Research needs

In patients with advanced nonsmall cell lung cancer, drugs against newer molecular targets (e.g. Ros1) are currently being evaluated in early-phase clinical trials. It is a priority that these agents are then tested in later-phase trials so that any benefits discovered can be translated into better patient outcomes as soon as possible.

Refining radiotherapy techniques also holds considerable promise, while there is ongoing work in the area of biomarkers for the early diagnosis of lung cancer. Novel staging tools (for example, newer PET ligands and magnetic resonance imaging (MRI)) may improve the accuracy of  lung cancer staging, thereby leading to more appropriate treatment for patients.

Lung cancer screening is another promising research field. Since the majority of lung cancer patients present late in the natural history of the disease, the concept of screening high-risk asymptomatic people to detect early-stage (curable) disease is attractive. The advent of low-dose helical CT has revolutionised the landscape of lung cancer screening and has made this a possibility. In 2011, the National Lung Screening Trial (NLST) in the USA demonstrated that screening with the use of low-dose CT reduces mortality from lung cancer by 20%. The challenge is now to determine whether results from this trial can be reproduced in trials in Europe and whether the intervention is cost-effective. Currently, there is optimism about screening with low-dose CT scanning, with results awaited from ongoing lung cancer screening trials in western Europe (NELSON and the UK Lung Cancer Screening (UKLS) trial). Further research is required on identifying high-risk patient groups using phenotypic or genetic characteristics or biomarkers. Finally, studies of pre-malignant lesions may offer insight into cancer formation and provide targets for preventing the development of lung cancer.

There is a great need to establish well-organised and reliable lung cancer databases with a uniform design and standardised collection of (and ready access to) epidemiological data across Europe. This would allow trends to be identified, and prompt investigation at a public health level to clarify the reasons  for differences in survival between countries. In addition, reporting of the disease and its impact on patients would be improved.

Lung cancer in never-smokers is of particular interest, and these patients comprise a growing proportion of adults with lung cancer in economically developed countries. It is important to identify epidemiological, clinical and molecular patterns of this disease and, in particular, the relevant risk factors. A uniform database of patients with lung cancer would be an important step forward in achieving these goals.

See the entire Lung Cancer Chapter