Updates and Commentary on the Latest in Cancer

By Dr. Ajaz Bulbul

Immunotherapy improves survival in stage III lung cancer

The recent World Conference on Lung Cancer (WCLC) concluded and among some of the important lung cancer research presented was the eagerly awaited results of the so-called PACIFIC trial which last year had shown that the immunotherapy drug durvalumab prolongs the time to progression in lung cancer now shows that it will even improve survival in stage III lung cancer patients.

Anytime a drug improves survival in a cancer population it invariably becomes the new standard of care. So most stage III lung cancer patients who do not undergo surgery receive chemotherapy and radiation should receive one year of immunotherapy treatment and this will improve the chances of survival by 42%. Overall survival at 24 months was 66.3% in the durvalumab group vs 55.6% in the placebo group (those who didn’t get the drug).

Lung Cancer screening is here and it saves lives!

Another study presented at the WCLC called the NELSON study that enrolled around 15,700 people considered at high risk for lung cancer had a 26% reduction in death from lung cancer if they received screening low dose CT scans of the lung to detect early tumors. Keep in mind that US preventive services task force already recommends low dose CT for lung cancer detection for high-risk individuals.

High-risk individuals are those who have a 30 pack-year history of smoking and are current smokers and includes even those who have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. The study used CT screenings at baseline, 1, 3, and 5.5 years after randomization.

The patients that were screened and lung cancers were detected, 69% were detected at stage IA or IB. These are early-stage lung cancers that are usually successfully removed by surgery and have excellent long-term survival.

Here at Carlsbad we have a Low Dose CT lung cancer screening program that does exactly that and if any suspicious nodule or cancer is found that is immediately followed up on and discussed between pulmonologists (lung specialists) and oncologists with other specialists involved to determine the best course of action. For those that need further biopsy that can be done locally most of the time.

Get in touch with the office of Dr. Sunkaru Touray (Pulmonologist) at Carlsbad Medical Center @575-234-1201 the lung cancer screening clinic to schedule your screening appointment and scan. If the first scan is clear guidelines recommend a follow-up in 3 years and then another scan in 5 years. Medicare and CMS approved this testing since UPSTF has already set up guidelines for this screening.

A thing to keep in mind for context is that the survival benefit from doing mammograms is around 20%, low dose CT shows similar if not higher survival benefit, so if mammograms are so common lung cancer screening needs to be just as common and we need to educate everyone we know who is or was a smoker into the benefit for lung cancer screening.

Exciting changes in Small cell lung cancer

Staying with WCLC, since there were so many important improvements presented this year. One of the eagerly awaited trials called IMpower 133 trial showed that adding the anti­–programmed cell death ligand 1 commonly called PDL1 antibody atezolizumab (Tecentriq) to standard chemotherapy in patients of small cell lung cancer a deadly form of lung cancer quite common in Southeast New Mexico prolongs overall survival.

This means the patients lived longer when they received this immunotherapy drug upfront in first line. Over the last 30 years, nothing new has appeared in the treatment armamentarium of small cell lung cancer, so these are exciting changes. Small cell lung cancer can only be caused by smoking, therefore, smoking cessation is critical to reducing the prevalence of this cancer.

Another drug approval in lung cancer

At the presidential session of the WCLC, data from a clinical trial studying a new drug called Brigatinib were presented. The use of this drug was associated with improved progression-free survival (time it takes for cancer to recur) vs another drug called crizotinib which has been the standard treatment for a special type of lung cancer called ALK-positive lung cancer. Interestingly Brigatinib was associated with improved responses in the brain. One of the common issues with ALK-positive lung cancer is the increased spread of the lung cancer to the brain and this new drug can prevent that much more efficiently.

Reader Q&A

Q: I have metastatic non small cell lung cancer, I received chemotherapy as the first line treatment. My tumor has progressed what are my options.

A: I am sorry to hear about your cancer. Treatment of stage IV lung cancer has undergone tremendous changes recently. As you can tell my blog even over the last month some very exciting changes have happened. The standard recommendation for you at this point would be starting immunotherapy treatment with drugs like nivolumab, pembrolizumab etc which are treatments that stimulate your immune system to fight the cancer for you. Your oncologist may want to test your tumor for PDL1 marker or even decide to do tumor profiling or tumor sequencing to check if your tumor has one of the so-called driver mutations that may be blocked or interrupted with the plethora of new drugs now available to stop tumor growth by inhibiting specific tumor mutations. The old treatments that included multiple rounds toxic chemotherapy are not what we use now thankfully.  Best of luck.

Q: I have lung cancer that has spread to the brain. I have only a couple of tumors in the brain. How should we proceed? My oncologist recommends brain radiation

A: Again,  I’m sorry about your diagnosis. Lung cancer is a difficult diagnosis and then brain metastasis is an even harder proposition. However, there may be a ray of hope here since you only have a few lesions. You may be a good candidate for something called SBRT. Gamma knife procedure. Essentially it is highly focussed high energy radiation beams that are focussed on the tumor cells in the brain to kill them. This spares the normal brain tissue from damage which commonly occurs in someone receiving whole brain radiation (WBRT). WBRT is the only option currently for those with multiple and or large brain metastasis.


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