Advances in Lung Cancer Treatment Mean Better Outcomes

Lung cancer is the leading cause of cancer- related deaths in the United States, according to the National Cancer Institute (NCI). However, more early-stage lung cancers are being detected due to expanded screening guidelines for highrisk persons, and the prognosis for people who have lung cancer has improved thanks to recent advances in treatment.

“The development of safe surgical approaches, targeted therapies, and immunotherapies has ushered in a new era in lung cancer treatment, providing more personalized and effective options for patients,” explains Jonathan Villena- Vargas, MD, assistant professor of cardiothoracic surgery at Weill Cornell Medicine.

Updated Screening Guidelines

Recent changes to screening guidelines have expanded the criteria to include more people who have an increased risk of lung cancer.

“In 2021, the U.S. Preventive Services Task Force (USPSTF) updated their guidelines to recommend annual lung cancer screening with a low-dose computerized tomography scan (LDCT) for individuals 50 to 80 years old who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. This is a change from the previous guidelines, which recommended screening for individuals 55 to 80 years old with a 30 pack-year smoking history,” explains Dr. Villena-Vargas.

If You’re at High Risk

If you haven’t been screened for lung cancer but you meet these criteria, it is appropriate to ask your doctor about it.

“In fact, the USPSTF recommends that clinicians discuss the potential benefits and harms of screening with their patients who are at high risk of lung cancer,” notes Dr. Villena-Vargas. “Primary care physicians can order this test. However, if there is any uncertainty about whether or not to undergo screening, or if there are additional risk factors that may need to be considered, your primary care physician may refer you to a specialist, such as a pulmonologist, for further evaluation.”

For best results, Dr. Villena-Vargas advises that patients undergo screening at accredited lung cancer screening centers. To find a screening center near you, use the lung cancer screening locator tool at the American College of Radiology’s website: https://bit. ly/3YqxEkF.

It’s important to be screened if you are at risk, since symptoms of lung cancer rarely appear before the disease is in an advanced stage.

“The unfortunate reality is that, more often than not, lung cancer is not found until it has progressed to an advanced stage, making it increasingly challenging to treat. This is precisely why experts suggest that individuals who are at a higher risk for developing lung cancer opt for lung cancer screening, which could facilitate the detection of the disease at an earlier stage, improving the likelihood of a successful outcome,” explains Dr. Villena-Vargas.

Treatment Options

There are two basic types of lung cancer: small cell and non-small cell lung cancer (NSCLC). Among NSCLC, adenocarcinoma and squamous cell carcinoma are the two most common types.

“The treatment of lung cancer is dependent on the stage of the disease, which is often categorized into four stages. The approach to treatment is guided by the size and location of the tumor, as well as the extent of the cancer’s spread,” explains Dr. Villena-Vargas. “In general, early-stage tumors are treated by surgical resection [removal] with or without added treatments such as chemotherapy, targeted therapy, or immunotherapy. Later-stage and small cell diseases do not usually undergo surgery and are treated by a combination of radiation, chemotherapy, immunotherapy, or targeted therapy.”

He adds, “It’s essential to remember that each patient is unique, and treatment approaches may differ based on the patient’s specific condition. Therefore, it is important for each patient to discuss his or her treatment options with a health-care provider.”

How Newer Therapies Work

Immunotherapy and targeted drug therapy are two relatively new treatment options for lung cancer.

”Immunotherapy works by activating the body’s immune system to detect and destroy cancer cells,” explains Dr. Villena-Vargas. “Normally, cancer cells can evade detection by disguising themselves as normal cells, but immunotherapy drugs target specific proteins that don’t allow cancer cells to hide, making them vulnerable to the immune system’s attack.”

Several immunotherapy drugs have been developed for lung cancer, including pembrolizumab, nivolumab, and atezolizumab. Dr. Villena-Vargas says these drugs are designed to block certain proteins that inhibit the immune system’s ability to attack cancer cells. Typically, immunotherapy is administered alongside other treatments, such as chemotherapy, radiation therapy, or even surgery.

Using targeted drug therapy, doctors are able to match, or “target,” specific medications to certain variables, such as genetic differences, that can now be detected.

“By blocking the activity of certain proteins involved in cancer cell development and progression, targeted therapy drugs selectively attack cancer cells while sparing normal ones,” explains Dr. Villena-Vargas.

And researchers are continuing to explore more treatment options.

“Although targeted and immunotherapies are typically used for metastatic lung cancer, recent trials have demonstrated their effectiveness in treating earlier- stage, resectable lung cancer. In particular, combinations of immunotherapy with chemotherapy and drugs that target specific gene mutations have shown promising results in conjunction with surgery,” explains Dr. Villena-Vargas. “As researchers continue to develop new strategies for immunotherapy and identify new targets for treatment, the potential for these therapies to improve outcomes for patients with all types of lung cancer continues to grow.”

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