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Integrating genomics into multidisciplinary care in the future could further enhance treatment decision-making. Expanding access to interdisciplinary care, especially in resource-limited settings, will ensure that all patients, regardless of location or socioeconomic status, can benefit from this approach.
Lung cancer is one of the leading causes of cancer deaths in India. Usually, the prognosis for this disease is not good and patients survive only for 4 to 5 years after diagnosis. Today, we have with us Dr Sanyo P Dsouza, Medical Oncology, KMC Hospital, Mangalore. In conversation with thehealthsite.com, he takes us through the intricacies of biomarker tests and how it helps with targeted therapy in lung cancer patients. He also sheds light on different kinds of lung cancer, treatment procedures and prognosis of this disease.
According to Dr Dsouza, lung cancer is the second most common cancer in males and the sixth most common in females in India. It is also the third most common cause of cancer related deaths in India. The average age of diagnosis of lung cancer in India is around 54 years, being more common among males and smokers. Cough of more than 2 weeks, chest pain and shortness of breath are common symptoms of lung cancer. Dr Dsouza shares his insights on the testing and treatment aspects of this dreaded disease below.
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There are two main types of lung cancer: Non-small cell lung cancer (NSCLC) and Small cell lung cancer (SCLC). Almost 85 per cent of this type of cancer is non-small cell lung cancer. Most often, 70 to 80 per cent of lung cancer is diagnosed in advanced stages. Apart from chemotherapy and radiation therapy, treatment of lung cancer is also decided based on results of biomarker testing (Eg. EGFR, Alk, PDL1, etc), which is commonly done on tumor tissue obtained by biopsy (needle test of tumor).
Patients with stage 4 lung cancer who are eligible for targeted therapies or immunotherapy are now surviving longer; 5-yr survival rates range from 15 to 50 per cent, depending on the biomarker. A biomarker may indicate the effect of a particular therapy or may indicate survival time of patient since it gives information about tumor behaviour.
Numerous gene alterations have been identified that impact treatment selection. This biomarker driven lung cancer treatment is possible in around 40 to 50 per cent of lung cancer patients. Most commonly seen are the epidermal growth factor receptor ( EGFR) gene mutations in 25 to 30per cent patients and Alk (Anaplastic lymphoma kinase) gene rearrangements seen in around 3-5 per cent.
Basically, these are mutations in DNA of lung cells that happens when two genes are fused or stuck together and hence become cancerous. These gene abnormalities are commonly seen among non smokers, young individuals and females. The presence of these abnormalities is associated with good response to oral drugs called TKI (Tyrosine kinase inhibitors) and, hence, those with these types of lung cancer survive longer. EGFR mutation positive patients are prescribed oral medications called Osimertinib, Gefitinib, etc, and patients with Alk positive lung cancer patients are prescribed Alk inhibitors like Alectinib, crizotinib and Ceritinib. The above treatment is also called targeted therapy since it targets specific abnormality in cancer cells.
The longest survival has been in Alk positive patients with Alk targeted therapy (average survival is 5 yrs) and these patients on targeted therapy do have better quality of life compared to chemotherapy. The average survival of stage 4 EGFR mutation positive patients with the present standard therapy is around 3 years whereas patients who are eligible to receive only chemotherapy survive 1.5 years on an average. The recognition of these mutation driven cancers have changed the outlook of this subset of lung cancer patients.