November 17, 2021
Advances in Lung Cancer Treatment Resulting in Lower Death Rates
In the last several years, lung cancer survival rates have been improving, largely due to the new and better non-small cell lung cancer treatments now available to help patients.
Personalized Treatment for Non-Small Cell Lung Cancer
Personalized treatment (also referred to as precision medicine) is the new hope for people diagnosed with lung cancer. Understanding the cancer’s genetic makeup directs the best treatment options for that patient. By looking at the cells, specific genetic mutations linked to lung cancer can be identified. For instance, oncologists can link more than 60% of patients with lung adenocarcinoma to a specific mutation. The process of evaluating cancer cells for genetic mutations is called genomic testing.
The results of genomic testing identify drugs that may be less or more effective than others against cancers with specific mutations.
Is Genomic Testing Different from Genetic Testing?
There is a lot of discussion related to cancer and genomic testing and genetic testing. While they sound similar, they are used for different purposes.
Lung Cancer Genomic Testing
Genomic testing is also referred to as biomarker testing, genomic profiling, or tumor testing. The information gathered through genomic testing helps the oncologist to personalize the treatment plan.
To do this, your cancer care team draws a sample of your cancer cells. They test the cells for the presence of specific biomarkers – or mutations in the DNA. These mutations are not likely to be handed down through your family tree. For most lung cancer patients the DNA mutations are caused by exposure to things in the environment such as cigarette smoke, radon, asbestos or other chemicals known to harm the lungs.
The results of genomic testing will give your oncologist a better idea of which treatments will be most effective. And in some cases, which treatments aren’t likely to work at all. For example, lung cancer patients with a BRAF-mutation usually won’t respond to chemotherapy. Immunotherapy appears to be a more effective treatment plan for these patients. This is science directing the treatment options in ways that were not previously possible!
Genomic testing also determines if your cancer is slow or fast-growing. This helps them understand how likely the cancer cells are to move to other areas of the body.
Common Genetic Mutations in Non-Small Cell Lung Cancer Cells
Some common genetic mutations found in patients diagnosed with NSCLC include:
1) KRAS Gene Mutation: Mutations in the KRAS gene are observed in about 25% of the patients with NSCLC.
2) ALK Rearrangement: Sometimes, the ALK gene fuses into the EML4 gene, and the resulting mutant gene is abnormal and is called EML4-ALK. The drug crizotinib is often used to treat the cancer type.
3) Squamous Cell Lung Cancer involves mutations in the FGFR1 and DDR2 genes and the PI3K pathway.
4) The EGFR mutation is observed in 10% of patients with NSCLC. EGFR-mutated lung cancers respond well to EGFR inhibitor drugs, a type of targeted therapy.
Treatments for NSCLC Based on Genomic Test Results
The opportunity to test for these gene mutations makes it possible to carefully target the mutation and stop it from growing using a category of drugs called targeted therapy. Targeted therapy can be useful for smokers and non-smokers with non-small cell lung cancer as proven by a study recently conducted at the Washington University School of Medicine.
The targeted therapy that’s used is specific to the genetic mutation that was found during biomarker testing.
Some of the targeted therapies are combined with other treatments such as immunotherapy, chemotherapy, radiation and/or surgery.
What Happens When a Patient Tests Negative for Lung Cancer Biomarkers?
Not everyone who tests for biomarkers has them, and that’s OK. The absence of biomarkers gives the oncologist a better idea of which lung cancer treatments are likely to work best. In 2018, an international study involving patients with non-squamous non-small cell lung cancer showed, through genomic testing, the absence of DNA mutations in the EGFR or ALK gene. These patients were given chemotherapy drugs along with an immunotherapy drug because they know that the targeted therapy isn’t as likely to work. The survival rate was almost double that of using chemotherapy as a standalone treatment.
Genetic Testing for Lung Cancer
There is a lot of discussion around genetic testing to see if you have an inherited gene that can lead to cancer. There is a low likelihood that lung cancer runs in your family. As of now, the BRAF gene mutation is the only one known to have a hereditary link to lung cancer. However, the BRAF gene can also mutate due to environmental exposure. Genetic testing could be done if genomic testing indicated that you have a BRAF mutation. This could help others in your family know if they should be tested for this mutation and so they can be screened for cancer at an earlier age than usual.
How Does the Future Look for Lung Cancer Patients?
In the upcoming years, lung cancer treatment will become even more personalized. Knowing that we can treat lung cancer based on biomarkers has opened the door to many clinical research studies to find the most effective first-line of treatment using targeted therapies, immunotherapies, and combinations of cancer treatments.
Cancer Care Centers of Brevard participates in clinical trials through Sarah Cannon Research Institute (SCRI), a joint venture with US Oncology Research, and is committed to researching and implementing new cancer treatments right here in Florida. If you have received a lung cancer diagnosis and would like a consultation with one of our lung cancer specialists, or you would like a second opinion, request an appointment at a location convenient for you in Brevard County.
Original Post Date, November 19, 2020. Revised, November 17, 2021.
Categories: Lung Cancer