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10 ways we’ve influenced progress in lung cancer

by Amy Warnock | In depth

1 November 2023

14 comments 14 comments

Microscopic images of pleural fluid cytology of a small cell oat cell carcinoma
Image credit: Shutterstock / David A Litman


This article was originally published in 2022 and has been updated for November 2023


 

Lung cancer is the third most common cancer in the UK; every year around 49,200 people are diagnosed with the disease*. 

Those diagnoses are often late, as early symptoms can be easily mistaken for other, less serious conditions. On top of this, tumours often evolve over time, which can lead to drug resistance and treatment failure: only around 5 in 100 people diagnosed with lung cancer at the latest stage (Stage 4) in England survive their disease for 5 years or more**.   

Clearly, there’s still a pressing need for better ways to prevent, diagnose and treat lung cancer. We know it’s possible to develop them because, thanks to our supporters, researchers and clinicians, we’ve already achieved so much.  

From uncovering some of the causes of lung cancer, through to contributing to drugs used to treat it, Cancer Research UK’s impact is far reaching. Here are 10 ways we have worked towards progress in lung cancer.  

1 – Uncovering faulty genes in lung cancer

Our scientists have been pivotal to discovering some of the genetic faults that can lead to the development of lung cancer, helping to improve our understanding of the disease.  

Some of the most important of these faults open up shortcuts lung cancers can use to grow as quickly as possible.  

Two separate teams we funded in the early 1980s found proteins on the surface of our cells called EGFR and NRAS. They’re part of a complex traffic light system our bodies use to tell cells when they need to grow or divide. In some lung cancer cells, EGFR and RAS proteins like NRAS can mutate until they’re stuck showing green.  

Image showing the protein structure of getfitinib
The protein structure of getfitinib

Those green lights mean cancer cells can start ignoring the rules that keep the rest of our cells from getting in each-others’ way. They’re free to start multiplying as fast as they want. 

Thanks to our discoveries, we now have ways to stop that.  

Drugs that block EGFR activity in cancer cells, like erlotinib and gefitinib, are now used to treat non small cell lung cancer (NSCLC). Because they target the mechanism that actually drives specific cancers, they don’t cause as many side effects in healthy cells – a problem with older chemotherapies.  

Years of research have shown that over a quarter of all cancer cases are driven by mutations to RAS proteins. Drugs designed to alter RAS activity are some of the best ways to treat them. For example, sotorasib is a KRAS inhibitor that can be used to treat NSCLC with a specific KRAS gene mutation. 

2 – Campaigning for tobacco control  

Smoking is the biggest cause of cancer, causing around 150 cases every day in the UK. 

Reducing smoking rates is key in preventing lung cancer cases, and we have been at the heart of progress in tobacco control since the 1950s.

Over the years, our supporters have helped us to campaign for smokefree workplaces, commonly referred to as ‘the smoking ban’, which first came into effect in Scotland in 2006, with Wales, England and Northern Ireland all following suit in 2007.  

After that, along with the help of our supporters, we lobbied to cover up tobacco displays in shops and remove tobacco vending machines, which happened in 2011, and successfully campaigned for plain cigarette packaging, which came into force in 2016. 

Image of person holding cigarette packet with text 'Smoking is still the biggest preventable cause of cancer' for our Smokefree campaign
In 2022 we launched our Smokefree campaign

Since then, with the importance of cutting smoking rates getting ever clearer, the governments of England, Scotland and Wales have all set out their goal to cut the number of smokers to less than 5% of the population. But these Smokefree targets won’t be met without hard work. 

So, last year, we launched our Smokefree UK campaign calling on the UK Government to take action by raising the age of sale of tobacco and providing more funding to help people across the UK quit smoking. 

In September, we brought our Smokefree UK petition calling for more funding for stop smoking services and public health campaigns to 10 Downing Street, alongside Campaigns Ambassadors, politicians and partners. Our policy calls were backed by almost 14,000 supporters, more than 50 MPs, councillors and Lords, and over 20 other organisations.   

Then at Conservative Party Conference in October, Prime Minister Rishi Sunak announced plans to raise the age of sale of tobacco, as well as provided increased funding for services and measures to help people quit smoking.   

This announcement was not just a big win for Cancer Research UK, but also our incredible partners and supporters who have been campaigning and working alongside us for years.  

But our work isn’t done yet, we’ll continue to press for more action to ensure that the Prime Minister’s plans to raise the age of sale of tobacco become a reality so that we can tackle the number one cause of cancer and save more lives. 

3 – Investing in the lung cancer research community  

Our 2014 research strategy made lung cancer a priority. Despite it being the most common cause of cancer death in the UK, there was limited lung cancer-specific research taking place around the country.  

Since then, we have increased our research spend in the area, investing in the people and ideas capable of radically changing the way we think about lung cancer.  

We committed over £10m to fund TRACERx – our flagship lung cancer research study, which aimed to track the evolution of individual people’s lung cancers over time.  

Some of the most important developments on this list came thanks to TRACERx. Now we’re building on them. Last year, we announced TRACERx EVO, which will continue to accelerate progress against lung cancer for many years to come. 

The next stage of our 2014 strategy was to create a collaborative environment where lung cancer research can flourish. It led to our Lung Cancer Centre of Excellence, which brings together the world-leading lung cancer researchers at the University of Manchester and University College London. It’s a way of ensuring the unique and complementary strengths of the two organisations can have the biggest impact possible – and the research it makes possible helps attract scientific talent from around the world. 

We have also invested in numerous other projects, including the National Lung Matrix Trial – our pioneering collaboration with pharmaceutical companies and the NHS to test the idea that genetic changes in people’s cancers could be used to match them to treatments.   

As well as catalysing numerous breakthroughs in lung cancer research, these investments have been instrumental in building a community of researchers and clinicians around the UK – supporting early-stage researchers and clinicians to begin their careers in the field and encouraging established experts to turn their attention to the challenges of lung cancer.  

4 – Contributing to drug treatments  

Our research has contributed to the development of some of the drugs that have had the biggest impact on treating lung cancer, including cisplatin, carboplatin, pemetrexed and etoposide.  

In the early 1970s a team of our researchers in London confirmed that the platinum-containing molecule now known as cisplatin was effective against cancer in laboratory models, and also identified exactly which parts of the molecule made it so effective.   

Another one of our researchers, Dr Eve Wiltshaw at the Royal Marsden Hospital, led the clinical trials of cisplatin, giving the drug to patients for the first time in the UK.   

Over subsequent years, cisplatin produced impressive results in patients with several different cancer types. It continues to be used for the treatment of some cancers today, including lung cancer. 

Both cisplatin and carboplatin are derived from platinum Credit: James St. John, CC by 2.0, via Flickr

However, cisplatin can produce some challenging side effects. So researchers started looking for platinum-based cancer drugs that were just as effective as cisplatin but caused fewer side effects.  

Drug development efforts by our scientists led to the chemotherapy drug carboplatin, which was trialled in the 1970s by clinicians at the Royal Marsden Hospital in London, whose work we also supported. It is now the most commonly used chemotherapy drug on the NHS, with more than 26,000 people receiving it every year.  

As well as platinum-based chemotherapy drugs, our scientists have also been involved in the development of other drugs commonly used to treat lung cancer.  

We headed one of the earliest trials of the drug pemetrexed – an antimetabolite which stops cancer cells making and repairing DNA so they can’t grow and multiply – establishing the maximum amount that can be given safely to patients. This helped to shape larger clinical trials to develop this new treatment further. In 2007, pemetrexed was approved by NICE for the treatment of some lung cancer patients.   

We were also involved in the development of etoposide. When it was first being tested, etoposide – which acts by destroying quickly dividing cells such as cancer cells – could cause unpredictable side effects. However, through monitoring its concentration in the blood, our researchers were able to find a way to reduce this unpredictability. Etoposide is now used in the treatment of lung cancer, sometimes in combination with carboplatin.  

5 – Finding the mechanisms behind lung cancer in never-smokers  

Although smoking remains the biggest risk factor for lung cancer, every year in England, around 1,700 people who have never smoked are diagnosed with lung cancer. That’s around 5 in every 100 lung cancer cases***. Until recently, scientists didn’t have a good understanding of why these people were affected by the disease. 

This year, the TRACERx team published groundbreaking research showing that air pollution can cause cancer in some people who have never smoked.   

An aerial view of London with lots of smog

Scientists examined data taken from more than 371,000 people from the UK and Asian countries, and found higher rates of EGFR mutant lung cancer, as well as higher rates of other types of cancer, in people living in areas with higher levels of PM2.5 pollution (tiny pollutant particles in the air smaller than 5% of the width of a human hair).   

The team then exposed mice with cells carrying EGFR mutations in their lungs to air pollution at levels normally found in cities. They found cancers were more likely to start from cells carrying EGFR mutations in these mice than in others not exposed to air pollution.  

While this research is still in its early days, studies like this could help us to improve our fundamental understanding of some of the biology of lung cancer. In that respect, TRACERx is building on the discovery of EGFR’s impact on cancer growth in the 1980s. By finding out more about what causes cancer today, we should be able to better diagnose and treat it in the future.    

6 – Laying the foundations for radiotherapy  

Radiotherapy is the use of high energy x-rays to destroy cancer cells and is commonly used to treat lung cancer.  

For more than a century, we’ve supported doctors, physicists and radiologists to establish the principles of radiotherapy and its application to the clinic. Our researchers helped to build understanding on how to measure radiotherapy doses and how cells respond to radiation. This work has been crucial to radiotherapy becoming a mainstream anti-cancer treatment.  

Today, radiotherapy is commonly used for the treatment of lung cancer. In fact, 38% of patients diagnosed with small cell lung cancer and 24% of patients diagnosed with non small cell lung cancer in England during 2018-2019 had radiotherapy, as part of their primary cancer treatment.   

And things are still improving. In 2017 we got the results from our CONVERT trial, which looked at finding the best way to give radiotherapy to people with small cell lung cancer. The trial team found that having radiotherapy once a day worked as well as having it twice a day when you have it alongside chemotherapy. This means patients and doctors can choose together which treatment suits them best.  

To keep driving radiotherapy research forward, in 2019 we announced RadNet, our multimillion-pound plan to establish a network of 7 national centres of excellence in radiation oncology and radiobiology. We hope that this will help to stimulate research in 3 key areas: discovery, translation and clinical use, to keep making radiotherapy more effective and safer for patients.   

Patient receiving radiotherapy
Patient receiving radiotherapy treatment at Addenbrookes Hospital

7 – Using blood tests to predict when lung cancer might return  

As with many cancers, once lung cancer has been treated – with surgery, radiotherapy or chemotherapy – there is a chance of it returning.   

After treatment, lung cancer patients are carefully followed up with tests including CT scans to find out if their tumour has been completely removed, but scans won’t pick up tiny quantities of cancer cells known as minimal residual disease, which could result in cancer returning in the future.  

Image showing two vials of blood in a researchers hand

Scientists at our Cancer Research UK Cambridge Institute found that a personalised blood test – a type of liquid biopsy that can pick up fragments of tumour DNA in a person’s bloodstream – can be used to identify people who are at a higher risk of their lung cancer returning.  

These fragments of DNA, called circulating tumour DNA, can also reveal the state of the tumour, its location and potentially its weaknesses, information that could provide vital clues on how best to treat individual people with lung cancer.  

While more research is still needed to be sure that these tests will work in practice, liquid biopsies are well on their way to providing doctors with a simple, non-invasive way of spotting lung cancer earlier and tracking how the cancer changes over time.  

8 – Tracking the evolution of lung cancer 

This year, a raft of papers published from our flagship TRACERx study revealed more of the secrets of how lung cancer can evolve, spread and resist treatment.  

As a tumour grows, its DNA continues to mutate, and new clusters of cells genetically different from the rest of the tumour can start to form.  

These clusters are called subclones, and as a tumour grows more and more subclones are likely to develop.  

TRACERx researchers have found that by looking at these subclones, it’s possible to predict how likely a cancer is to return and whether it might spread (or metastasise). 

Testing for these subclones usually involves doctors taking a small sample of tissue directly from the tumour, which can be uncomfortable and time consuming.  

But TRACERx researchers are working on that problem too. Another one of their recent papers showed that it might be possible to use blood samples to measure the proportion of different subclones in a tumour, which can be used to predict whether the cancer might spread.  

This suite of new findings adds to the wealth of knowledge researchers have already uncovered through TRACERx, and over the next few years TRACERx EVO will allow us to uncover even more about how lung cancer evolves and evades treatment. 

9 – Building evidence for lung cancer screening 

We already know that screening programmes for breast, cervical and bowel cancer save thousands of lives each year. 

One of the main reasons for low survival rates for those with lung cancer is that it’s often diagnosed at a late stage, when there are fewer treatment options available.  

That’s where screening can help.  

Our evidence, such as the Lung Screen Uptake Trial, supported the UK National Screening Committee’s review into lung screening and ultimately influenced the UK Government’s decision to begin rolling it out in England. England’s national lung screening programme will be specifically targeted at those most at risk of developing lung cancer: people aged between 55 and 74 who either smoke or used to smoke. Now we’re working to make sure it’s implemented as effectively as possible and launching a campaign to make sure it reaches people in the rest of the UK too. 

To achieve this, relevant ministers in Wales and Scotland must make a commitment to rolling out a national screening programme in their own countries as soon as possible. 

In Northern Ireland, ongoing political instability has meant there has been no Executive and Assembly to drive forward a decision on targeted lung cancer screening. But we need to see action on lung cancer here too, as soon as the political situation allows. 

There is evidence that targeted lung screening saves lives from lung cancer but no screening is perfect and tests like this still have risks. So whether people take up their lung screening offer has to be a personal choice. 

10 Linking working with asbestos to mesothelioma 

In the early 1900s, there was a boom in using a material called asbestos in construction. 

Asbestos is made up of thousands of tiny fibres, which makes it strong and resistant to degradation and heat. This made it seemingly ideal to use as insulation in new buildings. 

But these tiny fibres can easily break away from asbestos and, if inhaled, can cause damage to cells in your lungs. It can also damage the lining of the lungs, called the pleura, which can cause the cancer mesothelioma. 

In 1966 a study by the British Occupational Hygiene Society (BOSH) suggested a ‘safe’ level of asbestos exposure, but over a decade later, a study led by Professor Julian Peto and funded by Cancer Research UK’s predecessor, pointed out that there was no evidence for a safe level.  

Microscopic image of mesothelioma
Microscopic image of mesothelioma. Image credit: Shutterstock / Lisa Culton

Peto’s analysis showed that approximately 10% of men exposed to asbestos within the ‘safe’ levels for 50 years (a typical working life span) would die of an asbestos-induced disease. 

This study, along with other research, led to stricter regulations, and in 1985 the use of blue and brown asbestos (the types of asbestos strongly linked to mesothelioma) were banned. 

Fast forward over 30 years, we’re still investing in mesothelioma research.  

In 2021, the CONFIRM trial, funded by us, showed that the immunotherapy drug nivolumab increased survival and made the disease more stable for patients with relapsed mesothelioma. 

It was the first study to show that a treatment has been able to improve survival in patients with mesothelioma that’s come back after chemotherapy. 

Looking forward   

Increasing focus on lung cancer research and increased public awareness of the dangers of tobacco has helped contribute towards more than 562,000 fewer lung cancer deaths in men in the past 40 years****. But we’ve still got a long way to go.   

With our increased investments in lung cancer research we’re reaching a turning point, and we hope it won’t be long before some of our landmark discoveries lead to further improvements in survival. 

Correction, 6 November 2023 – The original article stated that the SUMMIT trial was funded by Cancer Research UK, which is incorrect. This has now been updated. 

* These figures are based on the years 2017-2019. 

** Those diagnosed 2016 to 2020, followed up to 2021. 

*** Calculated by the Cancer Intelligence Team at Cancer Research UK, November 2022. Based on National Lung Cancer Audit data for 2017-19 

**** Calculated by the Cancer Intelligence team at Cancer Research UK. Based on the expected number of deaths from lung cancer each year if the mortality rate had remained the same as it was in 1979. 

    Comments

  • Mrs Jean Bradshaw
    7 December 2023

    Your work is amazing and I will always support Cancer Research. My husband was diagnosed with small cell lung cancer in December 2012 ad died in December 2013. Doctors were amazed he was a non-smoker and put it down to working in an environment containing heavy smokers for a number of years. I wonder now if the fact that he had a great interest in old cars and used to respray these at home had n impact. Could the paint used have caused his cancer?

  • Heather Price
    23 February 2023

    I am truly amazed by the amount of research into lung cancer. I was diagnosed with lung cancer almost 2 years ago. I take osimertinib 40mgs, 80 mgs produced too many side effects

  • SUSAN POPHAM
    1 December 2022

    very good info

  • Jenny Bond
    30 November 2022

    Just been diagnosed so am pretty scared

  • reply
    Jacob Smith
    1 December 2022

    Hi Jenny,

    We’re sorry to hear about your diagnosis, and understand it can be a difficult time.

    Please feel free to reach out to Cancer Research UK’s nurses if you have specific questions about your diagnosis or treatment. You can call on freephone 0808 800 4040 between 9am and 5pm Monday to Friday. Or, to chat online with other people affected by cancer, you can join our fully moderated online community Cancer Chat at http://www.cancerchat.org.uk

    Best wishes,
    Jacob, Cancer Research UK

  • Christine Dunse
    30 November 2022

    Thats great my father died of lung cancer it was a horrible death he smoked 60 woodbine a day most in our living room the walls curtains and ceiling were brown weived in a smoke filled room. I am 71 and never smoked in my life . You are doing a great job well done x

  • Amanda Sands
    30 November 2022

    Is circulating DNA tested for in the NHS and if so which group of patients?

  • Stephen Whitehead
    30 November 2022

    Cut the quarter of a million pounds that Michell Mitchell gets and use it for research it would be more appropriately used .

  • Prit koonjul
    30 November 2022

    You Team are always highly praise of what you do.God bless and great work,bless you all for continuously involving in research for prevention and cure of Cancer.👍🏾🫶🏻🙏🏼👏🏻

  • Heather
    14 November 2022

    Great work. ALK +VE gene mutation included in all this please? On alectinib atm. Any new finds? Thank you for all yr perseverance and hard work

  • Phyllis Macrae
    12 November 2022

    Very encouraging thanks to all the hard work done,keep it up

  • Christine Smith
    11 November 2022

    Thank you for all you do I have had part of my lung removed because of cancer it was caught very early and I have a great team looking after me

  • Andrew Benson
    10 November 2022

    So good to get some insight into the brilliant work you are doing to fight lung cancer. Thank you.

  • Terry Kavanagh
    8 November 2022

    Agree with the previous comment. This info needs to be out there for people searching for information. Also described in more lay terms.

  • Janette Rawlinson
    8 November 2022

    some excellent process made so far – and more being researched all the time. Wish the findings of these excellent studies and treatment breakthroughs were more readily available to public and patients searching on the internet when first suspected for lung cancer to help improve public perceptions that nothing can be done. Keep up the good much needed research into lung cancer.

    Comments

  • Mrs Jean Bradshaw
    7 December 2023

    Your work is amazing and I will always support Cancer Research. My husband was diagnosed with small cell lung cancer in December 2012 ad died in December 2013. Doctors were amazed he was a non-smoker and put it down to working in an environment containing heavy smokers for a number of years. I wonder now if the fact that he had a great interest in old cars and used to respray these at home had n impact. Could the paint used have caused his cancer?

  • Heather Price
    23 February 2023

    I am truly amazed by the amount of research into lung cancer. I was diagnosed with lung cancer almost 2 years ago. I take osimertinib 40mgs, 80 mgs produced too many side effects

  • SUSAN POPHAM
    1 December 2022

    very good info

  • Jenny Bond
    30 November 2022

    Just been diagnosed so am pretty scared

  • reply
    Jacob Smith
    1 December 2022

    Hi Jenny,

    We’re sorry to hear about your diagnosis, and understand it can be a difficult time.

    Please feel free to reach out to Cancer Research UK’s nurses if you have specific questions about your diagnosis or treatment. You can call on freephone 0808 800 4040 between 9am and 5pm Monday to Friday. Or, to chat online with other people affected by cancer, you can join our fully moderated online community Cancer Chat at http://www.cancerchat.org.uk

    Best wishes,
    Jacob, Cancer Research UK

  • Christine Dunse
    30 November 2022

    Thats great my father died of lung cancer it was a horrible death he smoked 60 woodbine a day most in our living room the walls curtains and ceiling were brown weived in a smoke filled room. I am 71 and never smoked in my life . You are doing a great job well done x

  • Amanda Sands
    30 November 2022

    Is circulating DNA tested for in the NHS and if so which group of patients?

  • Stephen Whitehead
    30 November 2022

    Cut the quarter of a million pounds that Michell Mitchell gets and use it for research it would be more appropriately used .

  • Prit koonjul
    30 November 2022

    You Team are always highly praise of what you do.God bless and great work,bless you all for continuously involving in research for prevention and cure of Cancer.👍🏾🫶🏻🙏🏼👏🏻

  • Heather
    14 November 2022

    Great work. ALK +VE gene mutation included in all this please? On alectinib atm. Any new finds? Thank you for all yr perseverance and hard work

  • Phyllis Macrae
    12 November 2022

    Very encouraging thanks to all the hard work done,keep it up

  • Christine Smith
    11 November 2022

    Thank you for all you do I have had part of my lung removed because of cancer it was caught very early and I have a great team looking after me

  • Andrew Benson
    10 November 2022

    So good to get some insight into the brilliant work you are doing to fight lung cancer. Thank you.

  • Terry Kavanagh
    8 November 2022

    Agree with the previous comment. This info needs to be out there for people searching for information. Also described in more lay terms.

  • Janette Rawlinson
    8 November 2022

    some excellent process made so far – and more being researched all the time. Wish the findings of these excellent studies and treatment breakthroughs were more readily available to public and patients searching on the internet when first suspected for lung cancer to help improve public perceptions that nothing can be done. Keep up the good much needed research into lung cancer.