Molecularly targeted drugs, effective only in patients with a given genetic change, will make it possible to extend the life of some patients with advanced lung cancer by up to 50 months, doctors said on Tuesday in the capital city at the Lung Cancer conference 2014.
As they noted, the so-called personalized therapies also improve the patients’ quality of life, as they delay the onset of bothersome symptoms of advanced cancer.
These patients often return to normal functioning, they can even work – emphasized prof. Paweł Krawczyk from the Department and Clinic of Pneumology, Oncology and Allergology, Medical University of Lublin. He stipulated that these drugs do not fully heal and the disease progresses over time.
Experts also pointed out that Polish lung cancer patients do not have access to all modern molecularly targeted drugs.
Dr hab. Dariusz Kowalski from the Lung and Chest Cancer Clinic at the Oncology Center in Warsaw reminded that lung cancer remains the most common malignant neoplasm in the world and in Poland. In our country, it is diagnosed annually in 21-23 thousand. people (1,2-1,5 million in the world).
Moreover, the treatment of lung cancer is still much worse than many other cancers. The data presented by the specialist shows that, for example, among women diagnosed with breast cancer, 95 percent. patients survive for a year, and 61 percent. – 10 years, in the case of lung cancer, these percentages are respectively – less than 42 percent. and less than 7 percent.
Dr. Piotr Rudziński from the Polish Lung Cancer Group emphasized that in Poland, only 10-15 percent are eligible for surgical treatment, which can cure the disease. lung cancer patients. This is due to the fact that in most patients the cancer is diagnosed at a too advanced stage.
Another 20 percent. are patients with locally advanced cancer, without distant metastases, and potentially cured by chemotherapy and / or radiotherapy, explained Dr. Kowalski.
Unfortunately, 60-70 percent. patients are diagnosed in the advanced stage, when they can only be treated palliatively. This means that we can significantly improve their quality of life and, at the same time, extend their survival, but we will never cure them – said the specialist.
He recalled that until recently all these patients were treated in a similar way – regardless of the type of cancer. Until recently, the choice of treatment method was a bit like reading tea leaves. Today, thanks to the enormous progress that has been made especially in molecular biology, we already use the so-called individualization of treatment, i.e. personalized therapies – said Dr. Kowalski.
Experts emphasized that a pathologist who uses a microscope still plays a fundamental role in the diagnosis of lung cancer. Even the most modern methods of molecular biology are not enough to make a diagnosis – emphasized prof. Krawczyk.
According to him, until recently the classification of lung cancer from 1999 was sufficient – determining whether the lung cancer is small-cell or non-small-cell (80% of all cases).
When molecularly targeted therapies appeared, the determination of molecular abnormalities (e.g. genetic mutations) in the cancer cells of a given patient became an essential element of diagnostics and selection of the optimal treatment. Currently, mutations in the EGFR gene (encoding the receptor for epidermal growth factor – EGF) and the presence of ALK gene rearrangements should be assessed, recalled Prof. Krawczyk. There are drugs that work against these very abnormalities.
For patients with lung cancer with a mutation in the EGFR gene, three drugs are registered – erlotinib and gefitinib, which are available in Poland as part of the drug program, and the latest of them, afatinib, which is not reimbursed so far. Studies have shown that afatinib, by blocking three types of epidermal growth factor receptors, doubles the time to lung cancer progression and to pain and shortness of breath.
Patients with lung cancer with the EML4-ALK fusion gene should in turn be treated with a drug called crizotinib. It is available to patients in all European Union countries, including Bulgaria and Romania. In Poland, however, it is not reimbursed – said prof. Krawczyk.
Dr. Kowalski pointed out that another drug has already appeared in the USA that can be used in this group of patients after failure of treatment with crizotinib.
Experts emphasized that so far, molecularly targeted drugs can be offered to no more than a dozen percent of lung cancer patients. From the research of the team of Dr. Krawczyk shows that in Poland 10 percent. of patients with this cancer have mutations in the EGFR gene, and rearrangement of the ALK gene is found in 5%. sick. These are mainly non-smokers.
Dr. Kowalski recalled, however, that work is currently underway on a drug that is to work in patients with a mutation in the KRAS gene. It has a much larger percentage – about 30 percent. lung cancer patients.
Molecularly targeted drugs are a dramatic breakthrough in the treatment of non-small cell lung cancer – assessed the specialist. He noted that the average survival of patients who are treated with them is 18 months, but a certain group of patients with advanced lung cancer can be given up to 50 months of life in this way. (PAP)