Patricia Neal Succumbs to Lung Cancer

Academy Award winning actress Patricia Neal, 84, has died of lung cancer. The actress is known for her memorable roles such as Dominique Francon in The Fountainhead, Alma Brown in Hud (for which she won the Oscar for Best Actress), and Nettie Cleary in The Subject was Roses (for which she was nominated for an Academy Award). She was married to author Roald Dahl (author of such favorites as Charlie and The Chocolate Factory, James and the Giant Peach, and Fantastic Mr. Fox) for 30 years.  In 1965, while pregnant with their daughter Lucy, she suffered a severe stroke from the rupture of three cerebral aneurysms that left her paralyzed on her right side and unable to speak. With the help of her husband, and the Fort Sanders Regional Medical Center, which specialized in stroke, spinal cord and brain therapies, Neal was able to completely recover. In 1978, the rehab center at Fort Sanders was renamed The Patricia Neal Rehabilitation Center in her honor, and she remained actively involved with its foundation.  While visiting in Los Angeles in February 2010, she had a fall which resulted in a broken hip that required surgery. After surgery she came down with pneumonia, and further testing revealed she had lung cancer.

Although no further information has been released about the type of lung cancer Ms. Neal had, or what kinds of treatment she received, we can, nonetheless, use the opportunity to talk about some hopeful new treatments being used in the battle with lung cancer. For basics about lung cancer see our article on Bryant Gumbel.

Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the United States.

There are two main categories of lung cancer:

  • Small cell carcinoma – about 13% of lung cancers are of this type which tends to spread quickly
  • Non-small cell carcinoma – about 87% of lung cancers are of this type which spreads more slowly

Non-small cell carinoma (NSCC) ranks among the Top 10 deadliest cancers worldwide. In 2004, researchers discovered genetic mutations (called epidermal growth factor receptor (EGFR) mutations ) in some NSCC cells which gave them insights into how those cells function.  This, in turn, lead them toward treatments that could be more effective- by using drugs targeted against those specific mutations, clinically called Targeted Cancer Therapy.

What is Targeted Cancer Therapy?

According to the National Cancer Institute: “targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression. Targeted cancer therapies interfere with cancer cell division (proliferation) and spread in different ways. Many of these therapies focus on proteins that are involved in cell signaling pathways, which form a complex communication system that governs basic cell functions and activities, such as cell division, cell movement, how a cell responds to specific external stimuli, and even cell death. By blocking signals that tell cancer cells to grow and divide uncontrollably, targeted cancer therapies can help stop cancer progression and may induce cancer cell death through a process known as apoptosis.* Other targeted therapies can cause cancer cell death directly, by specifically inducing apoptosis, or indirectly, by stimulating the immune system to recognize and destroy cancer cells and/or by delivering toxic substances to them.”

*Apoptosis is a type of cell death in which a series of molecular steps in a cell leads to its death. This is the body’s normal way of getting rid of unneeded or abnormal cells.

The development of targeted therapies, therefore, requires the identification of good targets—that is, targets that are known to play a key role in cancer cell growth and survival. (It is for this reason that targeted therapies are often referred to as the product of “rational drug design.”) Targeted cancer therapies also hold the promise of being more selective for cancer cells than normal cells, thus harming fewer normal cells, reducing side effects, and improving quality of life.

There are two kinds of targeted therapy for lung cancer. Both drugs affect the function of the epidermal growth factor receptor (EGFR).

  • One kind is given through a vein (intravenous) at the doctor’s office, hospital, or clinic.  Erlotinib (Tarceva®) is approved to treat metastatic non-small cell lung cancer and pancreatic cancer that cannot be removed by surgery or has metastasized. It’s given at the same time as chemotherapy. The side effects may include bleeding, coughing up blood, a rash, high blood pressure, abdominal pain, vomiting, or diarrhea.
  • Another kind of targeted therapy is taken by mouth. Gefitinib (Iressa®) is approved to treat patients with advanced non-small cell lung cancer. Its use is restricted to patients who, in the opinion of their treating physician, are currently benefiting, or have previously benefited, from gefitinib treatment.  It isn’t given with chemotherapy. The side effects may include rash, diarrhea, and shortness of breath.

Since not all NSCC cells contain the EGFR mutation, non-small cell cancer patients should be genetically tested for the mutation, to see if these targeted therapies would be appropriate for them.

For more information about Targeted Cancer Therapy- click here.

For more information about Lung Cancer- click here.

Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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