PROGRAM AREA REPORTS

LUNG CANCER PROGRAM

General principles and basic strategies of the Lung Cancer Program Area were discussed in the previous years. As a result, the following three major clinical areas were selected for joint cooperation:
1. Microscopic Classification of Lung Cancer. In a joint meeting held in Tokyo on March 27, 1975, full agreement was reached on acceptance of the main classification of lung cancer according to the World Health Organization (WHO) with subclassification of the tumor cell types. The use of electromicroscopy for effective subclassification was advanced by the Japanese scientists with focus on oat cell carcinoma.
2. Staging. The U.S. and the Japanese TNM staging systems were very close; minor varients between the systems were translated into each other.
3. Early Diagnosis. In a meeting on “Early Detection of Lung Cancer” held in Tokyo, November 25-26, 1975, the role of sputum cytology, fiberoptic bronchoscopy, and roentgenologic examination of the chest for early diagnosis of lung cancer were discussed. The major activity of the Lung Cancer Program Area during 1976 and 1977 was the “Third Joint Seminar on Treatment of Lung Cancer,” held in Beverly Hills, California, on March 1-2, 1977, which permitted intensive scientific exchange of data. Considerable progress was made in two major areas:
• Morphology. Field testing the WHO-classification and proposals for a second edition of the WHO-classification. Full agreement on morphologic classification, including WHO subgroups, was obtained.
• The Current Status of Multidisciplinary Treatment of Lung Cancer. Options for immunotherapy (cell-wall skeletons, tumor associated antigens, etc.), progress in the treatment of small cell carcinoma, and multidisciplinary treatment of other cell types were the main topics.
Just recently the Fourth Joint Symposium was held in Honolulu on February 2-3, 1978, where the current and novel approaches to therapy, especially of small cell carcinoma, and newest concepts into the design of future clinical studies were discussed.
In addition, joint studies in treatment to prolong the life of patients with small cell lung carcinomas have been initiated. Other cooperative activities include review of microscopic slides between National Cancer Center Hospital and American institutions.
In May 1977, three Japanese scientists were invited to participate at the “International Workshop on Treatment of Lung Cancer” sponsored by the NCI at the Airlie House in Virginia.
For future program developments, it is envisioned to offer a forum for discussion of the newest and best current work in all major areas of lung cancer in Florida in February 1979. Topics will include (1) the relationship between dysplasia, in situ, and invasive cancer; (2) intermediate type of small cell carcinoma; (3) immunotherapy by BCG-CWS, Nocardia-CWS, and TAA; (4) treatment of small cell carcinoma with special reference to anatomical comparison between two countries, nude mouse study, and need for bone marrow biopsy; (5) role of surgery in multidisciplinary treatment; (6) anticarcinogenesis in man; and (7) treatment of early lung cancer such as X-ray negative, cytology positive.
For the anticarcinogenesis project, the use of anticancer drugs will be an interesting area for study among selected high-risk groups, and these studies will be initiated. The use of retinoid compounds, derivatives of Vitamin A, is also under trial. There are several retinoid analogues, such as 13-cis-retinoic acid, which show some promise. Summary of the deliberations will be considered for publication.