Advancements in Lung Cancer Treatment: Targeted Therapies and Immunotherapy

In the realm of medical science, certain challenges have been as alarming as the battle against cancer. Among its various forms, lung cancer has held its place as a specifically formidable adversary, claiming countless lives worldwide. However, in the face of this persistent disease, the unconquerable spirit of scientific advancement has driven a new era of hope for patients and their families.

Over the past few decades, groundbreaking advancements in lung cancer treatment have transformed the landscape of oncology, and two approaches, in particular, have emerged as beacons of promise: targeted therapies and immunotherapy. These cutting-edge treatment modalities represent a quantum leap in cancer care, offering tailored solutions and harnessing the body’s natural defence mechanisms to combat this deadly disease.

Immunotherapy
It is an innovative method that utilises the immune system to combat cancer cells. Among the popular types of immunotherapy for lung cancer is immune checkpoint inhibitors. These medications focus on specific proteins in either the immune cells or cancer cells that are the checkpoints. These checkpoints fend off immune cells from attacking cancer cells. By stopping these checkpoints, immune checkpoint inhibitors enable the immune system to recognise and battle cancer cells more efficiently.
Pembrolizumab, nivolumab, and atezolizumab are examples of immune checkpoint inhibitors used in lung cancer treatment. These drugs have shown tremendous success in some specific cases, particularly for patients with advanced non-small cell lung cancer (NSCLC) who have increased levels of PD-L1 expression, a protein associated with immune suppression. Immunotherapy is generally better tolerated than traditional chemotherapy, with fewer severe side effects.
Targeted Therapy
These kinds of therapies are structured to target specific genetic mutations or alterations that steer the growth and survival of cancer cells. These therapies are most efficient in cases where tumours have particular genetic alterations that can be targeted. In lung cancer, mutations in the anaplastic lymphoma kinase (ALK) along with epidermal growth factor receptor (EGFR) genes are among the most common, leading to the development of targeted drugs against them.
Osimertinib is an EGFR tyrosine kinase inhibitor (TKI) used to treat advanced NSCLC with specific EGFR mutations, taking into inclusion the exon 19 deletions or exon 21 L858R mutations. Crizotinib, ceritinib, and alectinib are ALK inhibitors used to treat lung cancer patients with ALK or ROS1 gene rearrangements.
Tyrosine Kinase Inhibitors (TKIs) are a subset of targeted therapies that block the action of specific proteins known as tyrosine kinases. These proteins play crucial roles in signalling pathways that regulate cell growth and division. By inhibiting these proteins, TKIs can slow down or halt the growth of cancer cells.
Erlotinib, gefitinib, and afatinib are examples of EGFR TKIs used in the treatment of advanced NSCLC with EGFR mutations. These drugs have shown significant benefits in improving development-free survival and overall survival in patients with EGFR-mutated lung cancer.
Chemotherapy
Chemotherapy remains a standard treatment option for lung cancer, particularly for patients with extensive-stage disease or when targeted therapies or immunotherapy are not suitable. Chemotherapy uses powerful drugs to kill rapidly dividing cancer cells. It can be discharged intravenously or orally, and different drugs or combinations of drugs may be used.
Common chemotherapy regimens for lung cancer include cisplatin and pemetrexed for non-squamous NSCLC, carboplatin and paclitaxel for both squamous and non-squamous NSCLC, cisplatin and etoposide for small cell lung cancer (SCLC).
Radiation Therapy: This involves the employment of high-energy rays, such as X-rays or protons, to kill or damage cancer cells. It is a localised treatment used to target specific areas affected by cancer. Radiation therapy may be employed as the foremost treatment for early-stage lung cancer, in combination with surgery for certain cases, or to relieve symptoms in advanced-stage patients.
Surgery: Surgical resection is a curative treatment option for early-stage non-small cell lung cancer (NSCLC). The tumour and nearby lymph nodes are surgically removed in this procedure to eliminate the tumour. Lobectomy (withdrawal of a lobe of the lung), pneumonectomy (removal of an entire lung), or the resection of a wedge (removal of a small section of the lung) are some of the surgical approaches used depending on the tumour size and location.
Combination Therapies
A lot of cases of lung cancer treatment involve a blend of distinct therapies to acquire the best possible outcomes. For example, combination chemotherapy regimens with immunotherapy have shown promising results in some advanced NSCLC cases. Also, targeted therapies and immunotherapy may be combined to tackle specific cancer subtypes with multiple genetic alterations.

Conclusion

It’s significant to consider that each patient’s treatment plan is customised based on factors like cancer stage, type, genetic profile, overall health, and treatment response. Additionally, ongoing clinical trials and research efforts at the best multispeciality hospitals in India persist to explore and come up with new therapies and treatment strategies for lung cancer. Therefore, it’s essential for patients to work in the vicinity with their healthcare team to determine the most appropriate and up-to-date treatment approach for their particular condition.

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Written by Parul Sevashram Hospital | 21 August 2023

Dr. Jagdish T. Gohil

Dean

Dr. Jagdish T. Gohil is the Dean at Parul Institute of Medical Sciences & Research. He has a vast experience of over 37 years in Obstetrics & Gynecology. He is an alumnus of Baroda Medical College. He has worked at the Government Medical College & SSG Hospital, Baroda in various capacities since 1988. He has been a UG & PG examiner at various universities in the country He is well known gynecologist has conducted many complicated surgeries during his tenure as Associate Professor at SSG Hospital, Baroda and still continues to do in spite of being the post of Dean. He has guided more than 30 PG students also more than 5 PhD. Scholars for their research. He has been an assessor for Medical facilities for the MCI at Medical Colleges & Hospitals. He has been a member of the PG council at the M.S. University of Baroda. He is life member of Indian Medical Association, Indian Association of Gynec Endoscopy, Life Member and Indian Menopause Society, life member of Indian Association of Gynec Oncology. He is active member of FOGSI since last 30 years. He had delivered many lectures in State and National Conferences.

M. No. : +91 9825151528
Email : medicaldean@paruluniversity.ac.in