In September this year, the first immunotherapy for patients with small cell lung cancer was registered in the European Union. In Poland, the drug is waiting for reimbursement.
For patients with small cell lung cancer, it is the first new drug in 40 years. It is also a chance for them to live longer. And a chance that they might live as long as patients with non-small cell lung cancer.
Today, most patients with small cell lung cancer live for several months after diagnosis.
In Poland, over 25 people suffer from lung cancer. annually. Approx. 15 percent of them, i.e. over 3 thousand. people have small cell lung cancer. The rest are patients with non-small cell lung cancer.
Small cell lung cancer is an extremely aggressive cancer – it quickly doubles in weight and, unlike non-small cell lung cancer, its treatment does not bring the expected results. Although it is sensitive to chemotherapy, cancer cells quickly become resistant to treatment. It is also prone to metastases to bones, liver, and most of all to the central nervous system.
The prognosis for this neoplasm is not good. Only 5 percent. patients have a chance to survive for 5 years from the diagnosis of the disease.
People between the ages of 65 and 70 usually get small cell lung cancer. – More and more often, this cancer is detected in young people, we see patients even before the age of XNUMX. This is dramatic because the younger the patient, the more aggressive the cancer is, says Dr. Izabela Chmielewska from the Department and Clinic of Pneumonology, Oncology and Allergology at the Medical University of Lublin.
Small cell lung cancer affects almost exclusively smokers. These people have a more sensitive epithelium than the rest, which is more easily damaged. The smoke causes mutations and inflammation in the bronchi, making it difficult to remove carcinogens. Oncogenic mutations occur. It is estimated that every 15 cigarettes smoked is one mutation that then leads to the development of cancer. – That is why it is so important for people not to start smoking or, if they have already started, to quickly part with the cigarette – emphasizes Dr. Chmielewska.
For comparison, among patients with non-small cell lung cancer, over a dozen percent are people who have never smoked.
Diagnosis
Small cell lung cancer is usually diagnosed late. This is because patients report to their doctor too late. The cancer does not cause chest pain, nor do they worry about a cough that lasts for several weeks. Only when there is blood in the sputum or they are very weak do they report to the doctor. – It also happens that the first complaints about which a patient with small cell lung cancer complains and with which he comes to us are not breathing problems, but headaches and dizziness. This means that there are distant metastases to the central nervous center – says Dr. Chmielewska.
It takes a long time to make a diagnosis. When a patient comes to the doctor because he has a cough, hoarseness, shortness of breath, smokes cigarettes and suffers from COPD, he has a chest X-ray. However, changes in the lungs are not always visible on an X-ray. It happens that the heart obscures the tumor.
When the disturbing symptoms persist, and blood appears in the expectorated secretion, the doctor orders a CT scan. If the suspicion of a neoplastic process is confirmed, he performs a biopsy. The tissue section is collected either through the chest wall or through the bronchial route. Recently, doctors have at their disposal EBUS bronchoscopy – the device, in addition to a webcam, is equipped with an ultrasound head, thanks to which they can see changes outside the bronchial wall, as well as precisely collect a tissue sample for examination.
– All these tests take several weeks. Only for the result of the histopathomorphological examination, we can sometimes wait up to four weeks. And only this examination decides whether the patient has lung cancer and what kind of cancer it is, says Dr. Izabela Chmielewska.
Treatment
Treatment of patients with small cell lung cancer depends on the stage of the disease. In the case of this cancer, surgery does not play a significant role, because a small number of patients have changes in the early stages of development. Most often, patients come to the clinics in the advanced stage. – When there are no distant metastases – to the liver, bones or the central nervous system, and the neoplastic changes are located only in the chest and lymph nodes, we can use chemotherapy and radiotherapy, during which the tumor and mediastinal lymph nodes are irradiated – says Dr. Chmielewska. When regression occurs, doctors irradiate the central nervous system to protect the brain from metastasis.
– Unfortunately, very few patients qualify for such treatment, only 10-20 percent. of all patients with small cell lung cancer. But still 80 percent. from this group there is a recurrence – says prof. Dariusz Kowalski from the Lung and Thoracic Cancer Clinic of the Oncology Center – Maria Skłodowska-Curie Institute in Warsaw.
In the remaining 80 percent. the sick, that is, those who have a disseminated form of the disease, doctors use different chemotherapy regimens. Chemotherapy is therefore effective, but all patients relapse after some time. Doctors can then use another line of chemotherapy, but the response rate is even lower. – We have nothing more to offer to the sick. Since the 70s, i.e. for 40 years, no new drug has appeared for these patients – adds Prof. Kowalski.
Now this has a chance to change. In the fall of that year, he was registered in the European Union atezolizumab, a drug that stimulates the immune response, i.e. immunotherapy, which forces the immune system to fight cancer cells. – The drug is designed to prevent relapse and make the patient’s immune system fight the cancer. Some patients who receive this new treatment will live longer than if they received their current treatment. Adding immunotherapy can reduce the risk of death by 30%. – explains Dr. Chmielewska. This treatment is already used successfully in standard clinical practice in patients with non-small cell lung cancer.
– It is the first drug in years that has therapeutic effects – it extends life and improves its quality. It can be used in the first line in patients with disseminated cancer, when radical therapy cannot be used – says Prof. Kowalski. And he adds: – This is not the spectacular effect that the new therapies can achieve in patients with non-small cell lung cancer, but it is a success. There have been many attempts with new molecules or new treatment regimens, but none have produced positive results.
– We know more and more about this cancer, we know more and more about the factors that determine the development of cancer, but there are also more and more questions. The new therapy may not be a breakthrough, but it is certainly the beginning of changes, a spark of hope that new, effective therapies will also be available to patients with small cell lung cancer – says Dr. Chmielewska.
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Patients
For patients with small cell carcinoma, the time they count in months is extremely valuable, while in other lung cancers – in years. That is why it is so important to offer patients the last few months of life. This is the time when they can participate in a child’s wedding, experience Christmas together, deal with urgent matters – says Anna Żyłowska from the Association for Fighting Lung Cancer, Szczecin Branch, who has been suffering from non-small cell lung cancer for 13 years. She is the longest-lived person with this cancer in Poland.
In the association he leads, there are no patients with small cell lung cancer. – When they become ill, they are very weak. On the other hand, the families of patients look for help and support with us. We are also there for them. We are here to answer and support both the sick and their relatives. We are trying to strengthen the family so that the relatives of the patient are prepared for talks with the doctor, but also that they have the strength to be with the patient in these last, difficult days – says Anna Żyłowska.
People with small cell lung cancer pass away very quickly. – How long have your loved ones lived since the diagnosis? – asks Anna on the patient forum. – It is bad here … The diagnosis was made in June – small cell lung cancer. After six treatments, on New Year’s Eve suddenly convulsions and loss of consciousness. It turns out there are metastases to the brain. Doctors give no hope.
Patrycja replies: – My mother was diagnosed in April. After radiation and chemotherapy, the disease began to regress. She felt fine almost all the time. Suddenly, after less than three weeks, metastases to the head appeared. Two days later she passed away. “
– Our fight lasted 2,5 months. 14 was diagnosed. Dad died on May 4 – writes Tom.
– On April 26, my mother was diagnosed with small-cell lung cancer in the disseminated stage. Brain metastases were detected in June. Until January 27, it was still functioning, but then during the week she stopped walking. Doctors stopped treatment. On February 26, she died. Exactly 10 months from the diagnosis – writes Malwi.
Modern immunotherapy can extend life to more than a year, on average by two months. Some patients will have their lives extended for many months or even years. It is not yet known to whom this new therapy will help. – Today, immunotherapy is used in patients with disseminated form of the disease. So there was hope that even in the most severe form, we would be able to offer patients treatment that would extend their lives, says Dr. Chmielewska.