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There are two main types of lung cancer: Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is more common and includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. SCLC, also known as oat cell cancer, tends to grow and spread more quickly than NSCLC.
From a clinical perspective, there are two main subtypes of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). SCLC is often diagnosed at an advanced stage, while NSCLC can be detected at an early stage when the tumor has not metastasized to local lymph nodes or distant organs.
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What are the treatment methods for lung cancer at its different stages?
Stage I or II NSCLC can be treated with surgery, sometimes followed by systemic treatment such as chemotherapy, combined with immunotherapy or targeted therapy if mutations are present. This combination is called adjuvant therapy.
For stage III locally advanced NSCLC, where the tumor has spread to lymph nodes in the chest or neck, treatment may involve multimodal protocols, with or without surgery. If the primary lung tumor is resectable, systemic treatment combined with chemotherapy and immunotherapy is recommended to reduce lymph node involvement and increase the possibility of tumor resection, i.e., its successful surgical removal. This preoperative treatment is known as neoadjuvant.
In daily clinical practice for SCLC, there is a distinction between limited-stage disease (LD) confined to the chest and extensive-stage disease (ED), which includes involvement of organs such as the brain and bones.
LD is treated with systemic treatment, which consists of chemotherapy, with or without immunotherapy, and local radiation therapy to the chest.
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What's new in lung cancer treatment?
Screening plays a key role in detecting cancer at an early stage, especially in women. It could reduce lung cancer mortality by up to 60%. Treatment of early-stage lung cancer yields good results. At the same time, screening for minimally invasive cancer and carcinoma in situ is becoming increasingly common.
Interventional bronchoscopy also has innovations, such as endobronchial ultrasound (EBUS) technology and electromagnetic navigation. These provide more accurate and faster diagnosis and staging.
Numerous minimally invasive surgical techniques are also being developed. Robotic thoracic surgery, sublobar resections, such as anatomical segmentectomy, and personalized precision surgery options are improving the treatment of patients with the disease in early or locally advanced stages. Furthermore, morbidity and mortality are reduced, and the quality of life after surgery is significantly better.
Immunotherapy, when administered to patients in early, advanced, or locally advanced stages, offers a longer lifespan. It is used in those who can undergo multimodal treatment.
Radiotherapy is also developing. Radiotherapy is used for lung cancer, with its intensity modulated according to the stage of the disease. Stereotactic ablative radiotherapy (SABR/SBRT) is used for inoperable early-stage patients.
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How does immunotherapy work?
Essentially, immunotherapy involves suppressing immune checkpoints, whose main function is to halt an exaggerated immune response that disrupts the functions of normal cells in the body.
The PD-L1 proteins on tumor cells and PD-1 on T-cells in the immune system can give a „stop signal“ that prevents normal tissues and tumor cells from being attacked in cancer.
If the binding of these core immune checkpoint proteins is prevented by immune checkpoint inhibitors, such as monoclonal antibodies, cancer cells can be attacked and destroyed by the immune system, specifically by T-cells.
In recent years, there has been a revolution in the treatment of lung cancer with immunotherapy. It is an integral part of multimodal approaches for patients with early or locally advanced stages when surgery is an option for treatment. Immunotherapy is administered before or after surgery, in conjunction with chemotherapy.
In locally advanced unresectable NSCLC and in patients with metastases, immunotherapy plays a key role in treatment and significantly improves patients' chances of recovery.
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What is the significance of precision medicine, including genetic testing and targeted therapies, for the treatment of lung cancer?
Precision medicine plays a key role in the treatment of lung cancer. Therapeutic approaches are personalized according to the presence of specific mutations in the patient's cancerous tissue.
These genetic mutations allow the use of targeted therapies that surpass chemotherapy and/or immunotherapy in terms of disease control and improved survival rates.
Personalized treatment approaches are suitable for all stages of lung cancer.
