Personalized treatment with genetic testing in lung cancer
Thanks to research aimed at deciphering the genetic code of cancer cells, a patient-specific treatment age is now entered instead of the same treatment for each patient. It is expected that two new treatment methods based on the genetic structure of cancer cells will be added in the near future and significant increases in survival rates. Saying that old and less effective methods have left their place to much more effective treatments, President of Turkish Lung Cancer Association Prof. Dr. Nil Molinas Mandel states that new developments in molecular oncology and genetics provide an understanding of the complex structure of cancer. Stating that lung cancer patients have different genetic features and treatments are now targeting these features, Prof. Dr. “Moreover, these targeted drugs only show their effects on diseased target cells,” Mandel said.
Different treatment for different types of cancer
Stating that lung cancers are divided into two basic groups as small cell and non-small cell, Prof. Dr. Mandel provides the following information: “Non-small cell cancers constitute the more common group with an incidence of 80-85%. Different cancer groups follow a different course in terms of disease growth rate, biology, and spread to other organs. The choice of treatment is also different according to these cancer types. Non-small cell lung cancers also have different subgroups. In the past, the same treatments were applied to all patients for a long time. However, in recent years, it has been realized that tumor biology is different and our treatment approaches have changed according to these subgroups. From here, the treatments gradually changed for the individual.”
Lung cancer patients’ hope increased with targeted therapies
Genetic changes in lung cancer and the effect of smoking
Stating that the genetic characteristics of the disease have started to guide cancer treatment today, Prof. Dr. “Working with pathologists has become increasingly important to look for these genetic changes and the presence of mutations that will determine treatment. While it was sufficient to determine the tumor as small cell or non-small cell tumor in the past, now we divide these groups into subgroups and want to examine the genetic changes. We can recommend to our patients the necessary genetic tests to offer different options besides chemotherapy.
However, according to these tests, it is possible for our patients to be directed to an appropriate treatment” and draws attention to the measures that can be taken to prevent the disease: “With these developments, we have become able to provide a more positive perspective to our patients, whom we could not hope for before. But first of all, it is necessary to prevent the disease and increase the possibilities of early diagnosis. It should not be forgotten that lung cancers are associated with smoking at a rate of 85-90 percent. Not starting and quitting smoking can prevent lung cancer. In other words, lung cancer is a preventable disease.
With genetic tests, the response to treatment is up to 60% in patients.
Stating that innovations in molecular oncology and revealing gene mutations make it possible to apply individualized treatments, Prof. Dr. Mandel continued his words as follows: “Therefore, subgroups have emerged that can survive with targeted treatments even though they do not benefit from chemotherapy. In non-small cell lung cancer, there has been a significant response to treatments targeting the gene mutation called EGFR for a while. Another important development in recent years has been the discovery of the existence of ALK gene mutations.
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When the right treatment is used in appropriate patients, the response rate is up to 60%. A new one is added to these promising drugs every day. However, it is essential to keep in mind that not every new drug may be suitable for all patients. A very close collaboration between the clinician, patient and pathologist is required to differentiate this. In the light of this information, we can say that lung cancer patients have the opportunity to live longer and benefit from different treatment options with personalized approaches and treatments.”
Tumor-targeting therapy in advanced cancers
Saying that it is very important to catch cancer at an early stage, Cerrahpaşa Medical Faculty Pathology Department Lecturer Prof. Dr. Büge Öz gave the following information: “However, today there are some things that can be done even in advanced stages. Since the tumor may have spread throughout the body in advanced cancers, there are some special treatments that target only the unwanted cells that make up the tumor instead of surgery. Today, we know that these cells acquire some genetic features that we call mutations that other cells do not have.
These gene changes give the cell features such as uncontrolled reproduction, immortalization of the cell, and also the ability to spread throughout the body. Treatments for these genetic traits are now being developed. It is possible to stop some of them with very special molecular agents. By using these molecular agents, it is aimed to prevent the immortality of the tumor, the cell, its continuous proliferation, and its travel to distant places in the body.”
The patient must be in direct communication with the oncologist and pathologist.
Stating that these two drug groups gave very good results in a very short time against these gene changes, Prof. Dr. Öz said, “These drugs have started to provide very serious benefits in the disease-free life span of patients, which is expressed as survival. However, in order for patients to benefit from this treatment, these gene changes must first be demonstrated with tests. Since these are important tests that affect the treatment decision, they must be done and interpreted correctly. We will come to a much better place in the very near future in terms of performing these tests reliably in university hospitals, some public hospitals and private laboratories.
The patients who can benefit from these treatments are determined by some genetic tests. A patient diagnosed with non-small cell lung cancer should definitely communicate with his oncologist. If the oncologist deems it necessary for these tests, he will refer the patient to the appropriate pathology laboratories and will work with the patient and the pathologist to interpret the results. These tests have started with two for now, but I wholeheartedly believe that more and more will come in the future. Thus, cancer may cease to be fatal in the near future, and significant increases in survival rates can be seen as patients receive the most appropriate personalized treatment according to their genetic characteristics.
Every year, February 4th is recognized as “World Cancer Day” by the World Health Organization (WHO) to raise awareness about cancer, which is one of the leading causes of death in the world. According to the 2008 Ministry of Health data, cancer is seen at a rate of 267 per 100,000 in our country. Lung cancer ranks first among cancer-related deaths in our country.