November is Lung Cancer Awareness Month; an important occasion when we can pause to reflect on valuable diagnostic and treatment advances in our journey to improving cancer outcomes. These scientific discovery milestones continue to excite me, along with the wider scientific community, and provide hope to patients and their loved ones.
At the heart of these developments are targeted treatments for different types of lung cancer, and better ways of identifying those patients who are most likely to benefit.
With targeted treatment comes the exciting potential for a more personalised approach to cancer care, and improved clinical outcomes for patients.
Lung cancer: One name, many diseases
Each year, over 1.8 million people are diagnosed with lung cancer, making it the most common form of cancer, worldwide.1 We no longer consider lung cancer as one disease but as many, with non-small cell lung cancer (NSCLC) identified in eight out of 10 patients.2 Within this large group, science has moved on and we can now identify specific DNA mutations which drive the growth of cancer cells.3 These act as biomarkers that enable us to understand the diversity of lung cancer better than ever before. Most importantly, some of these mutations make great targets for new treatments.
One of the most researched targets to date has been EGFR (epidermal growth factor receptor; thought to enable cancer cells to grow and multiply). We see mutations in this gene in the tumours of about one in seven people with NSCLC in Europe4 and the US,5 and at least one in three in Asia.6
In recent years, lung cancer drugs have been introduced to block the effects of these mutations. But unfortunately, tumours with EGFR mutations almost always develop resistance to treatment, leading to tumour growth resuming at some stage.
By following the science of how and why this disease progresses, scientists are slowly but surely ‘catching up’ with these tumour mutations. More treatment options are now available for patients with EGFR-mutated NSCLC who develop a resistance mutation called T790M. Recent clinical trial results have shown that these methods to block T790M can slow cancer progression compared to standard treatment with platinum-based chemotherapy.7
Research has also advanced in identifying other tumour drivers, including mutations in Kirsten rat sarcoma (KRAS) genes, anaplastic lymphoma kinase (ALK) genes, and mesenchymal-epithelial transition (MET) genes. Although the success in targeting treatments to these specific mutations has varied, there are already established therapies for ALK-positive NSCLC, and research is ongoing to provide options for patients with KRAS- or MET- positive tumours.
Liquid biopsy – A big leap forward for mutation testing
To bring targeted treatments to patients with particular mutations requires sensitive and widely-available testing methods, and advances in biomarker testing have taken a big leap forward over recent years. Often patients have a lung biopsy to obtain a piece of their tumour for an analysis of genetic mutations, however some patients are too ill, or their tumour is too small or inaccessible for an invasive biopsy. Recent developments allow some patients to have a non-invasive blood test to check their tumour mutation status.
Liquid biopsy – or circulating tumour DNA (ctDNA) testing – can analyse fragments of DNA from tumour cells that circulate in the blood. Growing use of this technique is helping to identify patients eligible for targeted therapies, and reduces the need for an invasive biopsy. With the availability of ctDNA testing, tumour biopsy (if it can be obtained) is only required with mutation-negative blood results.
Be lung cancer aware
Despite the encouraging progress in lung cancer research, there is still work to be done before we can offer effective options for every lung cancer patient. Early diagnosis plays a big part in patients’ prognosis, and sadly five in six patients are only diagnosed once tumour cells have spread from the primary site.8 Seeking help at the first sign of symptoms, when their disease is most treatable, is an important priority.
Recent surveys have shown that many patients are aware of the improvement in scientific understanding of lung and other common cancers,8 but there is still a lot to be done to ensure greater public knowledge.
The message of The International Association for the Study of Lung Cancer (IASLC) for Lung Cancer Awareness Month 2016 is “more research, more survivors.” We couldn’t agree more! We are using ground-breaking science to develop personalised treatment for patients with lung cancer, and our bold ambition is to eradicate lung cancer as a cause of death.
- GLOBOCAN 2012. Estimated cancer incidence, mortality and prevalence worldwide in 2012. Available at: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx. Accessed September 2015.
- Felip E, Vilar E. The expanding role of systemic treatment in non-small cell lung cancer neo-adjuvant therapy. Ann Oncol. 2006;17(Suppl 10):x108-12.
- Savas P, et al. Targeted therapy in lung cancer: IPASS and beyond, keeping abreast of the explosion of targeted therapies for lung cancer. J Thorac Dis 2013;5(Suppl.5):S579-S592.
- Szumera-Ciećkiewicz A, et al. EGFR mutation testing on cytological and histological samples in non-small cell lung cancer: a Polish, single institution study and systematic review of European incidence. Int J Clin Exp Pathol. 2013;6:2800-12.
- Keedy VL, et al. American Society of Clinical Oncology provisional clinical opinion: epidermal growth factor receptor (EGFR) Mutation testing for patients with advanced non-small-cell lung cancer considering first-line EGFR tyrosine kinase inhibitor therapy. J Clin Oncol.2011; 29: 2121-
- Ellison G, et al. EGFR mutation testing in lung cancer: a review of available methods and their use for analysis of tumour tissue and cytology samples. J Clin Pathol. 2013;66:79-89.
- Gao X, et al. The safety and efficacy of osimertinib for the treatment of EGFR T790M mutation positive non-small cell lung cancer. Expert Review of Anticancer Therapy. 16:4, 383-390.
- American Lung Association. Lung cancer fact sheet. Available at: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/learn-about-lung-cancer/lung-cancer-fact-sheet.html. Accessed November 2016.
- Use of Scientific Information About Cancer Among Carers, Patients and the Public. A PatientView survey of Patient Organisations Commissioned and Funded by AstraZeneca.