Porter Regional Hospital Changing Paradigms in Screening and Treatment of Lung Cancer

Porter Regional Hospital Changing Paradigms in Screening and Treatment of Lung Cancer

Lung cancer remains the leading cause of death among men and women in the United States. Only 15 percent of lung cancers are diagnosed at the localized early stage, when treatment could markedly improve patient outcomes. In 2011, the National Lung Screening Trial (NSLT) reported a 20 percent reduction in lung cancer deaths in high-risk individuals screened by low-dose CT scan. This means that annual lung cancer screening prevents one in five deaths from lung cancer.

A key element in the conversation with high-risk smokers and former smokers should be the fact that annual lung cancer screening with a low-dose CT scan is at least as effective in preventing death from cancer as annual mammography screening for breast cancer.

Low-dose CT scan became standard of care for a very specific group of patients:

  • Ages 55-77
  • Asymptomatic (no signs and symptoms of lung cancer )
  • 30 pack-year history of smoking (one pack a day for 30 years)
  • Currently smokes or quit smoking less than 15 years ago

Until the late 1990s, treatment of advanced lung cancer followed a straightforward regimen of various chemotherapies. Nowadays, cancer immunotherapy is a standard treatment option. For some patients with advanced-staged lung cancer, cancer immunotherapy is truly life changing. It often offers the only chance to live longer and better. And, many believe that this first wave of success with cancer immunotherapy is just the beginning.

While chemotherapy directly destroys cancer cells, cancer immunotherapy uses one’s own immune cells to fight cancer cells. In lung cancer, this can be achieved by a class of drugs called checkpoint inhibitors. These drugs can unleash the body’s own immune cells so they attack the lung cancer cells. Lung cancer cells harbor certain molecules on their surface (PDL-1) that can steer away immune cells and allow the cancer to evade the body’s typical immune response. The checkpoint inhibitors can disable these molecules (checkpoints) and allow the immune cells to effectively attack the cancer.

Lung cancer is the most common cancer worldwide, with 1.8 million new diagnoses in 2012. It is also the leading cause of cancer-related death, taking a staggering 1.6 million lives each year. This is equivalent to three people dying every minute. Non-small cell lung cancer accounts for 85 percent of all lung cancers. Until the approval of checkpoint inhibitors such as Pembrolizumab (Keytruda) and Nivolumab (Opdivp) in 2015, and Atezolizumab ( Tecentriq ) in 2016, the median life expectancy with standard chemotherapy was only 10 months. In 2016, researchers have tested pembrolizumab ( keytruda ) in the first-line setting in advanced lung cancer and found that in a group of selected patients, pembrolizumab outperformed chemotherapy and 70 percent of the patients taking this type of cancer immunotherapy are still alive after one one year of taking the drug.

Despite the initial success in immunotherapy in cancer treatment, not every patient with lung cancer will respond to this form of treatment. Cancer immunotherapy seems to work better for some patients with lung cancer more than others. Researchers have found in a landmark study (keynote -024) that patients who had certain characteristic biomarker (PDL-1 positive lung cancer) did better if treated with cancer immunotherapy than chemotherapy.

Today new molecular technologies can quickly pinpoint the molecular and genetic changes in the tumor, which can enable doctors to select the best therapy for their patients. This approach has paved the way to what is now known as precision medicine.

In addition to chemotherapy and immunotherapy, other forms of treatment such as targeted therapy have proven to be very effective in certain types of lung cancer. Some lung cancers can have specific genetic mutations such as EGFR, ALK and ROS1. These mutations are the drivers for lung cancer growth and can be targeted by medicines in the pill form, resulting in effective control over cancer growth. Patients with EGFR-positive lung cancer, which constitute 10-15 percent of lung cancer cases, can be effectively treated with Erlotinib (Tarceva) , Afatinib (Gilotrif) or Gefitinib (Iressa). Patients with ALK-positive lung cancer or ROS1-positive lung cancer can be treated with Crizotinib (Xalkori).

These advances in early lung cancer detection, and the newer therapies for treatment, have dramatically improved patients’ quality of life and survival.

Porter-Lung-Cancer-Innovations-2017_01 Tareq Braik, M.D., has devoted his medical career to learning all he can about the biology of cancer and blood diseases. After receiving his medical degree from University of Baghdad, Dr. Braik completed a residency in internal medicine and medical oncology at the Clatterbridge Center for Oncology in Wirral, England. He then continued with an internal medicine residency and hematology-oncology fellowship at John H. Stroger Jr. Hospital of Cook County in Chicago. Board certified in medical oncology, hematology and internal medicine, Dr. Braik treats all types of cancer with a special interest in breast, lung, GI and prostate cancers. His office is located in the Porter Medical Plaza, 85 E. U.S. Highway 6, Valparaiso. He is accepting new patients. Call (219) 983-6260.

Porter Regional Hospital offers low-dose CT Lung Cancer Screening. For more information, speak with your doctor and visit porterhealth.com.