HYDERABAD: Pfizer hosted an International Speaker Program recently at Taj Deccan where Dr Justin Gainor, Director of the Center for Thoracic Cancers at Massachusetts General Hospital (MGH) was invited to address healthcare professionals on how to mitigate the challenges of dealing with lung cancer. Accompanied by Dr MVT Krishna Mohan, Senior Consultant, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, he discussed the risk factors, key therapies used for managing the disease and more
With the aim to create awareness about the rising number of lung cancer cases in India, the role of diagnostic testing and how healthcare professionals can address it with their patients, Pfizer organised a media interaction with oncologists. Dr Gainor and Dr Mohan addressed some major questions about symptoms, causes, risk factors and therapies for treatment.
Cause for concern
Dr Gainor: Lung cancer is the most common cause of cancer-related mortality in the world, with 1.7 million people dying each year from lung cancer globally. In the last decade, we have seen a transformation which has stemmed from our greater understanding of the disease itself, facilitated by advances in technology like genetic sequencing.
Dr Mohan: If you look at the statistics, the GLOBOCAN (Global Cancer Observatory) data, lung cancer is the fourth most common type of cancer diagnosed in India. It is the most common cancer in men and the second most common cancer in women.
Treatment procedures: Target therapies, immunotherapies, surgeries
Dr Gainor: Our studies have led us to two major paradigms for how we treat lung cancer now. On the one hand, there is precision medicine, i.e., trying to develop personalised therapy for patients. This involves taking a biopsy, doing genetic sequencing, finding different genetic mutations, and then trying to match those mutations with a specific targeted therapy. When I first started, we had one of those mutation for which we had a targeted therapy.
And now globally, we have 10. So a significant proportion of patients now are treated with targeted therapies. However, there’s still no cure. But there are profound improvements, both in quality of life and activity. Tumour shrinkage was earlier seen in 10 to 20 per cent of patients but now we are talking about shrinkage in 80-90 per cent of patients.
When you treat lung cancer with targeted therapy, the tumour evolves and develops new mutations. The second major paradigm that has been recognised is that only a subset of people will have one of those mutations. What do we do for everyone else? This is where immunotherapy has been transformative. This is done using drugs called checkpoint inhibitors, to really boost a patient’s own immune system to target the cancer. About 10 to 20 per cent of patients who had formerly incurable diseases are living years and years. It’s a complete game-changer.
The other two major trends are that now we’ve had success using these targeted medicines and immunotherapies in patients with stage four, metastatic cancer. Can we take those same medicines and apply them to stages one, two and three, combining them with surgery? Secondly, what about lung cancer screening? Too many people are diagnosed at a late stage. And we’ve now learned from big studies that actually doing a low-dose CT scan as a screening tool can actually identify lung cancer earlier and can save lives. But the rates of screening worldwide are still low. That’s something where we really need to boost so that we find more patients with stage one lung cancers where they are curable in patients with stage four disease.
Major symptoms and risk factors
Risk factors: Smoking and second-hand smoking are important risk factors for lung cancer which are modifiable. There is an alarming rise in the incidence of lung cancer in nonsmokers as well. This can be due to indoor air pollution, occupational exposure or infectious diseases such as Mycobacterium tuberculosis.
Major symptoms: Breathlessness or continuous cough, sometimes chest pain. The symptoms of lung cancer are not specific to lung cancer. There are several diseases which overlap with the same symptoms like some infections.
Dr Mohan: The issue is that on a chest x-ray or a chest radiograph, we can only see up to 40 or 50 per cent of the lung if it is taken well. The rest of the areas are hidden behind the bones, behind the heart and we are not able to see. The message we usually convey to physicians is that if somebody is having respiratory symptoms for four-six weeks and you are not able to find anything on the chest radiograph, do not hesitate in referring them to a pulmonology centre.
Dr Gainor: Usually when you have a cough or these other symptoms, the tumour’s more advanced, at stage three or stage four. Usually, in stage one tumours, people don’t have the symptoms, which is why screening is important.
One of the major risk factors associated with lung cancer is pollution. According to a small study, Particulate Matter (PM 2.5) can contribute to the formation of lung cancers, a generation of a mutation that is typically found in never-smokers. The prevalence of Epidermal Growth Factor Receptor (EGFR) mutation is between 10-15 per cent in North America and Europe. In India, it is 30 per cent and in China, it is about 40-50 per cent. So pollution may be the link of why there are such significant differences.
What age group lung cancer is most visible in?
Dr Krishna Mohan: We are seeing patients in the average age group of 50 to 60 years. Lung cancer occurring in younger individuals is very rare. Around 66-70 per cent of all lung cancer patients are in this age group. The remaining are mostly elderly.
Barriers to seeking treatment
Both the doctors answered that one of the major barriers is the stigma around lung cancer, due to its association with tobacco.
Dr Justin Gainor: In the US, the funding for lung cancer research and treatment falls behind other cancer types due to this stigma. Financial barriers, including out-of-pocket expenses and insurance coverage, also hinder access to treatment.
Dr Krishna Mohan: Denial of a cancer diagnosis is one of the major barriers in India. Despite being diagnosed with cancer, people look for alternate treatments. Another significant barrier is the lack of expertise in intervention radiology.
Additionally, the high cost of targeted therapies poses challenges, although pharmaceutical companies now offer patient assistance programs to improve accessibility.