Lung cancer treatment in 2019

Medical oncologist, Dr Sze Wai Chan, informs us of all we need to know about how lung cancer has been treated in 2019.

Lung cancer is common and is the leading cause of cancer deaths worldwide. In South Africa, it often gets confused with the epidemic of TB.  

The signs and symptoms of TB are very similar to lung cancer and investigations for TB often delay the actual investigations and diagnosis of lung cancer. 

Common signs and symptoms

• Cough that doesn’t go away in a few weeks.
• Coughing up blood
• Short of breath
• Chest pain
• Loss of weight
• Night sweats
• Hoarseness
• If lung cancer is spreading to bones – backache, ribs pain, unusual fractures, vertebral collapse resulting in weakness and incontinence.
• If spreading to brain – headache, confusion, seizures and weakness.

Causes

• Smoking (90% of all cases).
• Others – asbestos, underground mining, toxins/chemical, radon, air pollution, diesel fumes and vaping.
• Family history (hereditary, rare).

Basic investigations

For establishing lung cancer diagnosis, it requires radiology imaging in the form of CT scan, and a biopsy of the suspicious mass or lymph node for microscopic confirmation. treatment options

Each lung cancer is unique. Recent research and development, for the past 10-15 years, had identified lung cancer abnormalities at the DNA level in the form of specific mutations (changes in the DNA) which lead to the development of targeted therapy, i.e. oral drugs termed tyrosine kinase inhibitors (TKI), designed to go directly to the DNA changes (mutations), and switching off the cancer growth.  

These mutations are usually found in non-smokers, such as EGFR mutation, and is treated by an oral TKI, such as erlotinib.

In general, treatment options are:

• Chemotherapy
• Targeted therapy (mutation and oral TKI)
• Immunotherapy (for immune-active lung cancers)
• Clinical trials
• Surgery and radiotherapy for earlier stage lung cancers.

As each patient is different (in age, general health, smoking status, background medical and family history, etc.), and each lung cancer is classified differently at the DNA level, your oncologist will incorporate this knowledge into your unique treatment plan accordingly. This approach is often termed personalised medicine or precision medicine.

What to know about clinical trials in SA

In most major South African oncology practices, lung cancer clinical trials currently available are either phase II or phase III global trials.  

These phase II or III trials are better designed, usually comparing a trial drug with the standard of cancer care (at the time). These trials have gone through strict ethics and regulatory approval, both locally and across the world. 

Being phase II and III also means that the drug has passed the initial phase of testing (i.e. drug dose is usually established and side effect profile is known) and is ready for clinical use.

Phase III trials are testing for efficacy of the trial drug, mainly for registration purposes.

By participating in the clinical trials, the patient may benefit from accessing newer treatment (such as immunotherapy and targeted therapy) before the drug is commercially registered and available.  Most of the cost is covered by the trial itself.

South African oncology centres (in private and government settings) have participated in many lung cancer trials before. Both the doctors and patients have benefited from the past trials and research, not only from earlier use of newer treatment, but also by helping to establish drug efficacy and safety, and being part of the development process leading to drug registration and establishing new standard of care. Immunotherapy trials, using anti-PD1 treatments for lung cancers, are such examples.

To access more information about clinical trials in SA, please ask your oncologist, or check out www.clinicaltrials.gov

Final thought

One size does not fit all for lung cancer. To successfully treat lung cancer, personalised approach is now the standard.

Finally, if you never smoke, don’t start. If you do smoke, stop smoking now to reduce the risk of lung cancer.