Personalised Treatment for Advanced Lung Cancer
Publish date：2020-12-09
Lung cancer remains the top cancer killer in Hong Kong for both genders. For most patients, lung cancer do not produce any noticeable symptoms until it is quite advanced, so as a result, many unfortunately present with late stage disease. As such, the case exists for population screening but this is not yet adopted in many countries.
There are several different types of lung cancer, and in determining the best approach in managing late stage lung cancer, we first need to define the ‘type’ of cancer. This necessitates obtaining a tumour tissue sample which is usually done by tissue biopsy either by passing a needle directly at the tumour or using endoscopy.
Major types of lung cancer are Adenocarcinoma, Squamous cell carcinoma or Small cell carcinoma. Of these three types, adenocarcinoma is the commonest, and is often unrelated to smoking. Adenocarcinoma and Squamous Cell carcinoma are collectively called Non-Small Cell Lung Cancer (NSCLC).
Major advances in treatment of NSCLC have been made in recent years and the treatment recommendations are nowadays personalised according to the individual patient’s tumour biological characteristics. In general, especially for adenocarcinoma, a genetic analysis is necessary to predict if the patient will likely benefit from target therapy. There are now advanced genetic tests that screen for all known mutations, so we can create a detailed profile of all the genetic mutations in a particular patient’s tumour, including rare but treatable mutations that would otherwise be missed.
For example, although the commonest genetic alterations involve EGFR and ALK genes, a growing list of other rarer alterations can also be treated such as ROS1, HER2, RET, MET, NTRK, BRAF, TMB, MSI-H etc. If such analysis yields a positive result, then target therapy will often be the treatment of choice. Currently, there are a rapidly growing number of such target therapies either available on the market or under active development, for use with different types of genetic alterations. For example, at least three generations of drugs (with at least 5 drugs on market and more in development) are now available against the common EGFR-mutation.
For those cases not suitable for target therapy, laboratory testing can also be done on the tumour tissue sample to see if the cancer might be likely responsive to immunotherapy. Depending on the result of the testing, immunotherapy may be offered either alone or in combination with conventional chemotherapy. A certain proportion of patients could derive very durable benefit and survival prolongation with immunotherapy.
Conventional chemotherapy still retains a very important role in the treatment of late stage lung cancers, but the emergence of target therapies and immunotherapy have considerably increased the additional treatment options available to these patients.
In contrast to NSCLC, small cell lung cancers are less common, and are mostly related to smoking. Conventional chemotherapy treatment remains the core treatment for this type of cancer. However, recent studies have shown that immunotherapy can confer added survival benefit when added to chemotherapy.
As mentioned above, because treatment largely depends on the individual patient’s tumour biological characteristics, optimal treatment of advanced lung cancer nowadays requires thorough laboratory testing to guide treatment selection. Patients should consult their oncologist regarding the most suitable individualised treatment.
Source: Clinical Oncologist, Dr. Conrad Lee
There are several different types of lung cancer, and in determining the best approach in managing late stage lung cancer, we first need to define the ‘type’ of cancer. This necessitates obtaining a tumour tissue sample which is usually done by tissue biopsy either by passing a needle directly at the tumour or using endoscopy.
Major types of lung cancer are Adenocarcinoma, Squamous cell carcinoma or Small cell carcinoma. Of these three types, adenocarcinoma is the commonest, and is often unrelated to smoking. Adenocarcinoma and Squamous Cell carcinoma are collectively called Non-Small Cell Lung Cancer (NSCLC).
Major advances in treatment of NSCLC have been made in recent years and the treatment recommendations are nowadays personalised according to the individual patient’s tumour biological characteristics. In general, especially for adenocarcinoma, a genetic analysis is necessary to predict if the patient will likely benefit from target therapy. There are now advanced genetic tests that screen for all known mutations, so we can create a detailed profile of all the genetic mutations in a particular patient’s tumour, including rare but treatable mutations that would otherwise be missed.
For example, although the commonest genetic alterations involve EGFR and ALK genes, a growing list of other rarer alterations can also be treated such as ROS1, HER2, RET, MET, NTRK, BRAF, TMB, MSI-H etc. If such analysis yields a positive result, then target therapy will often be the treatment of choice. Currently, there are a rapidly growing number of such target therapies either available on the market or under active development, for use with different types of genetic alterations. For example, at least three generations of drugs (with at least 5 drugs on market and more in development) are now available against the common EGFR-mutation.
For those cases not suitable for target therapy, laboratory testing can also be done on the tumour tissue sample to see if the cancer might be likely responsive to immunotherapy. Depending on the result of the testing, immunotherapy may be offered either alone or in combination with conventional chemotherapy. A certain proportion of patients could derive very durable benefit and survival prolongation with immunotherapy.
Conventional chemotherapy still retains a very important role in the treatment of late stage lung cancers, but the emergence of target therapies and immunotherapy have considerably increased the additional treatment options available to these patients.
In contrast to NSCLC, small cell lung cancers are less common, and are mostly related to smoking. Conventional chemotherapy treatment remains the core treatment for this type of cancer. However, recent studies have shown that immunotherapy can confer added survival benefit when added to chemotherapy.
As mentioned above, because treatment largely depends on the individual patient’s tumour biological characteristics, optimal treatment of advanced lung cancer nowadays requires thorough laboratory testing to guide treatment selection. Patients should consult their oncologist regarding the most suitable individualised treatment.
Source: Clinical Oncologist, Dr. Conrad Lee
