1. Chinese Guideline for Diagnosis
and Treatment of Lung Cancer.
Abbreviation: TNM, tumor mode metastasis.
tobacco to minors, there is again no specific action on
execution of this law. Unless the government has substantial
change in attitude toward tobacco control, the burden
related to lung cancer is unlikely to cease.
The Treatment
Treatment for lung cancer is quite diverse in China.
Economic and technologic advantages in urban areas provide
much better access to high-quality care, whereas treat-
KEY POINTS
● China has a large burden of lung cancer. Being the
largest tobacco-producing country and a major consumer,
its incidence of lung cancer is expected to
increase unless major action on tobacco control is
taken.
● Treatment guidelines are available, but clinical practice
may not always follow the guidelines.
● With the exception of bevacizumab, most of the active
agents for lung cancer are available in China. Drug
cost is either partially reimbursed or self-financed.
● Despite the high incidence of lung cancer, routine
EGFR mutation analysis is available to only a small
fraction of patients and is limited to major academic
centers.
● The Chinese Thoracic Oncology Group (CTONG) is an
extremely active and well-organized study group.
Within a few short years since establishment, they
have already published major studies such as OPTI-
MAL and INFORM.
ment in rural area could be quite primitive. Unfortunately,
limited information is available from rural area, and for the
selected patients from rural areas who can afford the medical
expenses, they would travel to urban areas for cancer
care. Thus, in this review, we will focus on only the current
status of lung cancer treatment in major cities.
Treatment guidelines are available, although there is no
legal or financial obligation for doctors to follow the guidelines.
These are being used as references because the reimbursement
system does not always follow the guidelines.
The most commonly used guidelines include the Chinese
Guideline for Diagnosis and Treatment of Lung Cancer 7 and
the Chinese translation of the National Comprehensive
Cancer Network (NCCN) Guideline. The former was developed
by local experts, whereas the latter is a direct translation
of a U.S. national guideline with minor variations.
Contents of the two guidelines are very similar. The basic
framework of the Chinese guideline is summarized in Figure
1. Use of a multimodality approach is well recognized. The
major difference is limited to the availability of specific
medication in China. For example, bevacizumab has not
been approved for use in lung cancer in China. The Chinese
Guideline stated that “antiangiogenesis drug may be added
if applicable,” whereas the Chinese translation of NCCN
guidelines include endostar (a Chinese made angiotensin)
and ginseng extract as an option for first-line treatment in
combination with chemotherapy. Pemetrexed was not approved
for first-line use until recently. Apart from the minor
variation, the use of surgery for early-stage disease, chemoradiotherapy
for local advanced disease, epidermal growth
factor receptor tyrosine kinase inhibitor (EGFR TKI) for
patients with EGFR mutation, and systemic chemotherapy
for stage IV disease are well accepted. However, the guide-
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