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Britain's Most Deadly Cancer

4/23/2017 | By: Medix team

How is it diagnosed and treated?

Data from the National Lung Cancer Audit reveals that lung cancer is the third most common type of cancer among UK residents, behind breast and prostate cancer. But while more patients get diagnosed every year with breast and prostate cancer, lung cancer is the most deadly cancer for the local population, accounting for 22% of all cancer deaths in the year 2014.

 

There are different types of primary lung cancer and they are divided into 2 subtypes:

 

  1. Small Cell Lung Cancer (SCLC) accounts for 15% of new cases, and unfortunately has very few effective treatments.
  2. Non-Small Cell Lung Cancer (NSCLC) includes several further subtypes, accounts for 85% of all new lung cancers, and has had several meaningful breakthroughs in its treatment over the last few years which have improved patient outcomes.

 

Both types are attributable to genetic mutations, with smoking being a major risk factor for the development of both types. Lung cancer is discovered in most patients after the disease has progressed to an advanced stage, at which point respiratory symptoms appear. Many diagnostic tests are utilized in the diagnosis and staging of lung cancer:

 

Computed Tomography (CT) of the chest is the most commonly used imaging modality for determining the existence and spread of lung cancer. In some countries, low dose CT scans are used for screening of patients who are at increased risk for lung cancer. In the UK, there is a current pilot trial examining the feasibility of a screening program.

 

Brain imaging using Magnetic Resonance Imaging (MRI) is very useful for detection of brain metastasis, which are quite common and very dangerous for patients suffering from lung cancer. Nuclear imaging (PET CT) is also very useful for examining the patient’s entire body for distant metastasis.

 

Pathology and molecular testing of tumor samples can be very useful for decisions regarding the treatment for patients with advanced disease. Samples from the tumor are usually taken using needle biopsy, bronchoscopy or thoracoscopy.

 

For patients with localized disease, surgery and/or radiation therapy have been the most proven treatments for a long time. For patients with advanced disease which has spread outside the lung, treatment with chemotherapy can be beneficial, but for many years was very unsatisfactory with regard to the disease outcomes. Given the deadly nature of this disease, many new treatments have been developed over the last few years.

 

For 12% of British patients who suffer from NSCLC, it is related to a somatic mutation of the EGFR gene. This mutation helps the cancer cells grow and proliferate. However, this mutation has also been used as a weapon against the cancer.

Researchers have discovered that treatments that target the mutation, which is discovered by biopsy and molecular testing, can be extremely effective. Such treatments include 1st generation drugs like Erlotinib and Gefitinib. When it was seen that these cancers can mutate themselves in order to develop tolerance to the 1st generation treatment, further 2nd generation (Afatinib) and 3rdGeneration (Osimertinib) treatments were developed. These can be used in some cases when the first generation inhibitors stop being effective. Results from clinical trials with Osimertinib appear to indicate that it could quickly become the preferred first treatment for many options with EGFR positive disease.

 

Several physician researchers based in the UK are leading the way in advancing our understanding of lung cancer treatments. One example is Mr. George Ladas, a surgeon at the Royal Brompton Hospital, who is part of a pioneering effort to use laser surgery to treat lung tumors, and has performed this treatment to the benefit of hundreds of patients at the Royal Brompton over the last several years.

 

Dr. Sanjay Popat at the Royal Marsden is another renowned Lung cancer expert, whose main focus is in understanding the genetics of Lung cancer, and developing personalized treatment choices based on genetic markers.

 

Immunotherapy treatments, such as PD-L1 blockade drugs (Keytruda, Opdivo), also hold much promise in the treatment of Lung cancer. While this type of treatment made headlines last year after showing significant benefit to patients with advanced Melanoma, similar trials for patients with NSCLC also showed very promising results, especially for patients for whom diagnostic testing for PD-L1 expression is positive.

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