How cancer treatments can be tailored, supported or combined with technology to best help cancer sufferers

7th September 2015 by Camila de Sousa

Lung cancer is one of the most common forms of cancer, presenting with 1.6 million new cases each year.1 In fact more people die of lung cancer than of colon, breast and prostate cancers combined.2 In Europe alone, lung cancer is responsible for almost 270,000 deaths each year.3

Advances in research and drug development is crucial to tackle such an aggressive and lethal cancer. Since lung cancer is more than one disease, distinct subtypes can be characterised by receptors that are frequently altered or overexpressed in cancer cells. One such molecular marker is epithelium growth factor receptor (EGFR).

The prevalence of tumours harbouring EGFR mutations is between 10-15% in Caucasian and 40% in Asian non-small cell lung cancer (NSCLC) patients.4 ASCO recommends that if a doctor is thinking about giving an EGFR (tyrosine kinase inhibitor - TKI) to a patient with advanced NSCLC who hasn't received chemotherapy before, the patient should be tested for tumour EGFR mutation status to determine the most appropriate treatment.

Mostly doctors believe that EGFR testing helps them move towards personalised medicine, rather than interpersonal chemotherapy treatment, where all patients take the same medicine.5 It is really important to remember that each person is different and their biology should be taken into consideration when deciding which treatment they should receive.

The introduction of biologics for cancer treatment (immune-oncology) has enabled doctors to tailor treatments for each patient, and this therapy has demonstrated durable responses.5 In clinical trials, afatinib has been shown to offer patients with NSCLC a significant delay in tumour progression, coupled with improvements in their lung cancer related symptoms (e.g. shortness of breath, cough and chest pain) and quality of life.6,7

Other drugs that have been used for the treatment of NSCLC with significant improvement in overall survival versus chemotherapy are gefitinib and erlotinib. Therefore, early mutation testing for EGFR status is an important step in the treatment decision making, to give patients the opportunity to receive the appropriate personalised therapy from the start.

Immunotherapy is a relatively new area of medicine, and for cancer treatments it works by increasing the ability of the healthy cells to activate an immune response against the cancerous cells. It has been demonstrated that there is a very vigorous immune response against tumours that can be activated using antibodies that block immune checkpoints. It can also be used in combinations with vaccines, or by taking this response out of the body and re-educating and re-engineering it with T-cells in the adoptive T-cell transfer approach.

A good example of this is with anti-PD1 and anti-PD-L1 agents, which have been granted breakthrough status and are likely to become standard care for melanoma.8 What is really exciting is the fact that a prolonged immune response is triggered due to the immunologic memory.9 Scientists around the world have now observed several success stories in various areas of oncology using this method of treatment.

Immunotherapy is here to stay and it will continue to make a significant impact in cancer treatment and patient care. This is both exciting and encouraging and one of several new breakthrough areas for treating cancer patients.  


References

  1. Ferlay J et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008. International Journal of Cancer. 2010; 127 2893-2917.
  2. American Cancer Society. What are the key statistics about lung cancer? Available at http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-key-statistics. (Accessed July 2015).
  3. Malvezzi M et al. European cancer mortality predictions for the year 2013. Annals of Oncology, 2013.
  4. Jang, T.W. et al. 2009. EGFR and KRAS Mutations in Patients With Adenocarcinoma of the Lung. The Korean Journal of Internal Medicine, March; 24(1), pp.48–54.
  5. Cancer net - http://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/epidermal-growth-factor-receptor-egfr-testing-advanced-non-small-cell-lung-cancer (Accessed July 2015)
  6. Yang J, Hirsh V, Schuler M, et al. Symptom Control and Quality of Life in LUX-Lung 3: A Phase III Study of Afatinib or Cisplatin/Pemetrexed in Patients With Advanced Lung Adenocarcinoma With Epidermal Growth Factor Receptor Mutations. J Clin Oncol 2013.
  7. Sequist L, Yang J, Yamamoto N, et al. Phase III Study of Afatinib or Cisplatin Plus Pemetrexed in Patients With Metastatic Lung Adenocarcinoma With Epidermal Growth Factor Receptor Mutations. J Clin Oncol 2013.
  8. ESMO conference 2014 - http://www.esmo.org/Conferences/Past-Conferences/Immuno-Oncology-2014/Press-Media/Immunotherapy-Set-to-Revolutionise-Cancer-Treatment (Accessed July 2015)
  9. Fight cancer immunotherapy - http://www.fightcancerwithimmunotherapy.com/ (Accessed July 2015)

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