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Lung cancer is leading site of cancer in Indian males today. The incidence is on the rise. It is generally diagnosed in late stages. The progression free survival and overall survival still remains low. Majority of oncology research today is driven towards molecular profiling of lung cancer. Receptor tyrosine kinases have emerged as major molecular markers and targets. These are the results of gene mutations or amplifications. There are many developed targets where therapeutic option is available like EGFR, ALK, MET, KRAS and so on. This review features on few important molecular profiles of lung cancer, especially with more therapeutic implications.

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The blood plasma levels of ACTH, CEA, calcitonin, parathyrin, hydrocortisone, serotonin, and histamine were measured radioimmunologically in 58 cases of small cell lung cancer prior to treatment. Elevated concentrations of CEA (61%) and ACTH (44%) were relatively frequent. Blood plasma--ACTH level in cases of expanded small cell lung cancer was higher than in healthy subjects and patients with localized tumor. A correlation was found between cancer patients survival time and the basal levels of CEA, ACTH and calcitonin. Polyamines were assayed in diurnal urine of 24 cancer patients prior to treatment and during chemotherapy. The mean level of putrescine before treatment was much in excess of normal value. Responders to treatment revealed a considerable rise in spermidine excretion within the first 10 days after treatment. In non-responders, spermidine excretion remained at the same level.

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Electronmicroscopic study of 35 small-cell lung carcinomas showed these to be a group of lung carcinomas having different histogenesis (cytogenesis). Apart from carcinoma without signs of differentiation, this group also includes squamous-cell carcinoma, adenocarcinoma, apudoma and mixed carcinoma with various differentiation of tumour cells. A certain correlation between the ultrastructural features of the tumour and its susceptibility to the treatment is established. Small-cell carcinomas consisting of undifferentiated cells are most susceptible. A relatively good prognosis can be expected when a variant with the endocrine differentiation of tumour cells is treated. Tumours interpreted light microscopically as small-cell carcinoma but ultrastructurally identified as having squamous-cell differentiation, or as adenocarcinoma and mixed carcinoma have the least favourable prognosis after treatment.

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T-activin immunotherapy in conjunction with maintenance chemotherapy was given to 13 patients suffering small-cell carcinoma of the lung in whom previous cytostatic and combined treatment (chemotherapy+radiation) resulted in a complete regression of tumor. The median survival time in those patients was 113 weeks versus 75 weeks in 13 controls. The results make the case for further studies on application of the said agent aimed at longer survival and remission in patients with small-cell carcinoma of the lung.

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An electron microscopic study of small-cell carcinoma of the human lung showed that tumors identified by light microscopy as small-cell lung cancer were, in actual fact, histologically heterogenous, ranging from those free from any signs of specific cell differentiation, neoplasms with endocrine differentiation, squamous cell cancer, adenocarcinomas to tumors with mixed cell differentiation. Elevated blood-ACTH concentrations occur in patients with tumors which do not incorporate cells with endocrine differentiation. In such cases, activation of ACTH synthesis may be due to hyperfunction and hyperplasia of apudocytes (elements of a diffuse endocrine system--the APUD system) of the lung or other organs in response to tumor growth.

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The results of combined chemotherapy and chemoradiotherapy of 158 patients with small cell lung cancer are presented. Adriamycin was used as one of the components of the induction chemotherapy of 98 out of the 158 patients. Chemoradiotherapy (nitrosomethylurea, methotrexate, CCNU, adriamycin, vincristine, DTIC, radiotherapy) was performed according to 4 schemes and combined chemotherapy (cyclophosphamide, adriamycin, methotrexate, or CCNU, cyclophosphamide, methotrexate plus adriamycin, vincristine, natulan) was performed according to 2 schemes. The total efficacy (complete and partial regression) of the 6 schemes averaged to 80 per cent. The number of patients with complete regression amounted to 29 per cent. Long-term survival for more than 2 years was observed in 17 per cent of the patients. No signs of metastases or relapses for 5 years were recorded in 6 per cent of patients. Adriamycin is one of the most active antitumor drugs in combined chemotherapy and chemoradiotherapy of small cell lung cancer.

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A study on the advantages offered by a "prophylactic" cranial irradiation in cases of localized small cell cancer of the lung has been conducted at the Center since April of 1981. The report deals with preliminary results on tolerance and immediate reactions of the brain obtained on the basis of 25 cases. A good tolerance of doses ranging 25-30 Gy was recorded. Acute reactions followed gamma therapy in 32% which, however, did not prevent the completion of the full course of prophylactic irradiation. Neurologic symptoms developed after cranial irradiation in 3 cases; this was interpreted as a possible post-radiation encephalopathy. Metastasis was found in one case. The results suggest that the study be continued.

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