Lung cancer - behind every percentage is a person

The majority of patients (60-80 percent) at the time of diagnosis are in the advanced (inoperable) stage. Thanks to the revolution in diagnostic methods, the prognosis of patients has improved significantly. More than a dozen drugs are currently registered for the treatment of NDRP. This applies to patients diagnosed with certain genetic changes.

The type of mutation matters

One of the best-studied molecular abnormalities in lung cancer is a mutation in the EGFR gene. This mutation affects about 7-10 percent. Modern targeted drugs (triton kinase inhibitors) have improved the prognosis of patients compared to chemotherapy. However, they too are not effective in all patients. The key in such cases is modern diagnostics.

- Approximately 4-12% of patients with mutations in the EGFR gene have so-called insertions in exon 20 of the EGFR gene, which are among the mutations that determine resistance to treatment with standard EGFR tyrosine kinase inhibitors, says Adam Płużanski, MD, of the Department of Lung and Chest Cancer at the Maria Sklodowska-Curie National Cancer Center - National Research Institute.

Targeted diagnostics

In such cases, PCR is not always enough. A much more accurate technique is next-generation sequencing (NGS). The tests should be performed in a laboratory with the appropriate quality control certificate," notes Adam Pluzanski, MD. In patients with insertions in exon 20 of the EGFR gene, the effectiveness of treatment with classical tyrosine kinase inhibitors is lower, and the prognosis worse, compared to patients with other types of mutations in this gene. Chemotherapy, including cisplatin or carboplatin, in combination with taxanes or pemetrexed in the first line, remains the standard of care, resulting in only a short-term response: median progression-free time is about 4 months and median overall survival about 1 year.

Molecular testing and targeted treatment

The opportunity for these patients lies in an even more targeted treatment: the first bispecific antibody against the EGFR and MET receptors registered for this indication. - The registration is for second and subsequent lines of treatment, after failure of prior systemic treatment. More drugs, including tyrosine kinase inhibitors, are awaiting registration. - Adam Płużanski, MD, adds.

However, a prerequisite for the use of many modern therapies is specialized molecular testing. Research using the NGS technique is already being carried out in cancer centers in Poland. The tests are there, the funding is there. However, they require experience, and their availability is limited at smaller lung cancer centers. - With improved accessibility to experienced laboratories and Molecular Biology Departments performing NGS testing, as well as better accessibility to modern therapies for patients with the right molecular disorder, we will be able to help a larger group of lung cancer patients more effectively in the future, says Adam Płużanski, MD.

Genetic testing and personalized treatment are changing the prognosis of lung cancer. Let's remember that behind every percentage is a person and their loved ones.