NEPA Vital Signs - Winter Spring 2018 - 19

WINTER/ SPRING 2018

Feature

LUNG CANCER VACCINE
There has been news of a vaccine for lung cancer developed
in Cuba over the past few years. It became available in Cuba
in 2011 and has been used in not only Cuba, but also Bosnia
and Herzegovina, Colombia, Paraguay, and Peru, according
to the Roswell Park Institute (where it is now in clinical trial).
CimaVax, was developed for non-small cell lung cancer (NSCLC)
specifically targeting the overexpression of Epidermal Growth
Factor Receptor (EGFR). EGFR is the most common oncogene
mutation. The clinical trial currently ongoing in the US is
at Roswell Park Institute in Buffalo, NY. The trial was open
to persons with EGFR NSCLC at stage IIIB or IV. The study
began enrolling patients in January 2017 with a goal of 60-90
total. The vaccine is given along with Opdivo (also known as
nivolumab - a PD-1 immunotherapy agent).

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346887/
https://clinicaltrials.gov/ct2/show/NCT02955290

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that question. We only need to look at emerging information
in lung cancer to further blur this issue.

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Over the past 10 years or so it has been discovered that people
who never smoked seem to have oncogene mutations which lead
to non-squamous non-small cell lung cancer. Some of these are
Epidermal Growth Factor Receptor (EGFR), Kirsten rat sarcoma
virus (KRAS), and Anaplastic Lymphoma Kinase (ALK) - to
name a few.3 But what if we found out that some persons who
smoke or smoked also have these oncogene mutations? What
does that mean? Would they have developed lung cancer whether
they smoked or not? We really don't know - because we haven't
looked. All persons with Non-Small Cell Lung Cancer, whether they
smoked or not, should be tested for these oncogene mutations.

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PEDIATRICS OF
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As a physician I have enjoyed the increase in required evidence
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disease,
stroke, back pain, poor surgical outcomes... to name a
few. This article is not designed to question the fact that tobacco
is bad - it is instead to hopefully result in us questioning some
of our current thinking.

As for the persons who never smoked and develop lung cancer
the next question is - "were you exposed to radon" because
we have all been told that it is the second leading cause of lung
cancer - right? I need to direct you to a really interesting article
published in 2011 in PubMed Central® (PMC), a free full-text
archive of biomedical and life sciences journal literature at the
U.S. National Institutes of Health's National Library of Medicine
(NIH/NLM). This article titled: Residential Radon Appears to Prevent
Lung Cancer 4 is a very interesting, although somewhat challenging,
article which states that residential radon at the Environmental
Protection Agency's action level of 4 picocuries/L (approximately
150 Bq m−3) actually protects both smokers and non-smokers
from developing lung cancer. Obviously this requires additional
research and review - what if as this article states, when we place
mitigation systems in homes due to moderately high levels of
radon we are actually removing the natural protective agents and
therefore potentially causing an increased risk of lung cancer?
Wouldn't that be an interesting change in thinking?
N E PA

* Timothy D. Welby M.D.
* Kate A. Tigue M.D.
* John H. Marx M.D.
* Debra S. Georgetti M.D.
* April Troy M.D.
* Kathryn Horutz PA-C
* Dawn Strong PA-C

The next time someone says that they or a loved one has lung
cancer let's not ask if they smoked, instead let's offer them the
compassion deserved for developing the stigmatized and forgotten cancer.

KAREN E. ARSCOTT, D.O., M.SC., AOBNMM, is
an Associate Professor of Medicine at what is now Geisinger
Commonwealth School of Medicine and Chair of the Northeast/
Central Pennsylvania Interprofessional Education Coalition.

VITAL SIGNS

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346887/ https://www.clinicaltrials.gov/ct2/show/NCT02955290 http://www.pedsofnepa.com

NEPA Vital Signs - Winter Spring 2018

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