Kick the butt

About 80 to 90 per cent of lung cancer patients are smokers. We can prevent lung cancer by not smoking at all or by stopping smoking. This May 31 is World Tobacco Day let’s make a resolution to ‘kick the butt’

Lung cancer remains a common and most lethal solid tumor malignancy worldwide. It is one of the leading causes of cancer-related deaths among men and women. Average five year survival is < 15 per cent. Lung cancer causes more deaths than Colon, Breast and Prostate cancers combined.

Smoking is the single important identified risk factor. About 80 to 90 per cent of lung cancer patients are smokers. Lung cancer is a preventable cause of death due to cancer. We can prevent lung cancer by not smoking at all or by stopping smoking. Lung cancer risk is directly proportional to the quantity and duration of smoking.

In heavy smokers (>30 Pack years of smoking) risk increases by 20 fold. One pack-year is equal to smoking 20 cigarettes per day for one year. Smoking can be active or passive. For the same amount of smoking, women are 1.5 times more at risk of developing lung cancer.

There are two major types of lung cancers; non-small cell lung cancer constitutes 80-85 per cent and small cell lung cancer 15-20 per cent of the lung cancers. Small Cell Lung Cancer is strongly related to smoking.

Common clinical manifestations which needs to be given importance and should be evaluated at the earliest to rule out lung cancer include: Persistent cough, coughing up of blood, shortness of breath, bone pains, hoarseness of voice (change in voice), recurrent chest infections, unexplained weight loss.

Tremendous progress has taken place in the treatment of lung cancer, from surgery alone in 1970’s to targeted immunotherapy today.

In the early stages surgery is the main stay of treatment, it is the combination of chemotherapy and radiotherapy in case of locally advanced disease and it is chemotherapy along with targeted therapy or immunotherapy in the advanced stage disease.

With recent advances and understanding of molecular mechanisms, personalised medicine is gaining popularity and importance in the management of lung cancer.

Most important expectation of lung cancer patients undergoing treatment is improvement in the overall survival and progression free survival along with improvement in the quality of life.

With extensive research in the area of genomics and molecular biomarkers, personalised treatment is now possible in the management of lung cancer. With personalised treatment approach, specific pathways responsible for the development of cancer can be targeted. Significant development in this area is the introduction of EGFR TKIs (Epidermal growth factor receptor, tyrosine kinase inhibitors).

Patients with EGFR mutations respond significantly to agents such as Gefitinib and Erlotinib. The main objective of the personalised medicine is to provide right drug to the right patient with right dose at right time, based on the presence of genomic, molecular biomarkers, application of EGFR- and ALK-directed therapies in appropriately selected molecular subgroups has led to consistent better response rates, improvements in progression free survival, reduced toxicity, and improved quality of life compared with conventional chemotherapy.

Further, personalised medicine has improved the median overall survival from 9-11 months with chemotherapy to 24 – 36 months with targeted therapy or personalised medicine.

Dr Bathula Surendra
MD (Internal Medicine); DM (Medical Oncology), Senior Consultant Medical Oncologist, Omega Hospitals.