The emergence of personalized treatments has been a revolution in the treatment of lung cancer, but one in five Spanish patients have not had the opportunity to find out whether or not they can benefit from them.
In other words, if in our country there are a little more than 35,000 people suffering from the tumor, around 6,800 are treated with traditional therapies – surgery, chemotherapy or radiotherapy – without knowing whether or not they could benefit from the drugs that appeared these days. recent years. .decade and a half.
An analysis of the Registry of Thoracic Tumors presented at the last congress of the Spanish Society of Medical Oncology, held last month, put the finger on the problem: molecular determination of tumor characteristics had reached only 81.2% of patients at an advanced stage.
In oncology, certain proteins present on the surface of tumor cells which differentiate them from healthy cells are called biomarkers. The development of drugs targeting these proteins is the basis of personalized medicine: while traditional treatments are aimed at all people affected by the tumor, these work on those who express a specific protein (EGFR, ALK, PDL1 or ROS1 are the best known).
That is to say, even if they only target a small percentage of patients, they generally obtain notable benefits and with fewer side effects.
Oncology research in recent decades has been based on the search for biomarkers and the development of drugs intended for them. In lung cancer, 40% of patients can benefit from it.
But about 20% of patients don’t know if they could be treated with one of these drugs.
“I think patients don’t have the same opportunities,” he says. Mariano Provenciohead of the Oncology Department of the Puerta de Hierro University Hospital (Madrid) and president of the Spanish Lung Cancer Group, which prepared the study.
The first data extracted from the register show regional differences, not only between autonomous communities but also between hospitals in the same community, but they still need to be established in more detail.
Since last year, molecular determination of tumors has been part of the portfolio of common services of the National Health System, that is, it must be offered in any center in Spain.
However, “for years this was the responsibility of clinicians,” says Provencio, who advocates multidisciplinary and networked work ensuring that any cancer patient has access to all available diagnostic and treatment opportunities.
Cancer figures in Spain
This year, 32,768 new cases of lung cancer will be diagnosed in Spain, according to the Spanish Society of Medical Oncology. This number has gradually increased over the years, mainly due to the increase in diagnoses among women: if they were a minority several decades ago, today they represent a third of new diagnoses.
It is the third most diagnosed tumor (after colorectal and breast cancer) but the first in number of deaths: in 2022, 22,727 people died from this cancer.
The data of Five-year survival is 11.6% for men and 16.8% for women. However, they refer to the period 2008-2013 and it is possible that these figures improve over successive periods.
Among other things because “lung cancer is undoubtedly one of the tumors for which there has been the most progress over the last 10 years”, proclaims Provencio. “In fact, many tumors have followed the therapeutic pathway traced from lung cancer.”
This involves the use of chemotherapy and immunotherapy as neoadjuvant treatment, that is to say before surgery, which provides notable benefits. “It has been used as a model in other tumors, such as genitourinary or bladder tumors.”
Pilar Garridohead of the medical oncology department at the Ramón y Cajal Hospital (Madrid), emphasizes that the arrival of targeted drugs “has changed the prognosis for the better, but we cannot generalize.”
For example, in patients with an EGFR mutation, survival increased from a few months to “three or four years, while in those with an ALK translocation it exceeded seven years.”
In tumors that do not present a specific biomarker, there have been surprises: “In 20% of them, immunotherapy works even when it has to be suspended due to toxicity. We are beginning to think about the particularity of these tumors for this exceptional response. with a starting photo very similar to the others in which the response lasts very little.
Progress has not only occurred in the pharmacological field. “We are moving towards greater personalization of radiotherapy,” he says. Nuria Rodriguez de DiosSecretary General of the Spanish Society of Radiation Oncology.
He gives locally advanced tumors as an example (usually the cancer has spread to a nearby lymph node but without spreading as in metastases). “We usually give around 30 treatment sessions but now we obtain images before the session and, if we detect that the tumor is shrinking, we replan to adapt to the new situation: this allows us to adjust the margins, gain in precision and protect healthy organs.
Stereotactic radiotherapy has also appeared, reducing the number of sessions but concentrating the dose more. “It can take five, three or even one session, which is called radiosurgery. It’s important because There are fragile patients who cannot have surgery and this is how we treat them.“.
On the other hand, technology has advanced in such a way that the movement of the lung during breathing is taken into account. These improvements allow “minimal toxicity, good quality of life and the treatment of patients who could not be treated before”.
Screening yes, but stop smoking
There is another advancement to come, the implementation of screening. Like mammograms for breast cancer, it aims to perform imaging tests on a population likely to develop a tumor (people who have smoked for decades) in order to detect tumors at an early stage, the one of the great challenges of lung cancer.
Pilar Garrido points out that studies have shown that it reduces lung cancer mortality “by more than 20%” and that it is a cost-effective tool, but “the problem is that we have to identify smokers and this, from the point of view of From an epidemiological point of view, it is more complex.
In Spain, a pilot project is underway, called Cassandra, which aims to determine the feasibility of lung cancer screening. But Garrido cautions that a program with these characteristics must incorporate smoking cessation tools.
“It’s not worth saying ‘I’ll have a scan and if there’s nothing I’ll continue smoking’. There’s no point. Tobacco is an addiction and patients need to have the necessary tools to quit smoking.
Mariano Provencio does not see the implementation of screening as a bad thing but “it is a possibility for the future, we must focus on those who currently suffer from cancer and, in addition, prevent it with policies of stop: the number of young people who smoke is horrible and we will not be able to save them with screening.
About 85% of lung cancers are linked to tobacco. Treatment has progressed greatly in recent years but it can never replace prevention.
