New testing, treatments advance lung cancer approach

Each year, about 230,000 U.S. patients are diagnosed with lung cancer and more than 140,000 patients die of lung cancer – making lung cancer the leading cause of cancer deaths.

We are beginning to see a decline in lung cancer deaths in both men and women due to a decrease in smoking. The main risk factor for lung cancer is cigarette smoking. Other risk factors include prior radiation therapy and environmental toxins such as asbestos and radon.

Previously, lung cancer was mainly diagnosed based on symptoms. Chest X-ray screening has not shown to improve survival. However, the National Lung Screening Trial compared CT screening to chest X-rays and saw a 20 percent decrease in lung cancer mortality in heavy smokers who were screened annually for three years.

As a result, the Center for Medicare and Medicaid Services has agreed to cover the cost of CT screening in approved programs for those age 55 to 77 who have a 30 pack-year smoking history, and if they have quit, have done so within 15 years. The goal is to screen high-risk patients and diagnose lung cancer at an early stage to improve survival.

The most common symptoms at diagnosis include cough, shortness of breath, pain and weight loss. Once lung cancer is diagnosed, patient will have additional imaging to evaluate the extent of cancer involvement.

A patient with stage I or II cancer will usually undergo surgery to remove the lung cancer. After surgery, depending on the pathology result, additional treatment such as chemotherapy may be recommended. For patients with early stage lung cancer who are not able to undergo surgery, radiation may be an alternative method of treatment.

For patients with stage III disease, a combined approach using chemotherapy and radiation concurrently is generally preferred. Immunotherapy can be used after that if there is no growth of cancer. There also may be surgery in selected patients.

For patients with stage IV disease, we generally offer systemic therapy. There have been many new development in the last few years in the treatment of advanced lung cancer. Therefore, we are able to offer a more personalized approach to treatment.

For some patients, we may be able to find a driver mutation that causes cancer to grow, such as EGFR, ALK fusion, BRAF, ROS-1 or NTRK. As a result, we offer these patient oral medicine that specifically targets the driver mutation and, therefore, shrinks the cancer. A number of new targets are under investigation, including MET abnormality and RET rearrangement.

Another exciting major advance in treatment is immunotherapy. Patients without a drive mutation may be candidates for immunotherapy alone if tumor PDL-1 expression is 50 percent or higher, or a combination of chemotherapy and immunotherapy if PDL-1 is less than 50 percent.

In addition, maintaining an active lifestyle as well as good nutrition are important aspects of cancer treatment.

Dr. Gigi Chen is a medical oncologist and hematologist with Diablo Valley Oncology. She has extensive experience treating lung and gynecologic cancers and sees patients in Pleasant Hill, Rossmoor and San Ramon.