Genetics Leading the Way in Lung Cancer Treatment

Lung cancer is one of the most common and virulent cancers, and, despite improvements, it is still the leading cause of cancer death. This is because it is often detected at later stages, when surgery is less successful and medical therapies are less effective. As you will read in this issue, both of these factors are changing, providing an opportunity to improve outcomes.

Early detection through computed tomography scans for current or previous smokers is now a reality and has finally received the gold seal of approval from the U.S. Preventive Services Task Force. But screening is not perfect and sometimes results in unnecessary biopsies and surgeries. And it’s obvious that prevention is the best approach to eradicating lung cancer, because at least 80 percent of cases are due to smoking. We must not let up our guard to continue the trend in eliminating smoking as a societal priority.

The more robust, recentadvances have been due toour understanding of geneticmutations that can betargeted with specific drugs.

The other area of rapid change has been in medical treatments. While chemotherapy can improve the cure rate for early-stage lung cancer, it is not curative for advanced metastatic lung cancer, and survival rates in this situation have remained essentially unchanged until recently. We have a long way to go, but the barrier was initially cracked with targeted therapies, such as the drug Avastin (bevacizumab), which added a median of about two months’ survival time (and longer for some patients).

The more robust, recent advances have been due to our understanding of genetic mutations that can be targeted with specific drugs. Even for those patients with no specific “sensitizing” mutations, newer immune therapies—after decades of negative studies—are now yielding promising results as we learn more about the basic science of immune regulation. The new generation of biomarker-driven trials will ultimately lay the groundwork for personalized medicine. If we couple earlier detection with genetically tailored treatment to prevent (as opposed to manage) metastases, the survival statistics could change radically—a very welcome change, indeed.

Debu Tripathy, MD

Editor-in-Chief

Professor of Medicine, University of Southern California

Co-Leader, Women’s Cancer Program at the USC/Norris Comprehensive Cancer Center