NEW YORK, March 7 - Dana Reeve, 44, the widow of actor Christopher Reeve, died here last night, seven months after she announced that she had developed lung cancer.
Reeve, a singer and actress, was not a smoker. About 13% of lung cancer patients have no history of smoking, although some may have been affected by second-hand smoke. The details of Reeve's diagnosis and therapy were not disclosed.
Action Points
- Explain to patients that although Reeve was a non-smoker, the overwhelming percentage of lung cancer patients have a history of smoking.
- Point out also that women are relatively over-represented in the population of younger patients (
Although smoking accounts for the lion's share of lung cancer in women, the percentage is less than it is for men. Smoking in 1999 was responsible for approximately 87% of cases of lung cancer, including 90% of cases in men and 79% of cases in women, according to estimates by the American Cancer Society, the National Cancer Institute, and the CDC.
Studies at the University of Maryland and the University of Michigan, both published last year in Chest, reported that there was a greater percentage of lung cancer among women younger than 50, smokers or nonsmokers, than among men. This raised the possibility of differences in the pathogenesis of lung cancer in women and a possible increased susceptibility.
In the Michigan study, based on national Surveillance, Epidemiology, and End Results (SEER) data, women accounted for 40.9% of patients who were younger than 50 and for 35.4% of older patients.
While lung cancer is rare among non-smokers, researchers at the Memorial Sloan-Kettering Cancer Center, where Reeve was treated, reported in 2004 that a mutation in the epidermal growth factor (EGF) gene is more common in nonsmokers with lung cancer than in smokers.
That mutation, they reported in Proceedings of the National Academy of Science, suggests that non-smokers have a distinct form of lung cancer, according to William Pao, M.D. Ph.D., and colleagues.
The non-smokers in Dr. Pao's study had adenocarcinoma non-small cell lung cancer (NSCLC).
Patients with mutations in the EGF receptor may respond to two targeted therapies, Tarceva (erlotinib) and Iressa (gefitinib), a finding that was reported by Dr. Pao and has been confirmed in several clinical trials of the drugs. Those trials consistently reported better response rates for non-smokers.
Tarceva has been shown to increase survival, but Iressa has not demonstrated an overall survival benefit, which led the FDA to issue a label change that limits use of the drug.
Both Tarceva and Iressa have been studied in NSCLC, which accounts for 87% of lung cancers.
Patients with NSCLC diagnosed at its earliest stage, when the tumor is confined to the lung (Stage 1), have the best prognosis, although survival depends on tumor type and the overall health of the patient.
Stage 1 is divided into 1A and 1B depending upon the size of the tumor. In most cases the tumor is removed by surgery, but patients who are not candidates for surgery are treated with curative radiation. The resection is followed by adjuvant chemotherapy, usually with a cisplatin-based regimen in patients with Stage 1B.
Patients with cancers that have spread locally or regionally are candidates for a variety of combination therapies. If surgical resection is possible patients may undergo either pre-operative or postoperative chemotherapy or chemoradiation therapy.
Patients with unresectable locally advance disease are treated with a combination of chemotherapy and radiation therapy.
Reeve's late husband, who gained fame with his portrayal of Superman in a series of movies, died Oct. 10, 2004. A spinal cord injury suffered nine years earlier in a horseback-riding accident left Reeve paralyzed, but transformed him into an activist for the disabled.
Dana Reeve chaired the Christopher Reeve Paralysis Foundation, which awarded millions in research grants for paralysis and disability treatments.