title: Chemoprevention of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.
abstract: BACKGROUND
  Lung cancer is the most common cause of cancer death in men and women in the United States. Cigarette smoking is the main risk factor. Former smokers are at a substantially increased risk of developing lung cancer compared with lifetime never smokers. Chemoprevention refers to the use of specific agents to reverse, suppress, or prevent the process of carcinogenesis. This article reviews the major agents that have been studied for chemoprevention.
  
  
  METHODS
  Articles of primary, secondary, and tertiary prevention trials were reviewed and summarized to obtain recommendations.
  
  
  RESULTS
  None of the phase 3 trials with the agents β-carotene, retinol, 13-cis-retinoic acid, α-tocopherol, N-acetylcysteine, acetylsalicylic acid, or selenium has demonstrated beneficial and reproducible results. To facilitate the evaluation of promising agents and to lessen the need for a large sample size, extensive time commitment, and expense, surrogate end point biomarker trials are being conducted to assist in identifying the most promising agents for later-stage chemoprevention trials. With the understanding of important cellular signaling pathways and the expansion of potentially important targets, agents (many of which target inflammation and the arachidonic acid pathway) are being developed and tested which may prevent or reverse lung carcinogenesis.
  
  
  CONCLUSIONS
  By integrating biologic knowledge, additional early-phase trials can be performed in a reasonable time frame. The future of lung cancer chemoprevention should entail the evaluation of single agents or combinations that target various pathways while working toward identification and validation of intermediate end points.
authors: Lung and Upper Aerodigestive Cancer Research Group, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors: Eva
authors: E
authors: Szabo
authors: Division of Pulmonary, Critical Care, and Sleep Medicine, New Mexico VA Health Care System/University of New Mexico, Albuquerque, NM.
authors: Jenny T
authors: JT
authors: Mao
authors: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors: Stephen
authors: S
authors: Lam
authors: Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY.
authors: Mary E
authors: ME
authors: Reid
authors: VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO. Electronic address: Robert.keith@ucdenver.edu.
authors: Robert L
authors: RL
authors: Keith
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D018890:Chemoprevention / Q000379:methods*; D002986:Clinical Trials as Topic; D006801:Humans; D008175:Lung Neoplasms / Q000517:prevention & control*; D011322:Primary Prevention; D012307:Risk Factors; D055502:Secondary Prevention; D015398:Signal Transduction; D012907:Smoking / Q000009:adverse effects; D055512:Tertiary Prevention
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor
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