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Treatment landscape for lung cancer

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As November is observed as Lung Cancer Awareness Month, Dr. Shraddha Bhure, Medical Director, BI India and Dr. Partha Gokhale, Head Medical Affairs for Specialty, BI India highlight that toxic and non-specific nature of conventional chemotherapy is being replaced by personalised and targeted therapy, leading to better patient outcomes and comparatively better quality of life

Lung cancer is considered the deadliest of killers amongst all cancers. In 2018, nearly 1.8 million deaths across the globe were attributable to lung cancer alone. In India, 60,000 patients succumbed to lung cancer that year. While breast and prostate cancers have large and widespread awareness campaigns, lung cancer is often left languishing behind.

Lung cancer occurs when certain cells in our airways and air sacs undergo uncontrolled proliferation. This can become widespread and invade (metastasise) other crucial organs like the liver and brain. Lung cancers are usually multifactorial, i.e. interaction between a person’s genetic factors and the different types of external agents like smoking, tobacco, asbestos and coal.

The hazards of smoking and tobacco are well-researched and established. Cigarettes contain chemicals (carcinogens) that are responsible for lung cancer. In fact, about 80 per cent of lung cancer deaths are a direct result of smoking tobacco. The risk of inhaling these carcinogens is not limited to smokers alone. Passive or second-hand smoking has been implicated as one of the causes of lung cancer. Non-smokers exposed to second hand smoke have an increased risk of lung cancer by 20 per cent to 30 per cent.

In recent times, however, the rising trend of lung cancer is linked to ever-increasing air pollution, consumption of fumes, smog and particulate matter. International Agency for Research on Cancer (IARC) has classified outdoor air pollution as carcinogenic to humans. The incidence of lung cancer is expected to mushroom due to the increasing exposure to particulate matter of air pollution.

Lung cancer often manifests as cough, difficulty in breathing and chest pain. The cough of lung cancer usually worsens over time and can be associated with blood. The breathing difficulties and chest pain aggravates on exertion. Patients also complain of tiredness, loss of appetite and weight loss. These symptoms are non-specific as it is also seen with several common lung disorders, complicating diagnosis of lung cancer in early stages.

Irrespective of the cause and symptoms, lung cancer is usually classified into two types: Non-Small Cell Lung Cancer (NSCLC) and small cell lung cancer. NSCLC, is a slow growing and late spreading tumour, is the most common form of lung cancer accounting for about 80-85 per cent of cases. It is further categorised into Adenocarcinoma, Squamous cell carcinoma and large cell carcinoma. Lung cancer screening plays a pivotal role in early diagnosis. Screening and early diagnosis helps in initiating of treatment at a much earlier stage of the disease.

Treatment landscape for lung cancer

Concerning the treatment of lung cancer, the landscape has evolved for the better. A majority of people with lung cancer are diagnosed in early stages through novel testing methods like liquid biopsy and genetic analysis. Specific mutations which would be resistant to conventional chemotherapy like Epidermal Growth Factor (EGFR) and Anaplastic Lymphoma Kinase (ALK) can be examined in initial stages, and targeted therapy can be administered at a point when the disease is predominantly confined to the lungs.

The toxic and non-specific nature of conventional chemotherapy is being replaced by personalised and targeted therapy. Based on molecular biology and histological profile, lung cancer patients can now be treated by targeting specific oncogenic driver mutations. This, in turn, has led to lung cancer patients leading a comparatively better quality of life.

With November observed as Lung Cancer awareness month, we see a glimmer of hope at the end of this tunnel. Identifying the disease at an early stage improves the five-year survival rate by up to 50 per cent – the essential thing to remember is that lung cancer is treatable at any stage. Every year, thousands of people are cured of lung cancer and several patients in advanced stages are living normally. By driving awareness on the wide-ranging impact of the disease, we hope to drive improved outcomes for patients this November and beyond.

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