What Makes Molecular Profiling And Genetic Testing Game Changers In Lung Cancer Treatment?
Molecular profiling and genetic testing have revolutionised lung cancer treatment, says a doctor. They have enabled targeted therapies that are more effective and tolerable than traditional chemotherapy.
Treatment for lung cancer: Cancer of the lung is one of the most common malignancies in the world, affecting both men and women, smokers and non-smokers. Despite advances in science, this disease has a 'deceptive' growth. There is also -- what is understood to be -- a 'global inequity' in health-seeking ability and behaviour, which leads to delay in diagnosis in many patients. According to doctors, more than 40 per cent of patients in India are diagnosed when the disease has already spread out of the lungs to other sites -- an advanced stage. According to Dr Mihir Gangakhedkar, consultant pulmonology, Fortis Hospital, Mulund, while early cancers may be amenable to surgical clearance, advanced stages may need combination treatments like chemotherapy and radiotherapy. In fact, some cases may not be operable. Chemotherapy, the doctor explained, is a crucial tool for treatment. But, it can have significant toxicity risk, to the extent that some patients may be considered 'ineligible' because the risks outweigh the benefits!
The Role Of Molecular Markers And Genetic Testing
Dr Gangakhedkar explained that molecular markers and genetic testing of lung cancers have become game-changers. "Certain markers in the sampled tissue or even in the blood of the patient can tell us what exactly is 'driving' the cancer to multiply and spread," he said, adding that the cancer can then be targeted using specifically-designed molecules, their growth and spread arrested in time.
"These 'targetable mutations' have been studied extensively and there are newer mutations to be checked almost every year. The 'targeted therapy' -- decided in such a manner -- is often more easily tolerated than conventional chemotherapy. It can be in the oral form as opposed to intravenous, and in specific situations, may even be the first choice due to its efficacy. Having a specific target makes a molecule less likely to cause 'by-stander damage" to the rest of the body, making these therapies more tolerable," the doctor shared.
According to him, the other aspect of molecular profiling is also to understand if a medication is likely to fail. It helps one to adjust their treatment plan accordingly.
"Some markers help you prognosticate whether the disease itself is more aggressive and unlikely to respond to targeted therapy even. Immunotherapy is another treatment arm that has revolutionised oncotherapy for patients using molecular markers for understanding the pathogenesis of the disease," the expert explained, adding that increasingly, the use of these molecules is advancing to some earlier-stage cancers as well, given their excellent tolerability and proven disease-controlling ability.
The Setback
The doctor pointed out that with increased governmental support, expensive medications receive subsidies. "India, however, has a large population which is unable to afford these medications out-of-pocket. The opportunity to have a 'progression-free survival' is increasing with every passing year. Genetic profiling often gives you a clear direction for therapy and at times may be the only direction for patients who are too sick to sustain any form of chemotherapy.
"This makes it crucial for patients to be aware of what their options are for treatment. They must ask for the availability of 'next-generation sequencing (NGS)', 'mutation analysis' and 'immunotherapy' at the institute where they intend to receive therapy. It may just be the cornerstone of therapy for them," he concluded.