2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

lines are not necessarily routinely translated into clinical
practice.
Shanghai is among the few cities that have detailed
epidemiologic data on their patients with lung cancer. The
Shanghai Municipal Center for Disease Control and Prevention
reported a total of 25,927 male lung cancer deaths and
10,468 female lung cancer deaths between 2003 and 2007.
The pathologic distribution for adenocarcinoma, squamous
cell carcinoma and small cell lung cancer were 58.9%, 35.4%,
and 5.7%, respectively. Interestingly, the death rate has a
slight trend of decline since 2001, and the 5-year survival
rate has increased in the last decade. In Beijing, a total of
32,845 cases of lung cancer were diagnosed between 1998
and 2007. 8 The crude incidence in women has increased.
However, only approximately half of the patients (54.9%)
had histologic confirmation of diagnosis. Histologic subtypes
of squamous cell carcinoma and adenocarcinoma was 30.4%
and 42.8%, respectively, in 1998, and changed to 24.1% and
46.8% in 2007, respectively.
The quality of thoracic surgery is generally good in urban
major hospitals. Yang and colleagues 9 performed 621 anatomic
lobectomies between 1996 and 2003, of which 113 were
by video-assisted thorascopic surgery (VATS). Perioperative
morbidity and mortality rates was 0% and 0.9%, respectively.
The postoperative complication rate was 10.6%. The
survival rates at 5 years for stage I, II, and III non-small cell
lung cancer (NSCLC) were 79.1%, 45.2%, and 22.2%, respectively
for VATS; and 81.6%, 47.2%, and 24.1%, respectively,
for open lobectomy. Chen and colleagues from Peking University
School of Oncology (personal communication, November
2011) performed surgical resection in 660 patients
and reported 5-year survival for stage I, II and III disease to
be 78.3%, 52.3%, and 32.8%, respectively. These results are
not different from the international standard.
There is only limited information on the clinical practice
in management of advanced-stage disease in China. A national
survey on medical treatment of NSCLC was performed
by the Sun Yat-Sen University Cancer Center in
Guangzhou (personal communication, December 2011).
Questionnaires were sent to 202 practicing doctors in 135
centers in 12 major cities (Beijing, Shanghai, Guangzhou,
Chengdu, Hangzhou, Xi’an, Jinan, Wuhan, Tianjin, Nanjing,
Chongqing, and Shenyang). A total of 987 cases were
recorded (381 early-stage lung cancer, 606 advanced-stage
lung cancer). The majority of patients (525 of 606; 86.7%)
with advanced-stage lung cancer received first-line chemo-
434
therapy. The most commonly used regimens included gemcitabine/platinum
(27.4%), docetaxel/platinum (16.2%), and
paclitaxel/platinum (13.5%). For patients with adenocarcinoma,
approximately 16% would use pemetrexed/platinum.
Only 4.9% used first-line EGFR TKI. The main reason is
that the number of patients who underwent EGFR mutation
analysis was low. Only 47 patients underwent EGFR mutation
analysis, of whom 22 (47%) were positive for the
mutation. Demographics of the tested population are not
available, but the high mutation rate suggested that patients
were clinically selected (female, nonsmoker, adenocarcinoma)
for testing. Only 54 patients (9%) received secondline
treatment. Interestingly, gemcitabine/platinum was
still the most popular regimen, whereas single-agent docetaxel,
gefitinib, and pemetrexed account for 13%, 11%, and
9.3%, respectively. According to the authors, this is the first
national survey in China. This reflects the true clinical
practice across vast geographic areas. However, the study
falls short because of the relatively small sample size for a
large number of participating centers. On average, there
were fewer than eight patients from each center, and these
patients may not be representative of the clinical practice of
hosting hospital. This survey provides only a rough view of
current practice in management of advanced NSCLC in
China.
Molecular-targeted therapy has become an important part
of disease management. China contributed a substantial
proportion of patients to the IPASS study that established
the role of gefitinib in patients with lung cancer with EGFR
mutation. 10 However, the afore-described survey suggested
that molecular testing is not widely practiced in China. A
total of 26 hospitals in China have in-house capacity to test
for EGFR mutation as a standard service, whereas another
50 hospitals routinely send their specimens to other hospitals
or private laboratories. In 2011, an estimated 12,000
EGFR mutation analyses were performed, which is only a
small fraction of patients with lung cancer in China. The
cost of testing and availability of tumor sample are the
major reasons for not testing; furthermore, the majority of
patients were not able to afford the expensive EGFR TKI.
The Research
MOK, ZHOU, AND WU
Fig 2. Growth in Number of Clinical Trials in
China.
SEER, Surveillance, Epidemiology and End
Results.
China has become an important partner and contributor
in laboratory, translational, and clinical research for lung
cancer. The nation’s case number represents the largest
patient resource in the world. Educated investigators are