Lung cancer treatment breakthroughs

Lung cancer treatment is changing, because of breakthroughs and early detection. There are surgical advances, improvements in radiation, and new drugs that focus on specific traits of cancer and stimulate your system to fight the disease.

UCLA Health has helped drive monumental advances in the treatment of carcinoma – increasing survival rates within the nation’s leading explanation for cancer deaths.






The treatments center on immunotherapy to activate the body’s system to attack cancer, also as drugs that focus on gene mutations fueling tumor growth. For patients with advanced illness, both methods have first-line treatment options.

““In a relatively short period of time, we’ve had two major treatment revolutions,” said Edward Garon, MD, director of the Signal Transduction and Therapeutics Institute.“This is an exciting time since we’ve begun to discover new therapies that can improve the outcomes of patients with carcinoma.”

The Food and Drug Administration approved two targeted therapies for non-small cell carcinoma, the most prevalent form, in May alone, based on research led by Dr. Garon.

Breakthroughs in Lung Cancer Detection & Treatment

  • Low-Dose CT Scan.
  • Video-Assisted Thoracic Surgery (VATS)
  • Image-Guided Radiation Therapy.
  • Immune-based Treatments.
  • Targeted Treatments.

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Deadliest cancer

Roughly 200,000 cases of carcinoma are diagnosed annually within the U.S., with up to 90% occurring in people that currently or previously smoked. Each year, more people die of carcinoma than of colon, breast, and prostate cancers combined.



A report earlier this year by the American Cancer Society attributed the nation’s largest one-year drop by cancer mortality – a 2.2% decline from 2016 to 2017 – to a reduction in deaths from lung cancer. Deaths have decreased due to lower smoking rates, advances in early detection, and improved treatments, the ACS said.

““The most important thing that can be done to minimize carcinoma deaths is to get people to quit smoking–and hopefully never start,” said Dr.  Garon, professor of drugs at the David Geffen School of Drugs at UCLA.

For people who have smoked extensively in the past, a low-dose CT scan of the lungs has been prescribed since 2013. Patients should be mentioned the UCLA carcinoma Screening Program to work out eligibility.

According to Dr. Garon, carcinoma is typically detected at a later stage than many other cancers, after the disease has already spread. Although surgery remains the mainstay of care for early-stage carcinoma, patients with inoperable cancer or metastatic disease are treated with targeted molecular therapy and immunotherapy.

Targeted therapies

Initially developed quite a decade ago, targeted drugs can block or close up the signals that make cancer cells grow. They are designed to focus on cancer cells without affecting normal cells.

In 2010 only two targeted therapies, directed against EGFR mutations, were available within the daily practice: gefitinib and erlotinib. In the last ten years, around 20 new agents are developed and approved: therapies targeted to carcinoma driver mutations, antiangiogenic drugs, and immune checkpoint inhibitors. Just as some significant examples, a variety of major practice-changing targeted therapies achievements of the last decade are going to be mentioned here. There are currently several first-line EGFR-targeted therapies, the foremost recent of which are to be used when resistance mutations to previous EGFR tyrosine kinase inhibitors (TKI) targeted treatments take the driving role in the tumor. For example, in2015, osimertinib received accelerated approval for advanced NSCLC patients who acquired the resistance mutation T790M during or after treatment with a previous-generation EGFR TKI.

Prevention and early detection

Several reports show that the prevalence of smoking is decreasing, a minimum of in developed countries, mainly thanks to primary prevention achieved by awareness and regulatory policies. Nevertheless, exposure to tobacco smoke also as other carcinogenic environmental toxicants like asbestos, radon, heavy pollution, etc. continues to be an interesting burden for health everywhere in the world40-41. According to several estimates, about one billion people still smoke cigarettes around the world. Furthermore, in the last decade, a new possible epidemiological risk factor has emerged: the rise in the use of e-cigarettes and other vaping products.. Several wide international randomized trials (NLST in2011; NELSON in2018) have shown a decline in lung cancer, which has been a significant development in the last decade. mortality at the population level by low-dose CT (LDCT) lung cancer screening in high-risk individuals43-45. The group assigned to LDCT showed a minimum of 20% reduction in carcinoma mortality as well as a 6.7 percent reduction in overall mortality44 in the NLST trial, which included 53,454 ever smokers with at least a 30 pack-year background and 55 to 74 years old. Similar results are announced in Europe within the NELSON trial45.




Based on the data published by NLST, the US Preventive Task Force officially recommended in 2013 LDCT on a yearly basis for individuals with identical age and smoking exposure as the NLST inclusion criteria. However, evidence shows that up to 50% of patients with lung cancer do not meet these criteria46. Since then, an outsized number of studies try to refine the danger models, inclusion criteria, screening protocols, early-stage NSCLC diagnosed patients management, etc. In fact, the U.S. Preventive Services Task Force (USPSTF) has just published for public comment an updated draft of its carcinoma inclusion criteria. These revised criteria reduce the age of entry to 50 years old, and therefore the tobacco history to twenty pack-years. There also are an outsized number of studies trying to develop biomarkers-based methods to enhance the accuracy of risk models, increase LDCT specificity, improve the characterization of the indeterminate nodules found by the imaging technologies or improve the prognosis information of the diagnosed tumors47. The analysis of circulating blood molecules or breath analysis is the most common biomarkers.

DNA research

Dr. Garon said the pace of research has been accelerated by trying to find tumor mutations through DNA circulating within the patient’s blood, away far simpler than taking a biopsy from the lungs.Every day, new mutations are identified, and drugs are established to combat them,” he said.Dr. Garon believes that researchers will continue to refine targeted therapies and immunotherapies and that further drugs will be approved by the FDA.“I’m optimistic that survival rates will continue to improve,” he said.“We all know that, even with these advancements, we could use better treatments. We need to extend the number of patients who benefit.”

Immunotherapy

The news of the award of the 2018 Nobel Prize in Physiology or Medicine to Tasuku Honjo and James Allison for their discoveries in cancer immunology4 has confirmed the relevance of the therapeutic strategies supported the modulation of the antineoplastic immune reaction. In the case of carcinoma, the introduction in 2015 of immune checkpoint inhibitors for the treatment of non-small cell carcinoma (NSCLC) is indeed one of the foremost important breakthroughs of the present decade3. Several drugs, like nivolumab, pembrolizumab, or atezolizumab, were approved in 2015 for an outsized number of indications in carcinoma management. Other very encouraging recent news is that the Two immunotherapy drugs (pembrolizumab and atezolizumab) have been approved by the Food and Drug Administration (FDA) for advanced-stage small-cell carcinoma (SCLC)7-8. The look for biomarkers (expression of PDL-1 or other immune checkpoint proteins, tumor mutation burden, genomic tumor aberrations landscape, neoantigen production levels, antigen presentation capability, etc.) to pick those Patients who are likely to respond to immune-based therapies or develop resistance are receiving a lot of attention and are becoming a very active field9.

Surgery

The major efforts in carcinoma surgery within the last decade are dedicated to decreasing the invasiveness of the technical approaches to get rid of the malignant lesion preserving oncologic treatment success. VATS, which was first introduced in the 1990s, has been gradually integrated into the armamentarium of thoracic surgeons, and many centers prefer this less invasive surgical technique to open thoracotomy due to its reduced morbility30-33. The VIOLET trial’s preliminary findings, which have been shared at meetings but not yet released, appear to be very promising. The VIOLET trial may be a randomized controlled trial comparing the effectiveness, cost-effectiveness, and acceptability of VATS lobectomy versus open lobectomy for treatment of lung cancer34. Other very exciting achievements and developments in the surgery of carcinoma are the events of robotic-assisted thoracic surgery35-37 and unimportant VATS38. Although randomized trials are still required, these novel technologies seem to enhance pain control and shorten the duration of hospital stay. Bronchoscopic methods have also benefited from advanced interventional bronchoscopy in terms of management, protection, and effectiveness. Finally, in the last decade, researchers have developed a clearer understanding of the value of mediastinal lymphadenectomy for accurate patient staging39.




Radiotherapy

During the last decade, carcinoma patients have benefited from refinement and new technical approaches supported radiotherapy. Proton therapy, for instance, has improved significantly its efficacy for carcinoma treatment19. Rico et al. summarize the success in key areas of radiotherapeutic methods to combat advanced carcinoma in the current issue of Anales. The authors conclude that hypofractionated RT and stereotactic body radiotherapy (SBRT) are going to be very relevant within the management of NSCLC patients at stage III within the future1. They suggest that, although clinical trials are needed to work out the simplest fractionation and combination schemes, hypofractionation, alongside chemotherapy (CT) or immunotherapy could also be appropriate for patients who are not eligible for complementary chemo-radiotherapy are given this medication. On the opposite hand, Rico et al conclude that SBRT, during this locally advanced stage, could also be indicated after concurrent CRT. Clinical trials are currently underway, which can help to explain the possible benefits of combining SBRT with immunotherapy or other targeted treatments. In recent years, stereotactic ablative radiotherapy (SABR) has been proposed and tested for patients at earlier stages which will be unsuitable for surgery for several reasons. In this sense, many specialist societies have issued recommendations for the use of SABR in early carcinoma patients20-21. Clinical studies are currently underway, which may help to explain the possible benefits of combining radiotherapy and immunotherapy. The phase III clinical trial PACIFIC trial has been a key breakthrough within the study of the mixture of RT and immunotherapy in NSCLC.



It is clear that from the general public Heath perspective we are currently during a very exciting moment. It is very likely that within the decade that we’ve just started in 2020, through smoking reduction and high-risk individual carcinoma screening programs we’ll considerably reduce the incidence and mortality of lung cancer: one among the worst epidemics within the present and past centuries

Lung cancer treatment breakthroughs

Cleveland Clinic

Lung cancer treatment breakthroughs

Lung cancer treatment breakthroughs