A report from the American Lung Cancer Association, a society made up of doctors, researchers and others involved in the management of this tumor, concludes that Survival from this cancer, one of the most feared, has increased by no less than 26% over the last five years..
Being one of the most common tumors, its mortality remains very high. The report, based on data from the North American Tumor Registry, indicates that, despite this increase, five-year survival is 28.4%.
However, this increase is notable and indicates that something is starting to change. And not only in the United States: in Spain, the available figures are already more than 10 years old but everything indicates that the trend is similar.
It must be taken into account that lung cancer is not a single entity. The prognosis largely depends on the stage at which it is diagnosed and the subtype to which it belongs.
Thus, cancers detected at an early stage, when the tumor cells have not spread to other areas of the body, have a higher probability of survival.
The American Lung Cancer Association report refers to diagnoses made between 2013 and 2019. Of these, 27% corresponded to localized tumors, 22% to locally advanced tumors (the tumor has spread to neighboring areas) and 44% to metastatic tumors (the rest of the cases). the diagnoses did not establish the stage of evolution).
Although the majority of tumors continue to be detected at the metastatic stage, early diagnosis increased by 9% over the five years studied.
This is one of the reasons for the increase in survival: in the early stages it reaches 63%. In locally advanced, 35%. On the other hand, in metastatic cases, only 8% of patients are still alive five years after diagnosis.
A “turning point”
In Spain, the latest data available from the Spanish Network of Cancer Registries (Redecan) refers to the period 2008-2013, that is, ten years ago. Survival among men reached 12.7% compared to 11.2% established during the previous period, from 2002 to 2007. Among women, survival reached 17.6% compared to 16.2% during the five previous years.
Are these figures obsolete? “This is a common problem. In Spain we do not have a registry of lung tumors and we only have data from the INE and estimates from Redecan,” he explains. Javier de Castrovice-president of the Spanish Society of Medical Oncology (SEOM).
Despite this lack of data, there is no doubt that our country is also experiencing a notable increase in survival rates. “We’re at an inflection point, that’s a reality. We’re seeing an increase in long-term lung cancer survivors of two types: with increasing early detection, with what we can cure, and with what immunotherapy and targeted therapies mean in advanced disease.
Indeed, already in 2020, an article published in the medical journal New England Journal of Medicine warned of this “turning point”, the result of increased screening at early stages, which allows greater cures, as well as the incorporation of new therapeutics aimed at specific subtypes of metastatic lung cancer which achieved notable survivals.
As Pilar Garrido, head of the medical oncology department at Ramón y Cajal Hospital in Madrid, told this media on the occasion of the recent World Lung Cancer Day, “patients with EGFR mutation (15% of lung cancers in non-small cell tumors, the most common type of tumor), although they are metastatic, their life expectancy is measured at three or four years on average.
In another subtype of non-small cell cancer, that with changes in the ALK gene (5% of these tumors), “their usual life expectancy is more than seven years,” Garrido pointed out.
Javier de Castro emphasizes that There are already nine targets directed at specific mutations“which would represent 20 to 25% of the total cases”. The last major step in cancer treatment is immunotherapy, a precision medicine strategy (the same as that directed against EGFR and ALK mutations) but with a different approach, because it seeks to signal the tumor so that it or the immune system itself. who acts against him.
This therapeutic strategy has only been used for a decade in lung cancer, but the first results are already beginning to appear.
The possibilities of immunotherapy
A study published this summer in the journal Cancer quantified the effect of nivolumab, the first drug of its kind against lung cancer. Approved in 2015 for non-small cell lung cancer with metastases, it measured survival in cancers diagnosed in the five years immediately preceding and following, based on data from the Surveillance, Epidemiology and Outcomes Program finals from the United States National Cancer Institute.
With the new drug, overall one-year survival increased from 33.5% to 40.1%. Three years later, it was 17.8% compared to 11.7% for the previous period, and five years later, 10.7% compared to 6.8%.
Immunotherapies have also brought some surprises. Compared to treatments directed against specific mutations, These demonstrated long survival in tumors without specific biomarker.
As Pilar Garrido pointed out, within this group of patients without a characteristic mutation that defines their tumor, “there will be 20% in whom immunotherapy will work even if it has to be suspended due to its toxicity.”
Its incorporation into other treatment regimens also gives excellent results. Normally, new therapies relate to the latest lines of treatment, but there are studies, such as the Spanish NADIM, which evaluate the effectiveness of immunotherapy before operating on the tumor.
Administered in combination with chemotherapy, this new strategy increased the survival of early-stage tumors by 20%. Even in those who did not appear responsive to surgery, it was possible to undergo surgery.
As Mariano Provencio, president of the Spanish Lung Cancer Group and lead author of the study, pointed out, “Immunotherapy has revolutionized the entire treatment of lung cancer, which It is achieving survival rates never before seen and has progressed from more advanced stages to earlier stages.“.
Provencio, who heads the medical oncology department at Puerta de Hierro Hospital, highlighted in this newspaper that lung cancer is one of the tumors that has seen the most progress “in the last 10 years, in all areas, without the possibility of There is no doubt. In fact, many tumors have followed the path traced in this cancer to seek the same benefit.
Javier de Castro is optimistic about the current trend and believes that the real numbers are better than the latest estimated survival data, which would be outdated. “Despite all the inefficiencies in the Spanish system when it comes to measuring outcomes, the truth is that we are already seeing this increase in long-term survivors.”
