What are the treatments for lung cancer ?

The management of lung cancer depends mainly on its nature: small cell lung cancer or non-small cell lung cancer.

Management of non-small cell lung cancer

For non-small cell lung cancers, treatment will depend first on its size and extent. These two criteria define the stage of cancer.

Generally, three stages are distinguished :

  • The first stage is the early stage: at this stage, the tumor measures less than 7 cm. It may have spread to neighbouring lymph nodes but not to any other part of the body.
  • The second stage is locally for these cancers, the tumor may have spread to lymph nodes other than neighboring but not to other parts of the body. Alternatively, the tumor may have extended to other parts of the lungs, respiratory pathways, or nearby areas. It may potentially have reached the trachea, esophagus, or heart but no other parts of the body.
  • The third stage is the metastatic stage : cancer may be present in both lungs and/or may have spread to another part of the body, such as the liver, adrenal glands, brain, or bones. It may have caused an accumulation of fluid around the lung or heart containing cancer cells.

The choice of treatment will be made by physicians who meet within the framework of a Multidisciplinary Consultation Meeting or MCM. This includes at least an oncologist specializing in chemotherapy or targeted therapy, a radiation oncologist, and a surgeon.

In the early or locally advanced stage

For early or locally advanced non-small cell lung cancers, the most common treatment is surgery.

Depending on the size of the tumor, the surgeon will either remove only the tumor or the lobe of the lung where it is located. They will also remove lymph nodes present in the mediastinum. After a small incision, the surgical procedure is performed by inserting an endoscope to visualize and remove the tumor.

For locally advanced cancers, surgical intervention may be preceded by a so-called "neoadjuvant" treatment with chemotherapy. Chemotherapy combines two drugs administered intravenously.

TO REMIND YOU

A "neoadjuvant" treatment is a treatment (chemotherapy, targeted therapy, or immunotherapy) used before surgery to reduce the size of the tumor.

An "adjuvant" treatment is a treatment (chemotherapy, targeted therapy, or immunotherapy) used after surgery to prevent a possible cancer recurrence or to treat metastases.

Clinical trials are currently underway to determine whether surgical intervention should be preceded by neoadjuvant immunotherapy with or without chemotherapy.

💡 DID YOU KNOW ?

Immunotherapy treatment for cancers is a real revolution in the treatment of some cancers, including lung cancer.

These treatments are based on the following three discoveries :

  • The first is the identification of particular molecules, checkpoints , which can accelerate or slow down the immune system's functioning.
  • The second discovery is that cancer cells can use checkpoints that slow down the immune system to evade it. They use a checkpoint called PD-L1 , for example, to slow down the system. This molecule is present on the surface of cancer cells. It binds to another molecule called PD-1, which is present on the surface of lymphocytes, the immune system cells responsible for eliminating cancer cells. The binding of PD-L1 to PD-1 prevents lymphocytes from performing their role and eliminating tumor cells.
  • The third discovery is that drugs that block PD-1 or PD-L1 can stimulate the immune system to eliminate tumor cells. These drugs are immunotherapies since they do not directly eliminate cancer cells like chemotherapy does but stimulate the immune system to eliminate cancer cells. These immunotherapies are often more effective if cancer cells have many PD-L1 molecules on their surface . It is therefore useful to study this expression of PD-L1 on the surface of tumor cells to predict the effectiveness of anti-PD-L1 or anti-PD-1 immunotherapies.

After surgery, an "adjuvant" treatment with chemotherapy may be performed. Clinical trials are also being conducted to determine the benefits of adjuvant therapies with immunotherapy, either alone or combined with chemotherapy.

In recent years, new treatments, known as targeted therapies, have been increasingly used in neoadjuvant or adjuvant settings.

💡 DID YOU KNOW ?

As their name suggests, targeted therapies are directed against targets that are directly involved in the transformation of normal cells into cancerous cells, in the proliferation of cancer cells, or in the development of malignant tumors.

These targets can be located on the surface or inside cancer cells. On the surface, they may be receptors involved in cell proliferation, such as the Epidermal Growth Factor Receptor (EGFR). Internally, they can be molecules located on intracellular pathways crucial for cancer cell proliferation. By blocking these pathways with targeted therapy, tumor growth is directly inhibited.

If the tumor location or size don’t allow its excision by surgery, it is possible to use radiotherapy, which is administered in several sessions over 4 to 6 weeks.

The rays are administered very precisely to the tumor to kill cancer cells. Immunotherapy or targeted therapy may also be offered.

At the metastatic stage

For metastatic non-small cell lung cancers, treatment is done with chemotherapy. If the tumor has genetic alterations (e.g. ALK, EGFR, ROS1) that can be targeted by a targeted therapy this therapy will be used. For patients whose tumor has a high expression of the PD-L1 checkpoint, immunotherapy treatment may be used.

Management of Small Cell Lung Cancer

Small cell lung cancers are treated with chemotherapy and radiotherapy, possibly combined with immunotherapy. Due to its highly disseminated nature, surgery is rarely performed.

After treatment, medical follow-up will be conducted. For patients with localized cancer, the follow-up will involve radiological exams and clinical evaluations every 6 months during the first 2 years, and then annually.

Clinical trials

There are increasingly numerous clinical trials underway to study new treatments for lung cancers. Among these treatments are next-generation targeted therapies or new immunotherapies. A new class of drugs, antibody-drug conjugates, is also being developed.

💡 DID YOU KNOW ?

Antibodies are large Y-shaped molecules produced naturally by the cells of our immune system or artificially in the laboratory to create medications.

The tips of the small branches of the Y can very precisely recognize their target, called an " antigen " such as those on the surface of cancer cells.

By conjugating an antibody that specifically recognizes cancer cells with a chemotherapy molecule, the antibody-drug conjugate delivers chemotherapy precisely to the cancer cells.

Recently, a clinical trial demonstrated the benefits of an antibody-drug conjugate for the treatment of non-small cell non-squamous lung cancers .

Numerous clinical trials are also investigating combinations of immunotherapy with another immunotherapy, chemotherapy, or one or more targeted therapies.

These trials hold significant promise for new advancements in the treatment of lung cancer.

Know the clinical trials in lung cancer currently being recruited in France.

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Article updated on 15 oct. 2024

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