There's arguably no scarier six-letter word than "cancer." As the U.S. population has grown, so has the prevalence of cancer diagnoses... and deaths. The Centers for Disease Control and Prevention finds that cancer is the second-leading cause of death in the U.S., contributing to nearly 596,000 deaths in 2016. By sometime next decade, it's expected to surpass heart disease and become America's No. 1 killer.
But not all cancers are alike. For example, the American Cancer Society's (ACS) annual report, "Cancer Facts and Figures 2017," shows that five-year survival rates in prostate cancer and female breast cancer, two of the most commonly diagnosed cancer types, have risen to 99% and 91%, respectively, between 2006 to 2012. Five-year survival rates were just 75% for female breast cancer and 68% for prostate cancer between 1975 and 1977. Improvements in medicines to treat these diseases, along with patient and physician education, have gone a long way.
The 10 most frightening lung cancer statistics
At the other end of the spectrum is the deadliest cancer of them all in terms of sheer numbers: lung cancer. Below are 10 frightening statistics that describe why lung cancer is possibly the most feared of all cancer types.
- Approximately 222,500 people will be diagnosed with lung cancer in 2017, according to the ACS. This includes almost 117,000 men and more than 105,000 women. It's the second-most diagnosed cancer in the U.S. behind only female breast cancer and the most commonly diagnosed cancer type in the world.
- The ACS estimates that 155,870 people will die from lung cancer in 2017, which is more than three times higher than the next-deadliest cancer type, colon cancer, which is expected to claim 50,260 lives this year. It's also the deadliest cancer, as a whole, across the globe.
- Just 19% of those diagnosed with lung or bronchus cancer will live five or more years as of 2006-2012. That's just a 7 percentage-point improvement over more than three decades. More than half of those diagnosed with lung cancer pass away within a year.
- The average age at diagnoses is 70. Just 2% of cases involve people younger than 45, while two out of three people are diagnosed at age 65 or older.
- According to the ACS, lung cancer found in a localized state (i.e., stages 1 or 2) led to a five-year survival rate of 55% between 2006 and 2012. By comparison regional (stage 3) and metastatic (stage 4) lung cancer had five-year survival rates of just 28% and 4% over the same period.
- Approximately 415,000 Americans are alive today who have been diagnosed with lung cancer at some point in their lives.
- Smoking is a contributing factor to between 80% and 90% of lung-cancer cases. Men and women who smoke are a respective 23 and 13 times more likely to develop lung cancer than nonsmokers.
- Nonsmokers aren't out of the woods. Those who are exposed to secondhand smoke have a 20% to 30% greater chance of developing lung cancer.
- According to a study conducted by Milliman, lung cancer is also extremely costly. Using data between 2011 and 2014, it found the cumulative health expense for lung cancer after just five months post-diagnosis was more than $99,000. By month 23, the aggregate cost crosses $200,000. By comparison, colorectal cancer and breast cancer cost a respective $118,372 and $71,960 in its analysis at month 23. This is not cheap by any means, but nowhere near the cost of treating lung cancer.
- The National Institutes of Health estimates that lung cancer directly cost $13.4 billion in 2015, which doesn't include $36.1 billion in lost worker productivity tied to hospitalization and early death.
These top stocks are fighting back
Chances are that someone in your life has been affected by cancer, and for yours truly, lung cancer hit home. Having lost my mother to lung cancer in 2010, I'm eager to see medicines developed that give patients a fighting chance. Here are three top lung-cancer drug developers that are digging in their heels and hoping to make a difference.
Arguably the biggest advancement in years for advanced lung-cancer patients is the advent of cancer immunotherapies, such as Merck's (NYSE:MRK) Keytruda. Cancer immunotherapies look to suppress the ability of cancer cells to hide from the immune system, while also supercharging the immune system to fight back. In particular, Merck's Keytruda targets the PD-1 protein found on T cells (an immune-system cell).
Merck's Keytruda is currently approved to treat select advanced lung-cancer patients in both first- and second-line non-small cell lung cancer (NSCLC). NSCLC is, by far, the most commonly diagnosed lung cancer type. In the Keynote-024 trial for first-line advanced NSCLC patients who had at least 50% PD-L1 expressing cells (PD-L1 is a ligand that binds to PD-1 receptors on cells), progression-free survival was improved by 4.3 months (10.3 months vs. 6 months) compared to the chemotherapy arm, with a secondary overall survival benefit also observed. This increase in overall survival was the most exciting aspect of the study given that dozens of patients crossed over to the Keytruda arm from the chemotherapy arm once disease progression was noted.
For the time being, Merck appears just to be scratching the surface on possible combinations for Keytruda. With between 27% and 30% of advanced NSCLC patients having high PD-L1 expression, and these folks previously having few treatment options left, Merck and Keytruda are having an impact.
Another major cancer-immunotherapy player is Bristol-Myers Squibb (NYSE:BMY) with Opdivo and, to a lesser extent, Yervoy. While the company is certainly making waves, as you'll see below, things haven't gone perfectly. A first-line NSCLC study (CheckMate-026) involving Opdivo in patients whose tumors had at least 5% PD-L1 expression didn't even come close to meeting the primary endpoint of a statistically significant improvement in progression-free survival. In fact, in head-scratching fashion, the chemotherapy arm delivered a better result in terms of progression-free survival. But a single study failure hasn't kept Opdivo or Bristol-Myers down.
For instance, Opdivo has been, and continues to be, a foundational therapy in second-line advanced NSCLC. Approved in Oct. 2015 for second-line NSCLC, Opdivo wound up demonstrating a 19% partial or complete response in its pivotal-stage trial, leading to an average survival time of 12.2 months and an average progression-free survival for partial and complete responders of 17 months. Comparatively, the docetaxel arm showed an average survival of 9.4 months, with a 12% response rate and an average duration of response of just six months for those 12%.
Just this past month, Bristol-Myers reported encouraging data from an exploratory phase 1/2 analysis involving the combination of Opdivo and Yervoy in patients with recurrent small cell lung cancer. When Opdivo was given as a monotherapy, high tumor mutation-burden patients demonstrated a 21% response rate, with an overall survival rate of 35% at one year. But when combined with Yervoy, the overall response rate more than doubled, to 46%, and survival at one year leaped to 62% for this same group.
One of the most commonly prescribed treatments for NSCLC patients is Roche's Avastin, a targeted therapy. Avastin works by blocking vascular endothelial growth factor, or VEGF, which is responsible for stimulating the growth of new blood vessels. Because tumors grow considerably faster than normal tissue, blocking VEGF is believed to reduce blood flow to tumors by slowing blood vessel growth, and thusly starving parts, or all, of the tumor. Through the first half of 2017, Avastin tallied more than $3.4 billion in sales, making it one of the best-selling cancer drugs in the world.
But like its peers, Roche also has a cancer immunotherapy aimed at exposing cancer cells and kicking immune systems into high gear. Known as Tecentriq, this PD-L1-targeting therapy was approved by the Food and Drug Administration in Oct. 2016 for advanced NSCLC patients who've had disease progression during, or following, platinum-containing chemotherapy, and progressed following targeted therapy if their tumor has EGFR or ALK mutations. The phase 3 Oak study demonstrated a 4.2-month overall survival advantage to Tecentriq relative to docetaxel (13.8 months vs. 9.6 months).
Taking into account that no drug developer has a more expansive product portfolio and pipeline devoted to oncology than Roche, the company's a good bet to lead the charge against lung cancer in the years that lie ahead.