We treat lung cancer at world class level

In Poland, 22,000 people hear the diagnosis every year - lung cancer. According to the National Cancer Registry, it is the most common malignant tumor in Poland and the first cause of cancer deaths.

Early detection saves lives

Early detection of lung cancer determines a patient's prognosis. However, the screening program using low-dose computed tomography to detect cancer at early stages is used by few Poles.

Today, only about 15-20 percent of patients are diagnosed at an early stage. Meanwhile, in some centers, patients are diagnosed for as long as six months, taking them away from treatment.

Prof. Dariusz M. Kowalski of the Lung and Chest Cancer Clinic of the National Cancer Institute - National Research Institute in Warsaw, president of the Polish Lung Cancer Group, points out that the availability and quality of the latest diagnostics is also a problem. - Next-generation sequencing is performed in a few centers that are unable to meet the growing needs. We also have too few specialists in pathomorphological diagnostics, and modern treatment of this cancer without it is impossible, he adds.

World-class treatment

As of September 1 this year. new drugs entered reimbursement: lorlatinib as a third-generation drug in the first-line treatment of patients with non-small cell lung cancer (NDRP) with rearrangement in the ALK gene, atezolizumab for patients with early-stage non-small cell lung cancer as complementary (adjuvant) treatment after radical tumor resection, and sotorasib in the second and subsequent lines of treatment for patients with NDRP with the G12C mutation in the KRAS gene.

Prof. Dariusz M. Kowalski stresses that we already have world-class treatment for lung cancer. The changes in the reimbursement list are very positive for patients with rearrangements in the ALK gene, who account for 3 to 5% of all patients with adenocarcinoma of the lung. Unlike most lung cancers, this type of cancer is mostly suffered by young people and non-smokers, and far more often by women.

Prevention of metastasis to central nervous system

- The use of first-generation inhibitors in patients with advanced ALK-positivenon-small cell lung cancer in the first line of treatment is already an eminently suboptimal treatment, especially since we have the second generation available. The possibility of using a third-generation ALK tyrosine kinase inhibitor makes it possible to plan long-term treatment, emphasizes Prof. Ewa Kalinka, head of the Oncology Clinic at the Polish Mother's Memorial Health Institute in Lodz.

Rearrangement in the ALK gene is associated with aggressive growth of tumor cells and the ability to penetrate the blood-brain barrier, leading to metastasis to the central nervous system (CNS). Such metastasis occurs in about 35 percent of ALK-positive lung cancer patients at the time of diagnosis, and is found in more than half of patients at a later stage of treatment. The appearance of CNS metastases is associated with both an unfavorable prognosis and impaired quality of life.

Good changes for patients with rearrangements in the gene ALK

Prof. Dariusz M. Kowalski points out that in the CROWN trial, lorlatinib was shown to prolong disease progression-free time and reduce the rate of central nervous system disease progression in previously untreated patients with advanced ALK-positive non-small cell lung cancer regardless of the presence of central nervous system metastases.

The benefits of the third-generation drug were further confirmed by the trial data, which showed that 76% of patients receiving the drug experienced a complete or partial response compared to 58% of patients receiving the first-generation drug. Moreover, the response to the third-generation drug lasted longer compared to the first-generation drug. According to the authors' conclusions, the results of the registration study indicate a protective effect of the third-generation therapy within the central nervous system. Only 1 of 112 patients without a baseline diagnosis of CNS metastases showed progression in the head while receiving this therapy at 36 months.

Prof. Ewa Kalinka stresses that the form of administration of the drug is not without significance. Lorlatinib is used orally, which does not make patients feel sick and allows them to live a normal life. Especially since patients with this type of cancer are often young, active professionals.

Multidisciplinary treatment

During the Autumn Excellence Lung Cancer and Melanoma and Breast School organized by the Polish Lung Cancer Group together with several scientific societies on October 13-14 in Wroclaw, Poland, dedicated to the treatment of melanomas, breast cancer and lung cancer and pleural mesothelioma, it was emphasized that the treatment of lung cancer requires a multidisciplinary approach. - Patients cannot be treated by a single specialist. That era is coming to an end," points out Prof. Dariusz M. Kowalski.

Diagnosis and treatment of cancers of the thoracic area are handled by clinical oncologists, radiation oncologists, pulmonologists, thoracic surgeons, pathomorphologists, molecular diagnosticians, and rehabilitation specialists. Only this approach will ensure optimal treatment of these cancers.

According to Prof. Dariusz M. Kowalski, improving diagnostics with the drug program we currently have of European standard would improve the results of treatment of this cancer and lung cancer would increasingly become a chronic disease.