More than a quarter century after Yul Brynner’s death from lung cancer, treatment advances offer some patients new options, but the cancer continues to claim more lives than any other. And the actor’s haunting anti-smoking message lives on.
When Richard Rodgers and Oscar Hammerstein’s musical The King and I opened on Broadway on March 29, 1951, expectations were high. The famed songwriting team had already created four hit shows, and the role of Anna was to be played by theater star Gertrude Lawrence, whose name blazed across the top of the marquee. Less attention was paid to the relatively unknown actor Yul Brynner, who had been cast as the King. But after opening night, no one would forget his name.
The King and I is about the relationship between the King of Siam and a widow, Anna, who teaches English to his children. The role wasn’t created for Brynner, but Brynner was made for the part. As New York Times theater critic Frank Rich wrote in January 1985, when Brynner returned to Broadway with The King and I for the third time: “Mr. Brynner is, quite simply, The King. Man and role have long since merged into a fixed image that is as much a part of our collective consciousness as the Statue of Liberty.”
Rich’s piece was equal parts review and tribute, as it was widely known that Brynner had been diagnosed with inoperable lung cancer 16 months earlier. The secret had gotten out when Brynner’s voice grew hoarse from his radiation therapy, forcing his touring production of The King and I to close. But as soon as he learned that the treatment had slowed his tumor’s growth, the 63-year-old actor, who had recently married for the fourth time and was a father of five, quickly returned to his role. Regrettably, metastatic lung cancer doesn’t take direction from anyone, not even a king as commanding as Brynner. His final curtain call—his 4,633rd performance as the King—was on June 30, 1985. He died on Oct. 10, less than four months later. To this day, no one has performed a part as many times.
An International Upbringing
Yul Brynner was born Juli Borisovitch Bryner, in Vladivostok, Russia, on July 11, 1920, the second child of Boris Bryner and Marousia Blagovidova. (He added the second “n” to his last name years later, so that English speakers would pronounce it properly.) Vladivostok is a port city located in the southeastern region of Russia, close to the Sea of Japan. As Yul Brynner’s son, Rock, explains in his book Empire & Odyssey: The Brynners in Far East Russia and Beyond, for three generations the family’s choices were closely intertwined with the city’s location and the wars that encompassed the region.
Yul Brynner’s grandfather Julius Bryner moved from Switzerland to Vladivostok in the 1870s, established a successful import-export company, and went on to become one of the city’s most respected businessmen. Boris Bryner followed in his father’s footsteps; when Vladivostok became part of the newly established (and short-lived) Far Eastern Republic in 1920, during the Russian Civil War, he was asked to serve as minister of industry.
Boris Bryner’s high-powered position required extensive travel, and when Yul was 3, his father left his mother for a woman he had met in Moscow. To escape ongoing regional conflict, Yul’s mother moved him and his older sister to Harbin, China. But as war loomed between China and Japan, she feared a Japanese invasion of Harbin, and in 1932 she moved the family to France. There, Yul’s dreams of becoming an actor blossomed as he played guitar in Russian nightclubs in Paris, trained as a trapeze acrobat and joined a theater company. But Paris was not home for long. In 1938, Yul’s mother was diagnosed with leukemia, and, fearing that the Germans would soon invade France, she and Yul moved back to Harbin. By 1940, it became clear that he could no longer care for his mother alone, and the two moved to New York City, where his sister lived.
The Lights of Broadway
When he arrived in New York, Brynner barely spoke English. But that didn’t stop him from heading off to Connecticut to study acting with the renowned Russian teacher Michael Chekhov. There, he learned how to use his voice and body and began to embrace what it meant to be an actor. “When you are a pianist,” Brynner later explained, “you have an outside instrument that you learn to master through finger work and arduous exercises. … As an actor, you the artist have to perform on the most difficult instrument to master, that is, your own self—your physical and your emotional being.”
Brynner’s first Broadway performance was a small part in Shakespeare’s Twelfth Night in December 1941. Over the next few years, his acting opportunities were few, and Brynner decided to follow his first wife, actress Virginia Gilmore, to Hollywood, where he found work as a director at the new television station CBS. His path seemed set. Then in 1950 a friend convinced him to return to New York City to audition for the King.
Virtually overnight, Brynner became a household name. In 1952, he won a Tony Award for his performance in The King and I, and when the play was made into a movie a few years later, there was no question the part was his. Brynner proved to be as good on film as he was onstage, winning the 1956 Academy Award for Best Actor. Over the next two decades, Brynner appeared in more than 40 other films, but it was the role of the King that he returned to time and time again.
A Cancer Diagnosis
In September 1983, Brynner made an appointment to see his physician after finding a lump on his vocal chords. (He had been diagnosed with a precancerous lump on his larynx just the year before.) Brynner was in Los Angeles, with only three hours to go before he took the stage for his 4,000th performance, when he received the test results. The new lump was merely an enlarged gland, he learned. But there was a much bigger problem: He had lung cancer, and the tumor was too close to his heart to attempt surgery.
Initially, Brynner was determined to keep performing. But ultimately he had to admit that the radiation therapy, which was his only option for treatment, had made his throat so painful he could no longer act. It also became clear that the public wasn’t eager to watch an esteemed actor struggling with the effect cancer was having on his performance. “He called me one day to tell me ticket sales were falling off,” says Rock. “ ‘Cancer,’ he complained, ‘is a real poison at the box office.’ ”
Lung Cancer’s Toll
When Brynner was diagnosed, lung cancer was the leading cause of cancer deaths among American men, and the second-leading cause of cancer deaths among American women. It is now the leader among both men and women, with more Americans dying of it than of colon, breast and prostate cancer combined. The American Cancer Society estimated that in 2011 about 221,000 Americans would be diagnosed with lung cancer, and that about 157,000 would die of it, making the disease responsible for about 27 percent of all U.S. cancer deaths this year.
Yet many people remain unaware of lung cancer’s toll. A recent survey of 1,000 Americans conducted by the National Lung Cancer Partnership, a nonprofit patient support organization, found that nearly 80 percent of the respondents didn’t know that the No. 1 cancer killer in the U.S. is lung cancer. This is due, in part, to the fact that there are few long-term survivors. “Because lung cancer has a [five-year] survival rate of only 15 percent, you don’t have that mass of survivors who want to stand up and give back and say thank you for saving my life,” says Kim Norris, the president of the Los Angeles–based Lung Cancer Foundation of America. The lack of public awareness is also connected to the smoking-related stigma attached to lung cancer, she says. “Even family members can become victims of the stigma and be hesitant or unwilling to become an advocate or donate to an advocacy organization,” says Norris, “because they believe their loved one did this to themselves.”
The stigma attached to lung cancer also affects both government funding and corporate donations. Regina Vidaver, the executive director of the National Lung Cancer Partnership, explains that if you look at cancer funding through the lens of each cancer’s contribution to cancer deaths, lung cancer receives a disproportionately small share of the funding pie. In 2009, the National Cancer Institute’s research budget allotted just under $247 million for lung cancer, compared with $294 million for prostate cancer, and about $600 million for breast cancer.
Treatment Advances
Despite this funding disparity, lung cancer treatments have advanced in important ways since Brynner’s death in 1985. If Brynner had been diagnosed today, says Daniel Morgensztern, a clinical oncologist at the Yale Cancer Center in New Haven, Conn., “I think his odds might have been better.” Improved surgical techniques, he says, might have made it possible for Brynner to have surgery, despite the tumor’s proximity to his heart. He’d also have had a PET scan (a technology that wasn’t widely available until 1998) to see if the tumor had spread to other organs. This would have helped to determine his treatment.
Brynner also would have been offered more treatment options. The type and stage of Brynner’s lung cancer are unknown, but it’s likely he had non–small cell lung cancer. If he was stage III, says Morgensztern, he’d probably have had chemotherapy in addition to radiation. If he was stage IV, his tumor would have been tested to see if he was a candidate for one of the targeted therapies that in the early 2000s began to be approved for the treatment of advanced non–small cell lung cancer.
One of these drugs is bevacizumab (Avastin), which can disrupt angiogenesis—the growth of the blood vessels a tumor needs to survive—by blocking a protein called vascular endothelial growth factor (VEGF). Others are therapies known as epidermal growth factor receptor (EGFR) inhibitors, which work by blocking a protein that fuels tumor growth. These drugs—erlotinib (Tarceva), gefitinib (Iressa) and cetuximab (Erbitux)—are effective in only lung tumors that test positive for the EGFR genetic mutation. The most recent targeted therapy option is crizotinib (Xalkori), a drug that inhibits a biochemical pathway called anaplastic lymphoma kinase (ALK), which promotes tumor growth. It received approval from the U.S. Food and Drug Administration in August 2011 for the treatment of advanced non–small cell lung cancer that has an altered ALK gene. Studies suggest that about 3 to 5 percent of non–small cell lung cancers have this alteration.
A Dramatic Ending
Brynner was well aware that although he’d quit smoking in 1971, he was still at risk of developing lung cancer, says Rock. He’d smoked two-to-four packs a day since the age of 12, and “he was always holding a cigarette in the photos he chose for his publicists to distribute to his fans.”
In an effort to educate others about the risks of tobacco, Brynner orchestrated the creation of an anti-smoking commercial a few months before his death. He arranged an interview on Good Morning America, and he made a point to emphasize the importance of not smoking. Then, working with the American Cancer Society, he used a clip from his interview to create a public service announcement. Within days of his death, the PSA was running on the three major U.S. television networks, as well as on other stations throughout the world. For 30 seconds, his brown eyes stared into the camera, his distinctive voice uttering one last haunting plea: “Now that I’m gone, I tell you: Don’t smoke. Whatever you do, just don’t smoke.”
The idea that Brynner would have orchestrated a commercial that would influence how he was perceived decades later didn’t surprise anyone who knew him well. “He was the Emperor of the Universe,” says Rock. “Not just the King or the Pharaoh. He controlled everything within earshot and beyond. … From age 12 he learned how to seize control of every eyeball in a room.”
Despite guidelines calling for genetic mutation testing in certain patients with lung cancer, three new surveys fielded by Harris Interactive reveal a disconnect in the understanding of and communication about genetic mutation testing among healthcare professionals and cancer patients. Results of the surveys were announced today by Boehringer Ingelheim Pharmaceuticals, Inc., which sponsored the surveys in partnership with the Association of Community Cancer Centers (ACCC), ONS:Edge and the National Lung Cancer Partnership (NLCP).
Surveys of 95 community oncologists, 522 oncology nurses and 436 lung cancer patients across the U.S. were collected in October 2011 to measure perceptions and knowledge of genetic mutation testing and to identify unmet needs and gaps in education.
Cancer researchers are increasing their understanding of how certain mutations to cell DNA can cause cells to grow abnormally and form cancers, including lung cancer. Genetic mutation testing has the potential to identify these mutations and can aid in informed treatment decisions, but since the field is relatively new, knowledge of genetic mutation testing remains low and the practice has not been widely adopted.
The surveys found that while 94 percent of physicians responded that they discuss genetic mutation testing with their patients, only 17 percent of lung cancer patients surveyed were aware of genetic mutation testing. Nearly half of oncology nurses (44 percent) did not discuss genetic mutation testing with patients, primarily because they felt that they lacked the knowledge to discuss it (56 percent) or didn’t have the proper resources to share with their patients (33 percent). These findings highlight the need for a greater understanding of genetic mutation testing.
“Boehringer Ingelheim is committed to exploring the potential of personalized medicine and is excited by the possibility of being able to tailor an individual patient’s treatment based on genetic information,” said Christopher Corsico, M.D., M.P.H., Sr. Vice President, Medicine and Regulatory, Boehringer Ingelheim Pharmaceuticals, Inc. “Knowledge of genetic mutation testing among the medical and patient communities will help ensure that patients are receiving the most appropriate care as early as possible.”
Community Oncologists Focused on Testing, Face Barriers
The vast majority of community oncologists surveyed responded that they discuss genetic mutation testing with their peers during tumor boards (88 percent) and with their cancer patients (94 percent), and that patient discussions were driven by their desire for patients to be informed about all aspects of their treatment (89 percent) and for patients to have access to personalized therapies (78 percent). Despite this, respondents identified a number of issues related to testing, including cost, concerns regarding tissue acquisition and delays in initiating treatment.
“Community oncologists treat an estimated 60 percent of cancer patients nationwide, but as these results show, cost challenges, likely related to reimbursement, as well as issues including lack of tissue and multiple labs involved in testing create structural barriers to use of genetic mutation testing and establishing a treatment plan based on those results,” said Christian G. Downs, JD, MHA, Executive Director, Association of Community Cancer Centers, the leading education and advocacy organization for the cancer team.
Oncology Nurses Lack Resources for Patients
About half of the oncology nurses surveyed discuss genetic mutation testing (56 percent) and personalized medicine (46 percent) with their patients; 59 percent of their patients were very receptive or receptive to testing. However, because the nurses felt that they lacked the knowledge to discuss genetic mutation testing or didn’t have the proper resources, 69 percent were somewhat or not at all comfortable with having this discussion with patients. These findings point to a need for a greater understanding of genetic mutation testing among nurses, including latest practices, particularly because 52 percent of oncology nurses are involved in ordering or obtaining tests or results and they play a major role in helping cancer patients navigate their way through diagnosis and treatment.
“Oncology nurses are pivotal in educating patients about test results and treatment options,” said Keightley Amen, BA, AMWA, Project Manager, ONS:Edge, a subsidiary of the Oncology Nursing Society. “But as these survey results show, nurses need deeper knowledge and better tools to communicate effectively with cancer patients about this relatively new concept in their care.”
Lung Cancer Patients Need Education
Despite the development of personalized therapies that specifically address genetic mutations in lung cancer, only 8 to 10 percent of lung cancer patients surveyed were aware of each of the three primary mutations: epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and KRAS. Just 16 percent of lung cancer patients surveyed reported that their healthcare professionals discussed genetic mutation testing with them. Only 12 percent indicated that they had a tumor tested for a genetic mutation, with just 10 percent saying that they had requested a genetic mutation test for their lung cancer.
“Approaches to cancer treatment are changing rapidly, and it is important for patients to be educated and feel empowered when interacting with their healthcare team,” said Regina Vidaver, Ph.D., Executive Director, National Lung Cancer Partnership, an advocacy organization dedicated to raising public awareness of the disease and generating funding for lung cancer research. “The more patients, physicians and nurses know about genetic mutation testing, the easier it will be to properly diagnose and establish a treatment plan for the patient.”
About Lung Cancer
Lung cancer is the second most common cancer and kills more people than any other cancer. In 2011, approximately 221,130 new cases of lung cancer will be diagnosed in the United States, with 156,940 Americans dying from the disease. Non-small cell lung cancer (NSCLC) is the most common form, accounting for about 85 percent of all lung cancers.(i) Lung cancer remains an area of high unmet need, especially in its advanced stages where it is particularly aggressive and patients have limited treatment options.
While there are a wide variety of genetic mutations that can lead to lung cancer, the three most common mutations seen in lung cancer are: anaplastic lymphoma kinase (ALK) mutation, which occurs in 5 percent of lung cancer patients; epidermal growth factor receptor (EGFR)-mutation, which occurs in 40 percent of Asians and 10-15 percent of Caucasians with lung cancer; and KRAS mutation, which occurs in 10 percent of Asians and 30 percent of Caucasians with lung cancer.(ii)
About the Association of Community Cancer Centers (ACCC)
Since 1974, the Association of Community Cancer Centers (ACCC) has served as the leading national multidisciplinary organization that sets the standard for quality care for patients with cancer. ACCC is dedicated to promoting professional learning opportunities and to providing a forum for members to network and enhance their skills in the business, clinical and management aspects of care for the cancer community. Nearly 17,000 cancer care professionals from approximately 900 hospitals and more than 1,200 private practices are affiliated with ACCC. The organization’s unique membership includes all members of the cancer care team: medical and radiation oncologists, surgeons, cancer program administrators and medical directors, pharmacists, oncology nurses, oncology social workers, and cancer program data managers. For more information, visit ACCC’s website at www.accc-cancer.org .
About ONS:Edge
ONS:Edge, a subsidiary of the Oncology Nursing Society, is a healthcare intelligence company formed with the explicit purpose of bringing nursing knowledge and research deeper into the business of healthcare. ONS:Edge specializes in a core group of services: healthcare advisory boards, ancillary events at oncology nursing conferences, speaker bureau programs, strategic planning and marketing support, market research, and communications and awareness campaign development and support.
As the for-profit subsidiary of the Oncology Nursing Society (ONS), ONS:Edge’s competitive advantage is unparalleled access to key opinion leaders and the more than 37,000 members of ONS, whose commitment to evidence-based practice and dedication to excellence in patient care put them at the forefront of leading change in oncology care.
About the National Lung Cancer Partnership (NLCP)
The National Lung Cancer Partnership is a 501(c)(3) non-profit organization made up of leading doctors, researchers, patient advocates and lung cancer survivors dedicated to raising public awareness of the disease and generating funding for lung cancer research. For more information please visit www.NationalLungCancerPartnership.org .
About Boehringer Ingelheim Pharmaceuticals, Inc.
Boehringer Ingelheim Pharmaceuticals, Inc., based in Ridgefield, CT, is the largest U.S. subsidiary of Boehringer Ingelheim Corporation (Ridgefield, CT) and a member of the Boehringer Ingelheim group of companies.
The Boehringer Ingelheim group is one of the world’s 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 145 affiliates and more than 42,000 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel products of high therapeutic value for human and veterinary medicine.
As a central element of its culture, Boehringer Ingelheim pledges to act socially responsible. Involvement in social projects, caring for employees and their families, and providing equal opportunities for all employees form the foundation of the global operations. Mutual cooperation and respect, as well as environmental protection and sustainability, are intrinsic factors in all of Boehringer Ingelheim’s endeavors.
In 2010, Boehringer Ingelheim posted net sales of approximately $16.7 billion (about 12.6 billion euro) while spending almost 24 percent of net sales in its largest business segment, Prescription Medicines, on research and development.
For more information, please visit http://us.boehringer-ingelheim.com and follow us on Twitter at http://twitter.com/boehringerus .
References
(i) American Cancer Society. Cancer Facts and Figures: 2011. Available at: http://www.cancer.org/acs/groups/content/ @epidemiologysurveilance/documents/document/acspc-029771.pdf. Last accessed October 13, 2011.
(ii) Quest Diagnostics. Lung Cancer Mutation Panel (EGFR, KRAS, ALK). Available at: http://questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=Lung/TS_LungCancerMutation_Panel.htm . Last accessed October 13, 2011.
SOURCE Boehringer Ingelheim Pharmaceuticals, Inc.
Copyright (C) 2011 PR Newswire. All rights reserved
People with Lung Cancer Invited to Submit Their Personal Stories
Kathryn Joosten, two-time Emmy(R) Award-winning actress and star of Desperate Housewives and The West Wing, is opening up about her 10-year battle with lung cancer as part of a new national campaign, Lung Cancer Profiles. Lung Cancer Profiles aims to reduce the stigma associated with lung cancer by educating about the diversity of the disease inside and out. The campaign, created by Pfizer Oncology in collaboration with the nation’s leading lung cancer advocacy groups, also seeks to educate about the role of molecular testing and its potential to uncover the unique genetic drivers of each person’s cancer, which can help doctors devise an individualized treatment plan rather than using a one-size-fits all approach.
“I have lung cancer and it’s nothing to hide–anyone can get lung cancer, everyone’s cancer is different and it’s reassuring that the science is catching on,” Ms. Joosten said. “When my cancer returned after eight years, I was discouraged, but my doctor recommended I get my tumor tested to see if it would affect my treatment plan. We were able to identify my particular type of lung cancer and find a clinical trial designed specifically for people with my tumor type. I am passionate about this campaign because I know, first-hand, how hard it can be to learn you have lung cancer, how important it is to get tested and how impactful sharing my story might be on the lives of others with lung cancer.”
Lung cancer is the number one cause of cancer death worldwide(1) and the leading cause of cancer-related death in women in the United States.(2) Lung cancer can affect anyone: people with and without a history of smoking; young and old; men and women; and people of different ethnicities.(3,4)We now know that, rather than being one singular disease as previously thought, it is made up of many distinct sub-types based on the genetic characteristics of each tumor.(5)
As part of the campaign, in addition to featuring Ms. Joosten’s remarkable story, LungCancerProfiles.com will showcase other patients’ inspiring stories about their journey living with lung cancer. People with lung cancer are encouraged to submit their own personal “profiles” to show the diversity of lung cancer, highlight how molecular testing impacted their lives and provide a small snapshot of the hundreds of thousands of people with this disease.
“Today, we understand that lung cancer is actually made up of many distinct sub-types based on molecular profiling of genetic changes in each patient’s cancer,” said David R. Gandara, MD, professor of hematology and oncology and director of thoracic oncology at University of California Davis Cancer Center. “More and more, this information is changing how oncologists make treatment decisions for their patients. In 2011, we already have the ability to truly individualize therapy for some patients based on this ‘molecular fingerprint,’ and new discoveries are being made at a rapid rate. For now, the take home message is, `If you have lung cancer and your tumor has not already been tested, talk to your doctor to see if molecular analysis is appropriate for you.’”
Lung Cancer Profiles is a collaboration between Pfizer Oncology and the nation’s leading lung cancer patient advocacy organizations: Bonnie J. Addario Lung Cancer Foundation, Lung Cancer Alliance, Lung Cancer Foundation of America, LUNGevity, the National Lung Cancer Partnership and Uniting Against Lung Cancer. The partnership underscores the significant need to support lung cancer patients by educating them about all aspects of lung cancer, including the impact molecular testing potentially can have on diagnosis and treatment.
“For a patient likely overwhelmed with a devastating diagnosis, lung cancer can be a daunting topic to understand,” said Regina Vidaver, PhD, executive director of the National Lung Cancer Partnership. “With our partners, we aim to help patients understand the importance of molecular testing and encourage them to talk to their doctor to learn more. We’re also inviting others to submit their personal ‘profiles’ on the campaign website, to reinforce that lung cancer can impact anyone.”
For more information about Lung Cancer Profiles and to learn about submitting patient stories, visit www.lungcancerprofiles.com .
“Pfizer Oncology is proud to be working with our advocacy partners on this campaign,” said Mace Rothenberg, MD, senior vice president of clinical development and medical affairs for Pfizer’s Oncology Business Unit. “As more therapeutic options become available, we hope that this campaign will help spread the word about the important role of molecular testing in the selection of appropriate treatment for some individuals diagnosed with lung cancer.”
About Lung Cancer
Lung cancer is the leading cause of cancer death in the U.S.,(1) and more people die of the disease than of colon, breast and prostate cancers combined.(1,6)An estimated 221,130 new cases of lung cancer are expected to be diagnosed in the U.S. in 2011, and an estimated 156,940 deaths, accounting for about 27 percent of all cancer deaths, are expected to occur.(7)
Bonnie J. Addario Lung Cancer Foundation ( www.lungcancerfoundation.org )
Bonnie J. Addario Lung Cancer Foundation (BJALCF) has grown into the first international collaborative entity of its kind, raising over $6 million for lung cancer research. BJALCF plans to become the global leader for lung cancer. The ultimate goal of the organization is to increase the low survival rate of lung cancer by becoming the largest source of non-profit funding dedicated to turning Lung Cancer into a manageable chronic disease.
Lung Cancer Alliance ( www.lungcanceralliance.org )
Lung Cancer Alliance is the only national non-profit organization devoted solely to support and advocacy for all those living with or at risk for lung cancer. Headquartered in Washington, DC, Lung Cancer Alliance is organizing state chapters nationwide.
The Lung Cancer Foundation of America’s mission is to save lives by dramatically increasing the five-year survival rates for all stages of lung cancer, the nation’s leading cause of cancer deaths for both men and women. The LCFA will accomplish this by providing the necessary and critical funding for creative and leading edge lung cancer research programs.
LUNGevity ( www.lungevity.org )
LUNGevity moves forward firmly resolved to provide the energy, inspiration, and resources that are critical to making lung cancer a national priority. Our goal is to Stop Lung Cancer Now. Our vision is a world where no one dies of lung cancer. A world that LUNGevity helped to create by bringing together world-class scientific minds, passionate advocates, and an efficient and effective organization. Our vision is to unite the country in one movement to end lung cancer now.
National Lung Cancer Partnership ( www.nationallungcancerpartnership.org )
The National Lung Cancer Partnership is the only lung cancer advocacy organization founded by doctors and researchers working together with survivors and advocates to increase lung cancer awareness and research funding. Headquartered in Madison, WI, the Partnership supports a nationwide network of grassroots lung cancer advocates through its programs.
Uniting Against Lung Cancer ( www.unitingagainstlungcancer.org )
Uniting Against Lung Cancer funds innovative lung cancer research to find a cure for the nation’s leading cancer killer. We also work to increase awareness of the disease, including in people who have never smoked.
About Pfizer Oncology
Pfizer Oncology is committed to the discovery, investigation and development of innovative treatment options to improve the outlook for cancer patients worldwide. Our strong pipeline, one of the most robust in the industry, is studied with precise focus on identifying and translating the best scientific breakthroughs into clinical application for patients across a wide range of cancers. Pfizer Oncology has biologics and small molecules in clinical development and more than 100 clinical trials underway. By working collaboratively with academic institutions, individual researchers, cooperative research groups, governments, and licensing partners, Pfizer Oncology strives to cure or control cancer with breakthrough medicines, to deliver the right drug for each patient at the right time. For more information please visit www.Pfizer.com .
Pfizer Inc.: Working together for a healthier world(TM)
At Pfizer, we apply science and our global resources to improve health and well-being at every stage of life. We strive to set the standard for quality, safety and value in the discovery, development and manufacturing of medicines for people and animals. Our diversified global health care portfolio includes human and animal biologic and small molecule medicines and vaccines, as well as nutritional products and many of the world’s best-known consumer products. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as the world’s leading biopharmaceutical company, we also collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For more than 150 years, Pfizer has worked to make a difference for all who rely on us. To learn more about our commitments, please visit us at www.pfizer.com .
(1) World Health Organization.Cancer fact sheet N deg 297. February 2011. Available at: http://www.who.int/mediacentre/factsheets/fs297/en/ . Accessed October 26, 2011.
(2) National Cancer Institute. Lung Cancer. 2011. Available at: http://www.cancer.gov/cancertopics/types/lung . Accessed October 26, 2011.
(3) National Cancer Institute. Surveillance Epidemiology and End Results. SEER Stat Fact Sheets: Lung and Bronchus. Available at: http://seer.cancer.gov/statfacts/html/lungb.html . Accessed October 26, 2011.
(4) American Cancer Society. Detailed Guide: Lung Cancer (Non-Small Cell). 2010. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf . Accessed October 26, 2011.
(5) Reade CA, Ganti AK. EGFR targeted therapy in non-small cell lung cancer: potential role of cetuximab. Biologics: Targets & Therapy. 2009; 3: 215–224.
(6) American Cancer Society. Detailed Guide: Lung Cancer (Non-Small Cell). 2010. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf . Accessed October 26, 2011.
(7) American Cancer Society. Cancer Facts and Figures 2011. Available at: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2011 . Page 15. Accessed November 1, 2011.
In partnership with the other leading lung cancer foundations and Pfizer, LCFA is excited to announce the launch of LungCancer Profiles, a web site designed to educate about the importance of molecular testing, unique to each person’s cancer and to share inspiring stories about the diversity of this disease. Please visit the site and share your story!
This video, provided by Stanford Hospital & Clinics, features 6 Stanford physicians (oncologists and thoracic surgeons) who speak on-camera about the disease and the need for more awareness. We would like to share the video and spread it to communities nationally and internationally in hopes that more awareness will lead to better screening and treatment options, prevention, funding and research.
There is a blight upon our country. It’s called lung cancer. Mr. President and Mr. Speaker, we urge you to lead us out of this valley of death and despair.
Lung cancer will kill 160,000 of us in 2011. That’s three times more than any other cancer. Among those hardest hit will be the men and women of our armed forces, past and present.
And when it comes to gender equality, lung cancer is an unfortunate area of catch-up, with lung cancer diagnoses among women up six-fold in 30 years. The toll is staggering. More than 70,000 women will die of lung cancer in 2011 – almost 80% more than will die of breast cancer.
Then there is this little known and disturbing fact: one in five women with lung cancer never smoked. That’s twice the rate seen among men with the disease. No one knows why.
We wish we could be hopeful, but while there have been dramatic improvements in the survival rates for many other cancers, the fact is that lung cancer remains a death sentence. The five-year survival rate for stage IV lung cancer – the most common staging at diagnosis – is just four percent, where it was decades ago.
Any way you look at it, lung cancer is a national disaster demanding your attention.
IF NOT YOU, WHO? IF NOT NOW, WHEN?
We are calling on you, Mr. President and Mr. Speaker, to come together – to look beyond partisanship to our common humanity – and to point the way forward in the fight against this dreadful disease. There is so much you can do.
On the legislative side, it is time to pass the Lung Cancer Mortality Reduction Act, which seeks to halve the number of lung cancer deaths by 2020.
You can devote more federal dollars to lung cancer research. Consider that per death, lung cancer receives just a fraction – less than 10% – of the dollars that go to breast or prostate cancer.
You can advocate for public education and for more attention to screening.
And you can take a closer look at the incidence of smoking and lung cancer among our active duty and veteran servicemen and women. It’s the least we can do in defense of those who defend us.
First and foremost, you can drag this killer out from the shadows and declare lung cancer a national health crisis.
THE OPPORTUNITY OF A LIFETIME…YOURS
On a personal level, there is this: For the sake of the nation and of your families, stand up and take a public pledge not to smoke.
Teach us – our children in particular – that smoking is unhealthy. Acknowledge that it is hard to stop but worth the effort. Most importantly, move us past this sorry game of blame-the-victim and help expose the insidious and unspoken notion that because most people who get lung cancer smoked at one time, they somehow “deserve it.”
Mr. President, Mr. Speaker you have a rare and powerful opportunity. Over the next five years, more than 1,000,000 Americans will be diagnosed with lung cancer. You can help save many of them. Do something.
We can all help. Visit www.lungcancerleaders.org today and encourage President Obama and Speaker Boehner to recognize lung cancer as a national health crisis.
By: MITCHEL L. ZOLER, Internal Medicine News Digital Network
AMSTERDAM – Management of advanced non–small cell lung cancer now demands molecular profiling and personalized treatment. This new era has just begun, but it will quickly transform the field over the next 4 years, Dr. David R. Gandara said in a talk on the state of lung cancer medical oncology.
Increased molecular profiling – Dr. Gandara called for routine molecular profiling for every patient with advanced NSCLC – will mean a “culture change” for the field, and a sharp turn toward “ungrouping” the universe of NSCLC patients into individuals, he told attendees at the World Conference on Lung Cancer, which was sponsored by the International Association for the Study of Lung Cancer.
“We shouldn’t even talk about non–small cell lung cancer” as though it were a single entity, said Dr. Gandara, professor and director of the thoracic oncology program at the University of California, Davis, Cancer Center in Sacramento.
He also recommended new paradigms of drug development to reflect the complex, underlying biology and the inter- and intrapatient heterogeneity of lung cancer. “Transition from empiric to rationally selected and personalized therapy is challenging,” Dr. Gandara conceded. But the transition is underway and accelerating.
Until about a year ago, the only lung cancer genes undergoing routine profiling at cancer centers were those for the epidermal growth factor receptor (EGFR) and, at fewer locations, for the oncogene KRAS. Dr. Bruce Johnson, a professor of medicine at Harvard Medical School and the Dana Farber Cancer Institute, both in Boston, takes credit for starting both; his EGFR program began 7 years ago and KRAS testing has been going for 5 years, he said.
Today, testing at several major U.S. cancer centers has added investigational tests for genes such as HER2, PIK3CA, ALK, MET, MEK, BRAF, AKTI, and NRAS. The Lung Cancer Mutation Consortium is in the midst of profiling 10 genes in 1,000 patients.
“Progress has been so dramatic. All but EGFR and KRAS came in the past year,” said Marileila Varella Garcia, Ph.D., professor of medical oncology at the University of Colorado in Denver and a leader of the consortium. “At the University of Colorado, it took us 18 months to optimize the test [for 10 mutations], but now we have it and it can only improve. We test for 10 mutations for the same cost as testing for one.”
At the Yale Cancer Center, the routine-profiling list stands at 13 genes, said Dr. Roy S. Herbst, chief of medical oncology at Yale in New Haven, Conn. “Right now, the only test that [insurers] pay for is the EGFR mutation test. Once the ALK story is more validated, they will probably pay to find ALK translocations, but with a chip, for the same money you can also test for other mutations for research,” Dr. Herbst said.
“In the United States, testing for EGFR mutations is standard of care at most top cancer centers. EGFR is an actionable mutation, with patients considered for erlotinib treatment.”
Dr. Varella Garcia, Dr. Johnson, and their collaborators from the consortium reported on the first 516 patients with advanced lung cancer who were tested with the 10-gene panel. The results showed that 280 of the tumors (54%) carried at least one mutation in at least one of the 10 genes that the consortium tested.
KRAS mutations were most prevalent, in 22% of the patients, followed by EGFR mutations in 17%, ALK rearrangement in 10%, MET amplifications in 4%, and a smaller number of genetic changes in each of the other six genes tested. Most mutations were mutually exclusive, with only 3% of tumors having mutations in two different genes, and no tumors with mutations in three or more genes.
“It was surprising that they found actionable mutations in more than half of the tumors they have tested so far. That is very promising,” Dr. Gandara said.
Over the next 3-4 years, further studies will likely validate additional genes and mutations, perhaps encompassing about 90% of patients with advanced-stage lung cancer by 2015, Dr. Varella Garcia said in an interview. It’s also likely that a small percentage of these cancers won’t link with any single, identifiable gene mutation and will instead depend on changes in several pathways, something much harder to sort out.
The number of “actionable” gene mutations (mutations that, once found, can receive a targeted treatment) also remains limited but growing. Until recently, the list had a single gene, EGFR. Patients with EGFR mutations are candidates for treatment with erlotinib (Tarceva) or gefitinib (Iressa, which was not approved for routine U.S. use), both drugs from the tyrosine kinase inhibitor class.
A second, recent success story for targeted treatment involves the ALK fusion mutation, a genetic profile of tumors responsive to crizotinib. Results from phase I and II studies showed that crizotinib improved progression-free survival and overall survival in patients with tumors that had an ALK mutation; phase III studies are in progress.
“Patients with tumors that depend on these drivers have significantly better clinical outcomes when treated with specific inhibitors,” Dr. Varella Garcia said.
This year’s meeting featured three main themes for patient management, but ultimately all three boil down to molecular biomarkers and molecularly directed treatment, Dr. Gandara said. One main theme – histologic profiles of advanced lung cancer – has been an important focus, but “histology is a transient selection method,” he said. “At best, histology is a crude molecular selection device” superseded by molecular profiling itself.
Another important, recent focus has been maintenance therapy, but “the real questions are who gets further treatment after platinum-based induction, and when should they get it,” questions best answerable by molecular profiling, he added.
“We have many ‘druggable’ molecular targets,” Dr. Gandara noted.
“For almost every mutation [of the 10 genes that] the consortium is testing, we have phase I treatment trials underway,” said Dr. Varella Garcia. Patients with tumors that carry KRAS and MEK mutations receive an investigational MEK inhibitor. Patients with tumors that contain HER2 mutations receive trastuzumab (Herceptin) as an investigational agent. Patients with MET mutations receive a MET monoclonal antibody.
Despite success so far, and pervasive optimism that current studies will validate new treatments, researchers cautioned that the management of advanced lung cancer also has some critical, unavoidable limitations.
“We will never cure advanced lung cancer; we can make it a chronic disease,” Dr. Varella Garcia said. Effective treatment means that patients’ quality of life improves, and their disease comes under control for several years. But “it is almost universal that these patients with eventually progress again. We cannot cure advanced lung cancer. We can control it with new, targeted treatments that use oral drugs with low toxicity.”
Dr. Gandara, Dr. Johnson, and Dr. Herbst disclosed relationships with numerous pharmaceutical and biotechnology companies. Among these, Dr. Johnson listed stock in Celgene and a patent for EGFR testing by Genzyme. Dr. Varella Garcia said that she has been a consultant to Abbott.
ABBOTT PARK, Ill., Aug. 26, 2011 – Abbott today announced it has received approval from the U.S. Food and Drug Administration (FDA) for a new molecular diagnostic test designed to detect rearrangements of the anaplastic lymphoma kinase (ALK) gene in non-small-cell lung cancer (NSCLC). The new Abbott Vysis ALK Break Apart FISH Probe test is designed to identify ALK-positive NSCLC patients for Pfizer’s approved NSCLC therapy, XALKORI® (crizotinib), an oral first- in-class ALK inhibitor.
The Vysis ALK FISH test uses Abbott’s fluorescence in situ hybridization (FISH) technology to detect rearrangements of the ALK gene on the 2p23 chromosome. The diagnostic test offers clinicians a standardized, clinically validated method to identify patients more likely to benefit from the new therapy.
“The Abbott-Pfizer collaboration marks a breakthrough in the advancement of personalized medicine – and companion diagnostics specifically – that will help a subset of lung-cancer patients get treatment tailored to their unique genetic profile,” said Stafford O’Kelly, head of Abbott’s molecular diagnostics business.
The simultaneous FDA approvals are expected to change clinical practice for the diagnosis and treatment of patients with NSCLC. The Abbott ALK test has been designed to identify those patients – about 3 to 5 percent of NSCLC patients – who would be candidates for the new drug.
“The FDA’s priority and expedited review process of the drug and combination diagnostic test have been impressive,” O’Kelly said. “We expect that many patients newly diagnosed with NSCLC will want to ask their doctors about the potential benefits of this new genetic test.”
Lung malignancies are the leading cause of cancer deaths worldwide, with more than 1.6 million new cases diagnosed each year. About 85 percent of lung cancer patients have the non-small-cell type and are usually diagnosed with advanced disease having a very low survival rate.
Abbott’s Vysis ALK FISH test will be available to clinicians and pathologists through Abbott Molecular. For more information visit www.AbbottALK.com.
About FISH
FISH (fluorescence in-situ hybridization) technology has a variety of uses. It can identify whether too many, or too few, copies of a particular gene are present in the body’s cells or whether certain genes have rearrangements that play an active role in disease progression. Since the technology works especially well for identifying genetic markers in solid tumors, cancer diagnostics are one of the fastest growing applications.
Similar to the Abbott ALK test’s ability to identify patients for XALKORI® therapy, Abbott’s PathVysion test, the first FDA approved FISH-based companion diagnostic, detects amplification of the HER-2 gene and acts as an aid in identifying patients for Herceptin® (trastuzumab) therapy for breast cancer. The Abbott UroVysion test also utilizes FISH technology to quantitatively assess chromosomal changes in the cell’s nucleus, which may aid in the diagnosis as well as in the surveillance and monitoring of bladder cancer.
About Abbott Molecular
Abbott Molecular, abbottmolecular.com, is a leader in molecular diagnostics — the analysis of DNA and RNA at the molecular level. Abbott Molecular’s tests can also detect subtle but key changes in patients’ genes and chromosomes and have the potential for earlier detection or diagnosis, can influence the selection of appropriate therapies, and may improve monitoring of disease progression.
About Abbott
Abbott is a global, broad-based health care company devoted to the discovery, development, manufacture and marketing of pharmaceuticals and medical products, including nutritionals, devices and diagnostics. The company employs nearly 90,000 people and markets its products in more than 130 countries.
Abbott’s news releases and other information are available on the company’s Web site at www.abbott.com.
Pfizer Inc. has received FDA approval of XALKORI ® (crizotinib) capsules – the first and only therapy specifically for patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) that is anaplastic lymphoma kinase (ALK)-positive as detected by an FDA-approved test. The effectiveness of XALKORI is based on objective response rates and, as XALKORI received accelerated approval from the FDA, Pfizer is conducting post-marketing clinical trials to further demonstrate its clinical benefit.*
On Tuesday, August 30 at 11:00 a.m. EST, Pfizer will convene a panel, including Pfizer Leadership, prominent lung cancer experts and patients who are treated with XALKORI, to discuss the implications of this important milestone for patients, oncologists and drug development at large. These panelists will be available for a Q&A session following opening remarks.
Geno Germano, Pfizer, President and General Manager, Specialty Care and Oncology – Pfizer’s business approach to cancer drug development
Garry Nicholson, Pfizer, President and General Manager of the Pfizer Oncology Business Unit – Global collaboration to ensure commercial availability of XALKORI
Mace Rothenberg, MD, Pfizer, Senior Vice President, Clinical Development, and Medical Affairs, Oncology Business Unit – XALKORI data and clinical development program; a biomarker-driven approach
Paul A. Bunn, Jr., MD, Professor of Medicine and James Dudley Chair in Cancer Research, University of Colorado, Denver – Molecular perspective on XALKORI and the significance of molecular testing in lung cancer
Mark G. Kris, MD, Chief, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, and Professor of Medicine, Weill Cornell Medical College – Clinical perspective on XALKORI and what this milestone means for patients
Jeff Wigbels, Senior Vice President, Senior Portfolio Manager, Morgan Stanley Smith Barney, patient with locally advanced or metastatic ALK-positive NSCLC who is being treated with XALKORI – Patient perspective on XALKORI and the importance of ALK testing
Richard Heimler, former non-profit executive, patient with locally advanced or metastatic ALK-positive NSCLC who is being treated with XALKORI – Patient perspective on XALKORI and the importance of ALK testing
Please join the teleconference by dialing either 866 246-2545 in the United States and Canada, or 706 634-2365 outside of the United States and Canada. The passcode is “Pfizer FDA Approval”.
*The FDA approved indication is based on response rate. There are no data available demonstrating improvement in patient reported outcomes or survival with XALKORI.
