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According to GLOBOCAN 2018, lung cancer is one of the leading causes of cancer incidence and mortality in India and around the world. There are different types of lung cancer: adenocarcinoma, squamous cell carcinoma and small cell carcinoma. Previously, survival after advanced lung cancer was poor, with average life expectancy measured in a few months and chemotherapy being the main treatment.
Immunotherapy: new hope
In the past five years, research has shown that immunotherapy has greatly helped lung cancer patients.
Immunotherapy involves the use of drugs designed to improve the effectiveness of the body's immune system against cancer cells. Immunotherapy has been used for more than 5 decades to treat various types of cancers, but recent developments in checkpoint inhibitors have shown promising results.
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How checkpoint inhibitors work
Control points are essentially the brakes applied to the immune system, thus preventing it from attacking its own healthy cells and tissues. However, these control signals are reinforced in some cancers that prevent the immune system from destroying cancer cells. Checkpoint inhibitors release these brakes in a controlled manner, allowing the immune system to recognize and eliminate these cancer cells.
The most important control points PD1 / PDL1 and CTLA-4 were identified by Tasuku Honjo and James P Allison, Nobel Prize winners in Physiology or Medicine 2018 for their discoveries.
The checkpoint inhibitors against PD1 / PDL1 have shown a remarkable benefit in almost all types of lung cancer. Some types of lung cancer have genetic abnormalities such as mutations, translocations, amplifications that play a driving role in the spread of cancer cells. There are different targeted therapies for these specific genes and, whenever a specific genetic defect is identified, a specific targeted therapy is used. However, for the vast majority of lung cancer patients, these drivers are not present.
All these patients are technically eligible for immunotherapy, alone or in combination with chemotherapy, regardless of the type of lung cancer. The PDL1 test is now a common practice in most cancer centers and immunotherapy with or without chemotherapy is planned according to the results.
Lung cancer: treatment options
In advanced lung cancer, chemotherapy has a modest benefit, with most patients surviving only a few months to a year. Chemotherapy should no longer be considered a standard treatment.
Today, immunotherapy is changing the landscape of lung cancer treatment. Most cancer-free patients should be offered immunotherapy, which is a new standard treatment in line with US and European international guidelines.
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The current standard is to use stage 3 and stage 4 immunotherapy for lung cancer. Although evidence of the role of immunotherapy in lung cancer is exciting and that most patients are eligible for it, it is not a cure but simply a cure. an extension of a life of good quality. Immunotherapy, although well tolerated, has its own side effects, which can be easily managed.
Immunotherapy: brought to India
Three medications are currently available in India: pembrolizumab (Keytruda®), Nivolumab (Opdivo®, Opdyta®) and Atezolizumab (Tecentriq®) – approved by the Drug Controller General of India for patients with dementia. stage 4 lung cancer.
Recently, another checkpoint inhibitor – Durvalumab (Imfinzi®) – has shown efficacy in stage 3 inoperable lung cancer. The drug will soon be launched in India.
Immunotherapy: the timing is important
The timing of use of immunotherapy is very important. Immunotherapy should be given as soon as possible to achieve a lasting remission of the disease. Most patients with advanced non-mutated conductive lung cancer should be able to benefit from immunotherapy as initial therapy (alone or in combination with chemotherapy) depending on the PDL1 status of the patients. tumor cells.
If the patient has not received immunotherapy as an initial treatment, it can be given later because there is good evidence of its use at all stages of treatment, as long as the patient is fit. Although immunotherapy is very promising, it only benefits a small percentage of patients. However, in patients who respond to treatment, the response may be lasting and long-lasting.
Various efforts are underway to improve the response rates of immunotherapy. The proper selection of patients and the identification of good molecular markers are key to the success of immunotherapy. One way to improve the response is to combine immunotherapy with chemotherapy, radiotherapy, and other targeted therapies.
Over the next few years, immunotherapy will likely be more badociated with proper selection of patients, making it a standard treatment in more than 50% of lung cancer patients.
(The author is Senior and Senior Consultant – Medical Oncology and Hematology, Aster CMI Hospital, Bangalore)
Celebrities who fought serious illnesses and inspired us to stay strong
Wiser and stronger
July 11, 2018
If you feel like tearing yourself down after seeing Sonali Bendre's Instagram post on Tuesday where she quoted Chilean author Isabel Allende about staying strong and cutting her hair, you're not alone.
Many, including his fellow countrymen and his supporters, were moved and wished him a speedy recovery. But the 44-year-old actress is not the only one to have managed to stay strong in the face of adversity.
Over the last ten years, a few others have demonstrated incredible courage and grace while battling real-life medical issues, and have proven to be a source of inspiration for their fans.
From Salman Khan to Yuvraj Singh to Irrfan Khan, we remain inspired by extraordinary stories of hope and strength.
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