The challenge of finding a permanent cure for the disease has been continuing for some time now. Medical sciences have been researching for cures that could eradicate the disease but the level of molecular intricacy is still not quite solvable. The treatment of cancer also depends highly on the stage of affliction. Dr. Prantik Das, Consultant Clinical Oncologist, Royal Derby Hospital, England, spoke to BE’s Isha Chakraborty about the causes of the increased incidence of lung cancer cases, the types of treatments and latest research.
Q) Why is lung cancer affecting many in India even after advancements in the field of cancer treatment?
A) Lung cancer is one of the most common types of cancers. Smoking can be linked to 86% of people who are diagnosed with lung cancer. Some other reasons that contribute to lung cancer are exposure to radon gas, to certain chemicals in the workplace, a history of other lung diseases such as tuberculosis, a family history of lung cancer, cancer treatment for other types of cancer, and a lowered immune system.
One of the most important reasons for the higher incidence of lung cancer is higher detection rate. We are diagnosing more lung cancer cases with the help of modern medical technology like X-ray, CT scan, etc. In the western countries, the number of active smokers has reduced significantly due to various initiatives by the government and health agencies but this is still lacking in India.
Q) What are the most harmful types of lung cancer?
A) There are two main types of lung cancer:
Non-small cell lung cancer: There are three common types. They are grouped together because they behave in a similar way and respond to treatment in a similar way. The first one being Adenocarcinoma, which is the most common type and originates in the mucus making gland cells in the lining of our airways. The second one is the Squamous cell cancer, which develops in the flat cells that cover the surface of our airways. It tends to grow near the centre of the lung. The third is the Large cell carcinoma in which the cancer cells appear large and round under the microscope.
There is another type under the NSCLC and that is the Undifferentiated non small cell lung cancer. If the cancer cells look too undeveloped under the microscope, the doctor won’t be able to tell the type of NSCLC. Undeveloped cancer cells are called undifferentiated cancers. So, your doctor might say you have undifferentiated NSCLC.
Small cell lung cancer: About 12 out of every 100 lung cancer patients are diagnosed with this type. It is usually caused by smoking. These cancers tend to spread quite early on.
Q) What are the advancements in this field?
A) The two major changes would be the targeted oral therapy and immunotherapy. Additionally, there are quite a few advancements brought in case of lung cancers. There is a huge improvement in the quality of diagnosis starting from imaging CT to PET scans in a proper way. There is an easier way of accessing bronchoscope and molecular testing. The techniques of performing radiotherapy on a patient have been improved as well in the recent years.
Q) Is the method of cloud cure effective?
A) Yes, the method of cloud cure can in turn improve the survival rate of the patient and control the disease in a much better way. Although one needs to strictly modify and maintain their way of living in order to completely delete the disease from the system, given the stage of the disease.
Q) Are these methods available in India?
A) I believe so. It is quite likely that the method is available in the private sector as it is quite expensive.
Q) How much does the new immunotherapy cost? Is it affordable?
A) The answer is yes, but I would say that having a private health insurance to back you up is the better idea since they are quite expensive in the longer run. The new method of immunotherapy in general would cost around Rs. 3,50,000, which is exclusive of any kind of blood test or doctor’s or hospital’s fee. So, having a medical insurance to support you is the feasible option.
Q) Are these treatments suitable for all age groups?
A) Yes, it is suitable for all age groups since neither we nor the disease differentiates between the age groups. We would not want to deprive anyone of having the better cure. As oncologists, we assess the patient, their fitness and other health related conditions. For example, I have patients who are 80 and still fit for the treatment but someone who is 60 may not be fit enough. So, it generally depends on the overall fitness of the particular patient.
Q) What are the basic treatments available? What is the last stage that they work on and what are their success rates?
A) Chemotherapy: Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. Chemotherapy for advanced lung cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time, but it can’t cure the cancer. These treatments won’t help everybody since it depends on how fit patients are and how well patients can cope with any side effects.
Radiotherapy: Radiotherapy means the use of radiation, usually x-rays, to treat cancer cells. Radiotherapy can shrink the cancer, relieve symptoms, and help patients feel more comfortable. But radiotherapy can’t cure advanced lung cancer.
Nivolumab: Nivolumab is a type of immunotherapy that stimulates the body’s immune system to fight cancer cells. Nivolumab is licensed to treat adults with non small lung cancer (NSCLC) who have already had chemotherapy. It is for people whose disease has spread outside the lungs and into the surrounding tissue (locally advanced), or to other parts of the body (advanced).
Pembrolizumab: Pembrolizumab is a type of immunotherapy. Your doctor might recommend you to have pembrolizumab if you have advanced non small cell lung cancer (NSCLC) and your cancer cells have particular proteins. It targets and blocks a protein called PD-1 on the surface of certain immune cells called T-cells. Blocking the PD-1 protein triggers the T-cells to find and kill cancer cells.
Targeted agents: Cancer cells have changes in their genes (DNA) that make them different from normal cells. These changes mean that they behave differently. Cancer cells can grow faster than normal cells and sometimes spread. Targeted cancer drugs work by ‘targeting’ those differences that a cancer cell has.
Targeted drugs: Erlotinib, gefitinib and afatinib work by blocking proteins on cancer cells called epidermal growth factor receptors (EGFR). Between 10 and 15 people out of every 100 with non small cell lung cancer (10 to 15%) have EGFR positive cancer. Crizotinib and ceritinib are both tyrosine kinase inhibitors. They work by blocking an enzyme called anaplastic lymphoma kinase (ALK). Crizotinib and ceritinib are used to treat some people with advanced NSCLC. These drugs only work in cancer cells that have an overactive version of ALK. So your doctor will check your cancer cells to see if this is the case. About 5 in 100 people (5%) with NSCLC have this. It is called ALK positive disease. The stage of a cancer tells you how big it is and whether it has spread. Knowing the stage helps your doctor decide the treatment. Stage 4 is part of the number staging system. It means that the cancer has spread. It is divided into stage 4A and 4B and is also called advanced lung cancer. The first stage i.e. 4A can mean that there is cancer in both lungs or the cancer is in the covering of the lung (the pleura) or the covering of the heart (pericardium) or there is fluid around the lungs or the heart that contains cancer cells or it can even mean that there is a single area of cancer that has spread outside the chest to a lymph node or to an organ such as the liver or bone. Another stage is 4B which means that the cancer has spread to several areas in one or more organs.
Q) What are the various side effects of these treatments or drugs?
A) The side effects of these treatments generally vary according to the treatments and also depend on the fitness and the general health of the patient.
Q) What kind of post-treatment care is needed?
A) It is important to get support to cope with the emotional, practical and physical issues when patients have advanced lung cancer. Advanced cancer means that the cancer can’t be cured. It might come back after original treatment or might have spread to other areas of the body. Treatment can often control the cancer and relieve symptoms. Doctors and nurses will help you to make the most of life and feel as good as possible for as long as possible. Otherwise there are support and discussion groups that the patients can join in after they are free from the disease. Now, certain hospitals have their own support groups. One needs to maintain their way of living as well.