Innovations in Lung Cancer Treatment – 2017 World Conference on Lung Cancer

Lung cancer remains the most common cancer worldwide and the one causing the most deaths. However, visible advances in treatment have occurred since 2010. The most notable was finding immunotherapies effective as initial treatment for stage 4 non-small cell lung cancer. In this article, from October 2017 in Japan at the 18th World Conference on Lung Cancer, the presented innovations in lung cancer treatment are summarized for you.

• To assess suitability for immunotherapies and targeted treatments, all advanced-stage non-small cell lung cancer patients are recommended PD-L1 screening and, for molecular targets, gene sequencing tests.

PD-L1is a cell-membrane protein produced in certain immune cells and cancer cells. Cells carrying PD-L1 on their surface appear friendly to the immune system, and tumors with abundant membrane PD-L1 are called PD-L1-positive . Tumors with greater PD-L1 expression are known to respond better to new-generation immunotherapies called immune checkpoint inhibitors.

• For a person with stage 4 non-small cell lung cancer, if more than %50 of tumor cancer cells are PD-L1-positive, the immunotherapy medicine pembrolizumab alone is recommended as first-line treatment. If %1-49 of cancer cells are PD-L1-positive, pembrolizumab with chemotherapy is recommended.
• If the patient has the adenocarcinoma subtype of non-small cell lung cancer, the first molecular targets to investigate are EGFR, ALK, ROS1 and BRAF genetic changes. The chance of detecting a targetable genetic mutation in lung adenocarcinoma is currently around %30 (EGFR %16, ALK %4, BRAF %7, ROS1 %2). In patients who have never smoked, a targetable genetic mutation is more likely to be found.
• For patients who are not PD-L1-positive or have no targetable genetic alteration, with stage 4 non-small cell lung cancer, taking their general condition into account, platinum based doublet chemotherapy is recommended.
• For earlier-stage cancer (stages 1-3), depending again on general condition, lung cancer surgery (lobectomy) and combinations of chemotherapy and radiotherapy remain the recommended standard treatments.
• In the future, combinations of immunotherapies and targeted smart medicines in inoperable stage 3 lung cancer, during, before or after chemotherapy/radiotherapy, are approaches that may improve treatment success.
• Success of immunotherapy Durvalumab in treating stage 3 lung cancer
• In addition to recent advances, use of immunotherapies and molecularly targeted treatments to shrink early-stage tumors before surgery (neoadjuvant treatment) is also under consideration.
• For people at high risk because of heavy smoking, early detection through low-dose CT lung cancer screening is increasingly becoming part of routine cancer screening in more countries.