JiLung cancer has been the number one cancer mortality rate in Korea for 10 years. Lung cancer has a high mortality rate because it has no specific symptoms and is difficult to detect early. What is hopeful, though, is that treatments are gradually improving, increasing the survival time of patients.
Cancer that progresses silently, lung cancer
Lung cancer is a malignant tumor in the lungs. It occurs in the lung itself or as it metastasizes to other organs. Primary lung cancer that occurs in the lung itself is divided into non-small cell lung cancer and small cell lung cancer. It occurs in 80% of non-small cell lung cancer and 20% of small cell lung cancer.
Currently, about half of lung cancer patients in Korea are diagnosed with stage 4 metastatic lung cancer, that is, cancer that has metastasized to other organs. Because there are no symptoms even when lung cancer develops, the patient is diagnosed with stage 3 or 4 as the cancer progresses without the patient’s knowledge. Accordingly, the 5-year survival rate of patients is only 8.9%. However, recently, immunotherapy has proven its effectiveness, and the treatment is also being developed more and more, and the survival period of lung cancer patients is greatly increasing.
Immunotherapy increases survival rate
Immuno-cancer drugs have the principle of allowing immune cells to attack cancer cells on their own by blocking the binding of immune cells to cancer cells. In other words, immuno-oncology drugs prevent the PDL-1 protein released by cancer cells from binding to immune cells T cells, thereby helping immune cells to fulfill their original function of attacking cancer cells.
Examples of immuno-oncology drugs include Opdivo, Tecentriq, Keytruda, and Imfinzi. These immuno-oncology drugs are known to have fewer side effects than the first-generation cytotoxic anticancer drugs and the second-generation targeted anticancer drugs, and their effectiveness is excellent, providing great hope for patients with terminal lung cancer.
Earlier this year, the World Lung Cancer Society announced that the survival period of patients with stage 4 lung cancer would increase if immunotherapy is used as the first treatment for lung cancer patients. In addition, according to the National Comprehensive Cancer Network Guidelines (NCCN) in the United States, it is recommended that all patients with stage IV non-small cell lung cancer be treated first with combination or monotherapy with immunotherapy.
In patients with metastatic non-squamous non-small cell lung cancer, the survival period more than doubled when immunotherapy is the first-line treatment, and it has also been proven that more than 80% of patients who have responded to immunotherapy have long-term survival. In addition, compared to targeted chemotherapy or targeted chemotherapy, patients who respond to immunotherapy maintain their quality of life and have a longer duration of treatment response.
Immunotherapy is advancing increasingly
The therapeutic paradigm continues to evolve. Previously, immunotherapy alone was used, but now it is possible to administer immunotherapy to more patients through combination with chemotherapy. As a result, the therapeutic effect is also increasing.
In addition to the existing immuno-oncology drugs, there are new drugs in clinical trials. Lazertinib is a third-generation EGFR (genetically mutated) inhibitor. As an anticancer drug with the same medicinal effect, Tagrisso currently dominates the market. However, if Lazertinib succeeds in clinical trials, it is expected to not only expand the choice of treatment for both patients and doctors, but also revolutionize the treatment of lung cancer worldwide.
As such, research for the treatment of lung cancer is active and the survival rate is increasing. But there are still mountains to climb. In the case of lung cancer, if immunotherapy is used as a second-line treatment, health insurance benefits are provided, but the first-line treatment is not yet applied. Hundreds of billions of won in insurance financing is expected. Even though immunotherapy alone and combination therapy are recommended as first-line treatment, the accessibility of actual patients is falling. It is hoped that an environment will be created where all lung cancer patients can receive optimal treatment by paving the way for immuno-oncology drugs to be widely used as first-line treatment.
Written by Hidak Medical Correspondent Young-Han Hong (Surgeon Specialist)
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