Experts: Curative lung cancer treatment may be possible for some patients

Lung cancer is one of the most deadly cancers, but in some patients it is possible to treat it with the intention of curing it, even if it is not operable, experts said during the debate "The road to curing lung cancer - challenges and hopes" organized at the Polish Press Agency headquarters in Warsaw.

Dr. Katarzyna Stencel, MD, PhD, from the Greater Poland Center for Pulmonology and Thoracic Surgery in Poznań, explained that there are two main types of lung cancer: non-small cell lung cancer and small cell lung cancer. Until recently, only early detection of this cancer, especially the most common non-small cell lung cancer (NSCLC), offered a chance for tumor removal and cure. "The 5-year survival rate for stage I or II NSCLC can be as high as 80 percent," said the specialist, head of the Clinical Ward with the Daytime Chemotherapy Unit.

Surgery is rarely used in patients with small cell lung cancer (SCLC) due to its often aggressive course. Data presented during the debate indicate that in 80% of cases, the cancer has already spread by the time of diagnosis. Only 20% of patients with SCLC are eligible for radical treatment with radiochemotherapy (concurrent radiotherapy and chemotherapy). For this reason, the 5-year survival rate does not exceed 20–30%, and the median survival is 20–30 months.

For almost 40 years, no new therapeutic option has emerged to improve survival for patients with small cell lung cancer. The breakthrough was the ADRIATIC study, which showed that early-stage small cell lung cancer can be cured.

This study showed that the drug durvalumab, used as consolidation therapy after chemoradiotherapy, extends the lives of patients with early small cell lung cancer. As Professor Damian Tworek from the Department of General Pulmonology and Oncology, Medical University of Lodz, reported during the debate, median overall survival (OS) with this therapy almost doubled (from 33.4 to 55.9 months), and progression-free survival (PFS) also increased (from 9.2 to 16.6 months). However, this applies to patients with locally advanced SCLC without distant metastases.

Treatment with curative intent, meaning long-term disease control, is also possible for stage III non-small cell lung cancer. Until recently, this disease was considered unresectable (inoperable) and difficult to treat. However, one in four NSCLC patients already has locally advanced stage III disease at the time of diagnosis.

For patients with EGFR+ mutations, consolidation therapy with osimertinib offers a chance for cure. This therapy is recommended by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN), a US organization of 31 leading cancer centers that develops guidelines for the management of cancer.

As the experts explained during the debate, this drug is a third-generation tyrosine kinase inhibitor and the only drug in this class that crosses the blood-brain barrier, allowing it to prevent or delay the development of brain metastases. The LAURA study showed that using osimetrinib reduced the risk of distant metastases by nearly 80 percent. Progression-free survival after its use was 39 months, compared to 5.5 months in the control group. This represents an almost eight-fold increase in the median progression-free survival.

Both therapies – durvalumab and osimetrinib – are not yet available in Poland. PAP asked the Ministry of Health about the chances of reimbursement for these drugs. The Ministry of Health's Communications Office reported that "drugs for patients with SCLC, including those with EGRF gene mutations, are currently in the reimbursement process." "The Minister of Health will issue a decision on the above-mentioned matter immediately after completing all stages of the reimbursement process," the response noted.

The Ministry of Health Communications Office also announced that "patients with lung cancer are provided with the diagnostics necessary to select therapy, including targeted therapy."

PAP also inquired about the progress of work on implementing Lung Cancer Units (LCUs) – centers specializing in the treatment of lung cancer. The Ministry of Health's Communications Office stated that "analytical work is currently underway regarding the recommendation received from the Agency for Health Technology Assessment and Tariff System on this matter."

It is expected that specialized LCU centers could provide rapid and comprehensive diagnosis and treatment in one location. This, similar to what is happening in other countries, would have the potential to increase the five-year survival rate for lung cancer patients. (PAP)

Zbigniew Wojtasiński

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