Why does one person respond favorably to lung cancer treatment while another does not?
The answer lies in their DNA.
Just 20 years ago, lung cancer was broadly categorized into two groups: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Relatively recently, the treatment of NSCLC shifted from chemotherapy as a single treatment option to treatment with precision medicine, which is positively impacting survival rates.
Within the past ten years, researchers and clinicians started to understand biological differences between the two most common subtypes of NSCLC (adenocarcinoma and squamous cell carcinoma), which provided insight into why certain patients had greater success with treatment.
A breakthrough occurred when we discovered specific ‘driver’ gene mutations within the tumor, realized each lung cancer tumor is unique, and started developing medications specifically targeting these mutations. This was the beginning of precision medicine in treating lung cancer.
This discovery allowed us to transition from a “one size fits all” to a “custom made” approach to treatment, and those treatments are working. Treatment with targeted therapies has improved survival and quality of life for patients with advanced non-small-cell lung cancer.
Precision or personalized medicine has many benefits, but the greatest is that it allows patients to receive treatments most likely to work for them while reducing drug toxicity. Essentially, we can use the most effective tools at our disposal rather than deploying them all at once.
So, what’s the bad news?
Testing for common targetable gene mutations/alterations is becoming standard practice in oncology, but many cancer patients do not undergo comprehensive genomic testing. That means targetable mutated genes are often going unnoticed.
Even if a patient has genomic alterations not currently treatable with precision medicine, this advanced testing may provide clinicians with vital insight to rule out which therapies will not work or may potentially negatively impact the efficacy of other treatments. Additionally, while some alterations may not be targetable with an FDA-approved therapy at this time, clinical trials may provide additional future options.
Today, new treatment options are being developed from lifesaving clinical trials regularly. For example, last year, a new drug was approved to target a specific gene abnormality that is present in about 13 percent of lung cancers. This new option provided a fresh path for patients who may have otherwise run out of options. We know even more progress will be made through research and clinical trials.
We are making breakthroughs in cancer treatment every day, and our ability to treat patients more effectively will continue improving as precision medicine advances. I encourage all patients who are diagnosed with cancer to talk with their doctor about individualized treatments and comprehensive genomic testing. I also encourage patients to ask about clinical trials, which truly are the medicine of tomorrow.
We now have capabilities that allow us to better understand why every person responds to cancer differently. More importantly, we are constantly developing new tools that can provide unique treatments for every cancer journey. In time, targeted therapies will move us further toward a world free of cancer.
Hirva Mamdani is the leader of the Thoracic Oncology Multidisciplinary Team, a member of the Phase I Clinical-Pharmacology Program, and director of the Lung Cancer Screening Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI, an NCI-designated comprehensive cancer institute with 16 cancer treatment locations in Michigan and Ohio. She can be reached on Twitter @HirvaMamdani and on LinkedIn.
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