Of all the advances in treating lung cancer, the field of personalized medicine is one of the most promising – and vital.
That’s because it helps doctors determine what – if any – “driver mutations” cancer cells may contain. These are alterations in the genetic material that impact cell growth and survival.
Mutations are found in more than 45 percent of patients diagnosed with lung cancer, which is why knowing about them makes all the difference in finding the right treatment, explains Dr Yasser Abdel Kader, director of the Oncology Department Research Unit for the Faculty of Medicine at Cairo University in Egypt.
“Because of this approach, globally, and in Egypt, the mortality from cancer is starting to lower,” he tells The Livehealthy Podcast. “So you have to test your patient in a very thorough way to give him the best chance for long-term success.”
There have been great leaps forward in terms of immunotherapy treatment, for example, but there are a variety of ways to treat lung cancer now — and due to driver mutations, any one of them can prove unsuitable or even dangerous for any given patient.
That applies to two people with the exact same diagnosis, as well as many different kinds of cancer.
“The role of personalized medicine has been expanded,” says Dr Yaser. “Look at the most prevalent cancers in the world: lung cancer, breast cancer, we can do it, and it has even been extended to pancreatic and GI cancers. So it is moving forward, definitely. And definitely by the end of 2022, every treatment will be done according to this genomic profiling.”
However the testing can take several weeks. This time lag is stressful for a patient who has just had a life-altering diagnosis, but there’s no point proceeding if that a particular treatment won’t be effective — or indeed could be more harmful — due to any given tumor’s genetic design.
“I have to wait,” says Dr Yaser. “I have to wait until I’ve fulfilled my patient’s full comprehensive genomic profile. Why? We have data. On clinical grounds, if you stop [treatment] and go to the exact perfect drug, you are introducing harm to your patient… you can induce severe life-threatening immune-related adverse events when you shift. So you have to wait.”
The introduction of this precision testing, along with new therapies, has already improved outcomes for people with lung cancer, and it’s only due to get better, says Dr Yaser.
Dr Yasser Abdel Kader
On one front, Covid-19 has been good for one thing when it comes to lung cancer, a disease that doesn’t cause symptoms until it is in a late stage that is difficult to treat, with a low survival rate.
“Because of the era of the COVID-19, we are doing plenty of CT scans,” he explained. “So we are discovering and seeing more and more disease in the early stage.”
The mortality for lung cancer was already starting to lower with new therapies. But before Covid, 69 percent of patients presented with local advanced and metastatic non-small cell lung cancer, a number that Dr Yaser has seen drop by almost half, “which is a very promising event”.
Those early, symptomless stages are much easier to treat because there are so many more options — including surgery.
“We have plenty of drugs, immunotherapy therapy and surgery for early detectable cases, and recently approved immunotherapy, not only in the metastatic or locally advanced cases but in the early setting, after surgery,” says Dr Yaser. “Breaking news for me and for the world.”
Despite all the medical advances, one thing that hasn’t been very successful in the MENA region in general, and Egypt in particular, is the campaign to stop people from smoking, which remains the number one cause of lung cancer.
“The campaign should not only include an anti-smoking campaign or to stop smoking, but to look at the most prevailing risk factors or predisposing factors to cancer,” says Dr Yaser. “It is not only smoking… don’t forget the number two cause, air pollution, or asbestos.”
Many smokers have moved to electronic cigarettes either part or all of the time, in an attempt to quit or because they believe they are less damaging. But they are also problematic, as are cigarettes and shisha, which has become more popular among women, says Dr Yaser.
“We advise people to stop smoking, whatever the material is,” he says.“Even though the data from immunology is very promising for smokers versus non-smokers, it’s not an invitation for the smoker to continue smoking indefinitely.”
As for those die-hards, who point to the person they know who smoked into their old age with no ill effects, Dr Yaser has a warning: “Yes, anyone can get lung cancer, any male or any female… but if we look at the data of non-small cell lung cancer, 85 percent of the patients have a history of smoking and 15 percent are not smokers.”
People also must stop smoking during their cancer treatment, as the chemicals can reduce the impact or even cause toxicity, he cautions.
Another thing to remember is that smoking doesn’t just cause lung cancer, but a range of other forms too, including bladder cancer and cancers impacting the head and neck.
Getting back to treatments, radiation was at one time the standard of care and chemotherapy still is, but that is changing with the rise of immunotherapy and other drug options.
“I think we are moving forward to omit chemotherapy from the treatment landscape of lung cancer in the near future,” says Dr Yaser.. “We are seeing many patients [who are] candidates for immunotherapy and being treated with immunotherapy and not chemotherapy whatsoever, and being treated for years.”
The main barrier for immunotherapy, particularly in the MENA region?
“Cost,” says Dr Yaser. “It’s a friendly drug, but a very costly drug. And you are giving your patient not just six cycles, but one or even two years.”
Dr Yaser hopes the trend to early detection continues and becomes standard practice post-Covid — something that would shift the survival rate dramatically.
He’d like to see a CT scan-based screening program that identifies patients according to their risk, perhaps at 45 or 50, who have been smokers or living in certain geographical areas with high pollution.
That’s not to say people should keep smoking until they are 50, he cautions. But it will give many more people getting a tough diagnosis a better chance at survival, because combined with precision testing, it gives their medical team the right tools to pinpoint the very best treatment.
“The doctor’s main job is to put the patient on the right track,” says Dr Yaser. “And to give him hope.”
• The podcast and this story were made possible during Lung Cancer Awareness Month through a Livehealthy partnership with Pfizer.