Despair in the Air

Despair in the Air

Lung cancer is one of the most common cancers diagnosed worldwide. Unfortunately, it is also the one cancer in which survival rates are the lowest. The poor prognosis of lung cancer could be attributed to the diagnosis of the disease at an advanced stage (It is seen only 15 percent of the cases are diagnosed at early stages).

Till very recently, the treatment of lung cancer followed a one-size-fits-all approach with all the patients getting similar chemotherapy regimens. These regimens were not only toxic but also associated with a very short duration of response. The median survival of an advanced stage lung cancer patient was 10-14 months. 

However, in the last few years, the treatment paradigm has shifted from universal treatment with cytotoxic chemotherapy to personalised therapy. It is now accepted that NSCLC is not a singular entity, but is, in fact, multiple pathologies with unique molecular signatures that we are only beginning to unravel and understand. The disease is now seen in women and also in non-smokers.

Personalised medicine refers to the incorporation of individualised patient-specific features to guide treatment decisions. In simple terms, it means one size does not fit all. The personalised treatment is popularly known as targeted therapies or magic pills. 

Till date, about 40 percent of adenocarcinoma patients can be treated with these magical targeted therapies. These drugs are highly active and are to be taken orally without any distressing effects of chemotherapy such as hair loss, nausea, and vomiting.

In addition to targeted therapy, immunotherapy has revolutionalised the treatment of lung cancer in the last five years. In fact, the Nobel Prize in medicine 2018 has been awarded jointly to James P. Allison and Tasuku Honjo for their discovery of cancer therapy by inhibition of negative immune regulation. In simple terms, immunotherapy in lung cancer works by releasing the breaks off the immune system, which then helps the immune system to recognise and attack cancer cells.

The treatment of lung cancer has shown an improvement in the fields of radiation and surgery also. The advantages of robotic surgery in lung cancer include shortened recovery time, less pain, reduced risk of infections, reduced blood loss and faster recovery to a normal lifestyle. However, all patients may not be fit to undergo surgery owing to their age and poor pulmonary reserves. The liquid biopsy is another step in the same direction. Liquid biopsy means performing complex tests on the DNA isolated from the patient’s blood.

Treatment of lung cancer has changed dramatically in the last decade. A disease that was once considered incurable is now being turned into a chronic disease with the potential for cure.

Courtesy: this article is given by Dr Ullas Batra, senior Consultant-Medical oncology at Rajiv Gandhi Cancer Institute and Research Centre, Delhi.