Lung Cancer is no more a Death Sentence

Dr. Niti Raizada

Director – Medical Oncology & Hemato Oncology,
Fortis Group of Hospitals, Bangalore

In India, around 13.2 Lakh new cancer cases are found every year. The total number of lung cancer cases in 2020 is approximately 72.5K, and the majority of these were men. Lung cancer remained the leading cause of cancer death, with an estimated 18 lakh deaths globally. The leading cause behind lung cancer is smoking and certain occupational hazards like working in chemical factories and coal mines without proper protective gear, getting exposed to certain radiation to name a few. 

The era of Precision Oncology 

The good news is that due to the advancement in precision oncology and personalized treatment the management of lung cancer has seen significant improvement over the last three decades, from the patient’s life expectancy going from less than six months to around ten years. 

The standard treatment procedure in the case of lung cancer includes radiation therapy, surgical removal of the affected section, chemotherapy, mostly in combination depending on the stage of the disease. The latest that medicine has to offer to manage lung cancer includes personalized precision treatment based on the genetic profile of the affected individual. 

Whole Exome based NGS Testing 

However, a precise diagnosis requires advanced technology, and next-generation sequencing (NGS) is a powerful approach in recent clinical practice. Whole Exome Sequencing (WES) by NGS identifies alterations within the cancer genome, giving insights into what is driving cancer, and whether that genetic alteration is a good candidate for targeted therapy for halting the cancer progression. WES remains an advanced solution to detect cancer predispositions, as most of our protein-coding genes are found in exonic regions. 

Approved Biomarkers for NSCLC treatment 

Global data suggests that lung cancer is common cancer and it takes multiple molecular genetic pathways to form and survive. NSCLC is the most common type of lung cancer and the genetic alterations that are associated with it are pretty high, and there are almost 9 FDA approved molecular markers (EGFR, MET, ALK, ROS1, RET, NTRK, BRAF, HER2, KRAS) for targeted therapy available for the treatment of NSCLC. It is also noteworthy that a gene’s mutational profile varies from population to population. For example, EGFR mutated lung cancer is less than 20% whereas in south Asian countries it’s estimated to be more than 50%. This frequency is very variable in respect to the Indian population, the northern part of India displays different frequencies in EGFR related NSCLC, and the Southern part of India displays different frequencies in EGFR mutated NSCLC. So, there is a high chance to find novel variants that drive particular cancer in that population. Population-specific cancer gene panels are better suited here like TARGT Indiegene.

Immunotherapy is a type of biological therapy that is widely used in cancer treatment and it has shown immense benefit when it comes to lung cancer treatment despite stage and aggressiveness. Lung cancer patients respond fairly well to immunotherapy regimens. To know the efficacy of immunotherapy, Tumour Mutational Burden (TMB), Microsatellite Instability (MSI) (genomic signatures), and PD-L1 (Programmed Death Ligand) to be tested.TMB and MSI are genomic signatures and they give good resolution when analyzed by sequencing the whole exome. 

The treatment combination in the battle of lung cancer management has increased significantly. The implementation of precision oncology in the treatment regimes increases the success in around 60% of the patients in whom the cancer-specific genes could be identified, and the treatment is modified to suit the patient eliminating the chance of overtreatment and undertreatment. 

A Missed Biomarker is a Missed Opportunity 

In the era of personalized treatment genomic medicine is an indispensable tool when it comes to precise management of lung and other solid malignancies. The broad NGS (WES sequencing) panel is the preferred tool in the proper diagnosis of cancer and few companies, unlike 4baseCare’s TARGT Absolute, provide broad NGS-based comprehensive genomic/molecular profiling with affordability for deciding on targeted therapy and immunotherapy treatment for lung cancer management. A comprehensive genomic profiling-based cancer panels are those panels that provide all the necessary DNA/RNA variants information by whole-exome sequencing for guiding targeted therapy decisions and TMB, MSI, and PD-L1 for Immunotherapy decisions with less tissue and time. 

Not Tough to Conquer 

Though lung cancer is an aggressive form of common cancer with a proper genetic screening test for early detection and comprehensive genomic profiling for proper precise personalized treatment (targeted and immunotherapy treatment) has increased the overall survival in the affected individuals with value addition that how precision oncology can benefit one’s with an advanced tumor. It’s not a death sentence anymore.