Lung Adenocarcinoma

Lung adenocarcinoma accounts for about 40% of all lung cancers. It tends to grow more slowly than other kinds of lung cancer.

There are numerous treatment options available to people affected by lung adenocarcinoma, and doctors are working hard to develop and improve these treatments.

Lung adenocarcinoma brochureTo help you understand and share this information, click here to download and print a booklet that summarizes the detailed information in the following sections.

This website can help you:

  • Learn about adenocarcinoma
  • Understand the treatment options available for adenocarcinoma
  • Consider whether participating in a clinical trial might be right for you
  • Understand how to manage the side effects associated with lung cancer treatment

What is lung adenocarcinoma?

Adenocarcinoma is a subtype of of non-small cell lung cancer (NSCLC). It tends to develop in smaller airways, such as bronchioles, and is usually located more along the outer edges of the lungs.1

Adenocarcinoma of the lung

Adenocarcinoma is a cancer that begins in cells in the glands. Glandular cells are found in the lungs and some other internal organs. Most cancers of the breast, pancreas, prostate, and colon are also adenocarcinomas. Only adenocarcinoma that begins in the lungs is considered lung cancer.2

Adenocarcinoma accounts for 40% of all lung cancers, is found more often in women, and tends to grow more slowly. Most lung cancers in people who have never smoked are adenocarcinomas.1

Diagnosing lung adenocarcinoma

This type of lung cancer may be diagnosed in many different ways. In addition, doctors have come up with very specific modes of categorizing lung cancer to help treat them better. Understanding the ways that doctors categorize lung cancers may help you understand your diagnosis.

How is Lung Adenocarcinoma Diagnosed?

Many different tests are used to diagnose lung cancer and determine whether it has spread to other parts of the body. Some can also help to decide which treatments might work best. The steps and tests used in diagnosing lung adenocarcinoma include:

  • Imaging tests
  • Laboratory tests
  • Biopsies

Not all of these will be used for every person. The approaches used for an individual will depend on your medical history and condition, symptoms, location of the nodule(s), and other test results.

Read the Diagnosing Lung Cancer section to learn about the different steps and tests for making a lung cancer diagnosis.

Stages of Lung Cancer

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostics to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to recommend a treatment plan. Although lung cancer is treatable at any stage, only certain stages of lung cancer can be cured.

The Lung Cancer Staging section provides more information about this way of understanding lung adenocarcinoma.

Biomarker Profile

Lung cancer describes many different types of cancer that start in the lung or related structures. There are two different ways of describing what kind of lung cancer a person has:

  • Histology—what the cells look like under a microscope. Adenocarcinoma is a histological subtype of non-small cell lung cancer. Other subtypes of non-small cell lung cancer include squamous cell lung cancer, large cell carcinoma, and some rarer types. Small cell lung cancer (SCLC) is the other major type of lung cancer.
  • Biomarker profile (also called molecular profile, genetic profile, or signature profile)—the mutations, or characteristics, as well as any other unique biomarkers, found in a person’s cancer that allowed the cancer to grow.

A person’s lung cancer may or may not have one of the many known mutations. For example, two patients may be treated with two different therapies because of their own cancer’s specific mutation or lack of a mutation.

Researchers are making progress in understanding mutations in adenocarcinoma. Several therapies targeting these mutations are approved for use as first-line treatment (and later) in adenocarcinoma, and others are being studied in clinical trials.3

The decision to test for mutations should be made together by you and your oncologist.

Here are the mutations that have been identified for adenocarcinoma at this time.4

Biomarker profile of adenocarcinoma

More information about mutations, and how and when testing for them is performed, can be found here (see “What is a mutation?,” “How is biomarker testing performed?,” and “Who should have their tumor tested and when?”).

Treatment options for lung adenocarcinoma

There are a number of treatment options for adenocarcinoma. Which ones are used to treat a specific patient’s lung cancer will depend on the stage of the cancer and the patient’s overall health and preferences.

Treatment options fall into two categories:

  • Those that are available for your doctor to prescribe, having been already approved by the FDA in the U.S. or other drug regulatory agencies in other countries
  • Those that are being studied in clinical trials

What are Currently Approved Treatment Options?

Approved treatment options for lung adenocarcinoma include:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted cancer therapy
  • Angiogenesis inhibitors
  • Immunotherapy

It is important to note that a patient’s age has never been useful in predicting whether that patient will benefit from treatment. Age should never be used as the only reason for deciding what treatment is best, especially for older patients who are otherwise physically fit and have no medical problems besides lung cancer.5

Surgery

Lung cancer that is only in one lung and that has not spread to other organs is often treated with surgery, if the patient can tolerate it. Read more about different surgical options and what to expect after surgery in the Treatment Options: Surgery section.

Radiation Therapy

Radiation therapy is a type of cancer treatment that uses high-powered energy beams to kill cancer cells. Depending on the individual patient’s situation, radiation therapy may be used when trying to cure cancer, control cancer growth, or relieve symptoms caused by the tumor, such as pain.

Radiation therapy can be given as the main treatment in early-stage lung adenocarcinoma if surgery is not possible. In that case, it may be given either with or without chemotherapy.

Read more about radiation treatment, including how it works, how and when it is given, the different kinds, and common side effects, in the Treatment Options: Radiation Therapy section.

Chemotherapy

Patients whose lung cancer has spread beyond the lung to local lymph nodes are often given chemotherapy and radiation therapy. As with other types of non-small cell lung cancer, patients with lung adenocarcinoma are often given two chemotherapy agents as first-line therapy. Which drugs are chosen will depend in part on the patient’s overall health and ability to tolerate different possible side effects.

Most often, the platinum drugs cisplatin and carboplatin are combined with another chemotherapy drug. Several combinations are used for patients with lung adenocarcinoma3:

  • Cisplatin or carboplatin and pemetrexed (Alimta®)
  • Cisplatin or carboplatin and docetaxel
  • Carboplatin and paclitaxel
  • Carboplatin and nab-paclitaxel (Abraxane®)

There are other drug therapy options, like targeted cancer therapies, angiogenesis inhibitors, and immunotherapy. These are discussed in more detail below. Your doctor will help to select the best treatment based on your medical history. Read more about chemotherapy, including how it works, how and when it is given, and possible side effects and how to manage them, in the Treatment Options: Chemotherapy section.

Targeted Cancer Therapy

Targeted cancer therapies are a type of therapy that aims to target cancer cell directly. They focus on specific parts of cells and the signals that cause cancer cells to grow uncontrollably and thrive. All of the targeted cancer therapies that have been studied and FDA-approved belong to a class of drugs called tyrosine kinase inhibitors (TKIs).

As discussed earlier in this section, there are a number of known mutations in lung adenocarcinoma. TKIs are currently approved by the U.S. Food and Drug Administration (FDA) for three of them: the epidermal growth factor receptor (EGFR) mutation, the anaplastic lymphoma kinase (ALK) gene rearrangement, and the ROS1 gene rearrangement. Lung cancers with these mutations are called EGFR-positive, ALK-positive, and ROS1-positive.

EGFR mutations occur in about 25% of lung adenocarcinoma tumors. There are currently three FDA-approved EGFR inhibitors approved as first-line treatment for patients with metastatic EGFR-positive non-small cell lung cancer:

  • Afatinib (GilotrifTM)9
  • Erlotinib (Tarceva®)10
  • Gefitinib (Iressa®)11

Erlotinib is also approved as maintenance therapy or second-line or greater therapy for EGFR-positive patients with metastatic NSCLC whose cancer has progessed after at least one prior chemotherapy regimen.10

ALK gene rearrangements happen in a small proportion (3–7%) of patients with lung adenocarcinoma. The following ALK inhibitors are currently FDA-approved for patients with ALK-positive metastatic non-small cell lung cancer, including adenocarcinoma:

  • Crizotinib (Xalkori®)6: as first-line treatment
  • Alectinib (Alecensa®)7: for patients whose cancer has grown while they were on crizotinib
  • Ceritinib (ZykadiaTM)8: for patients whose cancer has grown while they were on crizotinib

Both alectinib and ceritinib are also approved for people who cannot tolerate crizotinib.

About 1% to 2% of patients with lung adenocarcinoma have tumors with a ROS1 mutation.

There is currently one tyrosine kinase inhibitor that has been approved for patients with metastatic NSCLC whose tumors are ROS1-positive. This is crizotinib (Xalkori®), a TKI that is also used for patients with ALK-positive tumors.6

Other ROS1 inhibitors are currently being studied in clinical trials.

The biggest challenge of TKIs is that all patients with lung cancer who initially benefit from them eventually develop resistance, known as “acquired resistance.” Doctors and researchers are working to overcome resistance in tumors and to keep TKIs effective against cancer for longer periods of time. 

One cause of acquired resistance is the development of a new T790M mutation after treatment with an EGFR inhibitor. This develops in about two-thirds of patients with EGFR-positive lung cancer. There is currently one FDA-approved EGFR inhibitor approved for patients with metastatic EGFR-positive NSCLC that also has the T790M mutations:

  • Osimertinib (TagrissoTM)12
    • as second-line or third-line treatment
    • for patients whose lung cancer has grown or spread on or after another EGFR TKI therapy

Read more about targeted cancer therapy, including how it works, how and when it is given, and possible side effects and how to manage them in the Treatment Options: Targeted Therapy section.

Angiogenesis Inhibitors

As the body develops and grows, it makes new blood vessels to supply all of the cells with blood. This process is called angiogenesis. When the new blood vessels provide oxygen and nutrients to cancer cells, they help the cancer cells grow and spread.

Angiogenesis inhibitors help stop or slow the growth or spread of tumors by stopping them from making new blood vessels. The tumors then die or stop growing because they cannot get the oxygen and nutrients they need. The way they do this is by blocking the cancer cells’ vascular endothelial growth factor (VEGF) receptors.13

Currently, two angiogenesis inhibitors are FDA-approved for patients with non-small cell lung cancer, including adenocarcinoma:

  • Bevacizumab (Avastin®)14In combination with carboplatin and paclitaxel for the first-line treatment  of patients with unresectable, locally advanced, recurrent, or metastatic non-squamous  adenocarcinoma
  • Ramucirumab (Cyramza®)15In combination with docetaxel for the second-line treatment of patients with metastatic NSCLC

Read more about how angiogenesis inhibitors work and common side effects, as well as questions to ask your health care team, in the Treatment Options: Angiogenesis Inhibitors section.

Immunotherapy

Immunotherapy aims to strengthen the natural ability of the patient’s immune system to fight cancer. Instead of targeting the person’s cancer cells directly, immunotherapy trains a person’s natural immune system to recognize cancer cells and selectively target and kill them.

Currently, there are three FDA-approved immunotherapy drugs for people with non-small cell lung cancer. These drugs belong to the type of immunotherapy called immune checkpoint inhibitors, which work by targeting and blocking the fail-safe mechanisms of the immune system. The goal is to block the immune system from limiting itself, so the immune system can target the cancer cells.16,17

Nivolumab (Opdivo®)18, pembrolizumab (Keytruda®)19, and atezolizumab (Tecentriq®)20 are approved for people who have:

  • Metastatic NSCLC
  • Disease progression during or after treatment with platinum-based chemotherapy

Pembrolizumab’s approval also requires the following:

  • The patient’s tumors must express PD-L1
  • And, for patients with ALK-positive or EGFR-positive NSCLC, the lung cancer should have progressed on an approved ALK or EGFR inhibitor before they are treated with pembrolizumab.

Atezolizumab's approval also requires that for patients with ALK-positive or EGFR-positive NSCLC, the lung cancer should have progressed on an approved ALK or EGFR inhibitor before they are treated with atezolizumab.

For more about immunotherapy, including how the immune system works, possible side effects, other kinds of immunotherapy being studied, and questions to ask your health care team, see the Treatment Options: Immunotherapy section.

What clinical research study (clinical trial) treatment options are available?

In addition to the approved treatments described above, there is a great deal of promising research going on now in clinical trials focused on people with lung adenocarcinoma.21The following describe some, but by no means all, of the clinical trials available for people with lung adenocarcinoma.

Targeted Cancer Therapy

As shown earlier, a number of mutations have been found in lung adenocarcinoma in addition to EGFR, ALK, and ROS1. These include AKT1, BRAF, HER2, KRAS, MEK1, NRAS, NTRK1, PIK3CA, and RET. Currently, researchers are working to develop drugs that target most of these mutations.

Immunotherapy

Three main types of immunotherapy are currently being studied in clinical trials for people with all stages of non-small cell lung cancer:

  • Immune checkpoint inhibitors by themselves or combined with other drugs
  • Therapeutic cancer vaccines
  • Adoptive T cell transfer

Immune checkpoint inhibitors, such as nivolumab, pembrolizumab, and atezolizumab continue to be studied for treatment of earlier stages of lung cancer and in combination with other treatments.21

New Approaches to Existing Treatments

In addition to new treatments, doctors are also trying new approaches to existing treatments. Some examples include:

  • Chemotherapy agents given in combination with radiation therapy, surgery, immunotherapy, and targeted cancer therapy
  • Radiation therapy given in combination with chemotherapy and surgery
  • Looking at whether using imaging procedures, such as PET and CT scans, can help doctors guide radiation therapy so that higher doses can be delivered directly to the tumor, causing less damage to healthy tissue

Finding a Clinical Trial That Might Be Right for You

If you are considering participating in a clinical trial, start by asking your health care team whether there is one that might be a good match for you in your geographic area. In addition, there are several online and phone-based resources to help you find one that may be a good match. Read more about clinical trials and resources for finding one for you.

Managing symptoms and side effects

As already noted, lung cancer treatments can cause side effects. Some cancer therapy side effects are temporary, while others can be more long-term. When you start a new treatment, you should discuss with your doctor which potential side effects to expect, what can be done to manage them, and which side effects are serious and need to be reported immediately. Often, drugs can be prescribed to help reduce many of these side effects.  

In addition to the side effects of lung cancer treatment, lung cancer itself can result in a number of symptoms. Read more about the symptoms of lung cancer.

Note: It’s important to let your doctor or nurse know if you are experiencing any problems while on treatment, so they can sort out whether the problems are related to treatment or not.

Tips for managing specific symptoms and side effects related to treatment can be found in the Support & Survivorship section of the website, along with other practical and supportive resources for patients/survivors and caregivers.

To help reduce the severity and duration of most side effects and alleviate the cancer’s symptoms, you may want to request palliative care, also called “supportive care” or “symptom management.” There is sometimes confusion about the difference between palliative care and hospice care. Hospice care is a form of palliative care given only to patients whose life expectancy is six months or less. On the other hand, palliative care in general is an extra layer of support than can be initiated alongside other standard medical care. In fact, scientific evidence is starting to emerge that shows that palliative care may actually help patients live longer.

Read more about how palliative care can improve quality of life from the time of diagnosis.

Your health care team

There are a number of doctors and other medical professionals who diagnose and treat people with lung cancer. Together, they make up the comprehensive medical or health care team that a patient sees over the course of his or her care. Your health care team can describe your treatment options, the expected results of each option, and the possible side effects. You and your health care team can work together to develop a treatment plan.

Read more about what each member of your health care team does.

Updated November 4, 2016.


References

  1. Wistuba I, Brambilla E, Noguchi M. Chapter 17: Classic Anatomic Pathology and Lung Cancer. In: Pass HI, Ball D, Scagliotti GV, eds. The IASLC Multidisciplinary Approach to Thoracic Oncology. Aurora, CO: IASLC Press; 2014:217-240.
  2. NCI Dictionary of Cancer Terms. National Cancer Institute website. http://www.cancer.gov/dictionary. Accessed March 25, 2015.
  3. Ramalingham S, Pillai RN, Reinmuth N, Reck M. Chapter 44: First-line Systematic Therapy Options for Non-small Cell Lung Cancer. In: Pass HI, Ball D, Scagliotti GV, eds. The IASLC Multidisciplinary Approach to Thoracic Oncology. Aurora, CO: IASLC Press; 2014:583-605.
  4. Lovly C, Horn L, Pao W. Molecular Profiling of Lung Cancer. My Cancer Genome website. http://www.mycancergenome.org/content/disease/lung-cancer. Updated January 26, 2016. Accessed January 29, 2016.
  5. Lung Cancer – Non-Small Cell: Stages. American Society of Clinical Oncology website. http://www.cancer.net/cancer-types/lung-cancer-non-small-cell/stages. Approved August 20, 2015. Accessed January 29, 2016.
  6. Xalkori® (crizotinib) capsules [package insert]. Pfizer, Inc. New York, NY. http://labeling.pfizer.com/showlabeling.aspx?id=676. Revised March 16, 2016. Accessed March 23, 2016.
  7. Alecensa® (alectinib) capsules [package insert]. Genentech, Inc. South San Francisco, CA. http://www.gene.com/download/pdf/alecensa_prescribing.pdf. Revised December 2015. Accessed December 15, 2015.
  8. ZykadiaTM (ceritinib) capsules [package insert]. Novartis. Basel, Switzerland. http://www.pharma.us.novartis.com/product/pi/pdf/zykadia.pdf. Revised July 2015. Accessed November 2, 2015.
  9. GilotrifTM (afatinib) tablets [package insert]. Boehringer Ingelheim Pharmaceuticals, Inc. Ridgefield, CT. http://docs.boehringer-ingelheim.com/Prescribing Information/PIs/Gilotrif/Gilotrif.pdf. Revised December 2015. Accessed January 29, 2016.
  10. Tarceva® (erlotinib) tablets [package insert]. OSI Pharmaceuticals, LLC. Northbrook, IL. http://www.gene.com/download/pdf/tarceva_prescribing.pdf. Revised October 2016. Accessed October 26, 2016.
  11. Iressa® (gefitinib) tablets [package insert]. AstraZeneca Pharmaceuticals LP. Wilmington, DE. http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/206995s000lbl.pdf?et_cid=36354018&et_rid=933008744&linkid=http%3a%2f%2fwww.accessdata.fda.gov.... Revised July 2015. Accessed January 29, 2016.
  12. TagrissoTM (osimertinib) tablets [package insert]. AstraZeneca Pharmaceuticals LP. Wilmington, DE. http://www.azpicentral.com/tagrisso/tagrisso.pdf#page=1. Revised November 2015. Accessed January 29, 2016.
  13. Angiogenesis Inhibitors. National Cancer Institute website. http://www.cancer.gov/about-cancer/treatment/types/immunotherapy/angiogenesis-inhibitors-fact-sheet. Reviewed October 7, 2011. Accessed January 29, 2016.
  14. Avastin® (bevacizumab) solution [package insert]. Genentech, Inc., South San Francisco, CA; November 2014. http://www.gene.com/download/pdf/avastin_prescribing.pdf. Revised December 2015. Accessed January 29, 2016.
  15. Cyramza® (ramucirumab) injection [package insert]. Eli Lilly and Company, Indianapolis, IN; December 2014. http://pi.lilly.com/us/cyramza-pi.pdf. Revised April 2015. Accessed January 29, 2016.
  16. Vansteenkiste JF, Shepherd FA. Chapter 50: immunotherapy and Lung Cancer. In: Pass HI, Ball D, Scagliotti GV, eds. The IASCL Multidisciplinary Approach to Thoracic Oncology. Aurora, CO: IASCL Press; 2014: 691-704.
  17. Pardoll D. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer. 2012; 12:252-264. doi:10.1.1038/nrc3239. http://www.nature.com/nrc/journal/v12/n4/full/nrc3239.html. Accessed January 29, 2016.
  18. Opdivo® (nivolumab) injection [package insert]. Bristol-Myers Squibb Company. Princeton, NJ. http://packageinserts.bms.com/pi/pi_opdivo.pdf. Revised January 2016. Accessed January 29, 2016.
  19. Keytruda® (pembrolizumab) injection [package insert]. Merck & Co., Inc. Whitehouse Station NJ. https://www.merck.com/product/usa/pi_circulars/k/keytruda/keytruda_pi.pdf. Revised October 2016. Accessed October 26, 2016.
  20. Tecentriq® (atezolizumab) injection [package insert]. Genentech, Inc., South San Francisco, CA; 2016. https://www.gene.com/download/pdf/tecentriq_prescribing.pdf. Posted October 2016. Accessed October 25, 2016.
  21. Clinicaltrials.gov. U.S. National Institutes of Health website. http://clinicaltrials.gov. Accessed January 29, 2016.

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