- Some of these advances imply not administrating chemotherapy in the treatment regimens indicated to avoid relapse, which greatly reduces toxicity and increases the quality of life of patients.
- The application of these new therapeutic approaches requires the presence of multidisciplinary teams that are highly coordinated with each other.
- The paradox is that SEOM estimates that, due to COVID-19, by 2020 between 15% and 20% fewer cancer patients will be diagnosed
Madrid, November 16, 2020:- Curing the cancer is the main objective of any oncological approach, with the challenge becoming more complicated the more advanced at which the tumor is diagnosed and the fewer therapeutic strategies we have available to avoid relapse. The good news is that, in the last year, "the biggest advances in lung cancer come precisely from preventing the progression of the disease," says Dr. Pilar Lopez Criado, head of the Lung, Head and Neck Tumors and Melanoma Section at MD Anderson Cancer Center Madrid, who wanted to highlight this good news on the occasion of International Lung Cancer Day, next Tuesday, November 17.
So, for example, in lung cancer patients who have an EGFR mutation, the latest data show an important benefit in terms of survival with the administration of an EGFR inhibitor after surgery. "We are talking about patients we operate on and who do not have metastases, but positive lymph nodes, so they have a high risk of relapse," explains Dr. Lopez Criado. Until now, to reduce the risk of relapse, these patients were given four cycles of chemotherapy after surgery. "It is very good news that we can change this more toxic treatment for a therapy with pills only in these patients who are already cured, but who have a high risk of relapse," states the doctor.
On the other hand, in patients who are non-operable due to the large size of their tumors, the standard treatment today is a combination of chemotherapy and radiotherapy, an approach with which many patients are cured, but where relapses also occur. The novelty is that it has now been shown that lung cancer patients with overexpression of the PDL-1 protein may see their survival rates increased by 30% with the inclusion of immunotherapy after radiotherapy. "This approach is also supported by two clinical trials with two different immunotherapy drugs," says Dr. Lopez Criado.
Finally, the doctor wants to highlight the NADIM clinical trial, of the Spanish Lung Cancer Group, which assesses the advisability or not of reversing the order of treatments, that is, administering immunotherapy before surgical intervention, just the opposite of what is currently being done in patients with operable, but large tumors. The preliminary results, states Dr. Lopez Criado, for the moment, "show patients treated with chemotherapy and/or immunotherapy before surgery have seen their tumor reduced in size, their surgical options improved and, above all, their chances of a cure increased”.
The problem is that “the neoadjuvant framework (prior to surgery) is complicated because there is a risk that the tumor will grow if the treatment is not effective,” says Dr. Lopez Criado. To avoid this, the keys are to be very scrupulous in timing and to have a highly coordinated team of professionals on hand. “This approach can only be evaluated and implemented in centers where the surgical oncology, radiation oncology, medical oncology, pulmonology teams, etc., are perfectly coordinated, since the patient will require very close monitoring within very strict time limits”.
COVID-19 reduces early cancer diagnosis by almost 20%
The Spanish Society of Medical Oncology (SEOM) announced a few weeks ago that they estimated that in 2020 between 15% - 20% fewer cases of cancer would be diagnosed, a scenario that contrasts with the positive advances that have been recorded in this initial stage of cancer of lung in recent months. “We have the tools, but we do not have the resources to implement them,” Dr. Lopez Criado acknowledges and points out, for example, that although at MD Anderson Madrid they have not stopped, many centers have temporarily suspended spontaneous lung cancer screening in smokers.
Early diagnoses from findings in radiological studies prior to minor surgeries have fallen, given the decrease in these procedures during the pandemic. "Now we mainly find people with symptoms and advanced tumors, in stages 3 and 4," admits the doctor, who encourages the public to go to hospital centers as normal for medical examinations, checks and tests.