Fit & Proper: Targeted treatment for lung cancer

Leena (name changed), 23, was diagnosed with Stage IV lung cancer two weeks after her post-graduation. She is an athlete, runs marathons and has never smoked. Yet, the statistics were stark: a 16 per cent survival rate. Accepting this diagnosis was the most difficult part for her. She feared the side-effects of chemotherapy, which she thought was her only option. Instead, I recommended a recent breakthrough targeted therapy: personalised medicine that comprises comprehensive genomic profiling. She was advised to take oral pill to target the cancer cells and precision medicine to target and destroy genetically mutated cancer cells. She has been taking the medicine twice daily with few side effects. This has helped put her cancer on pause.
Lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs - usually in the cells that line the air passages. These cells, instead of developing into healthy lung tissue, divide rapidly and form tumours. Smoking is the leading cause of lung cancer, among other factors such as exposure to tobacco smoke and carcinogens such as radon and asbestos. Lung cancer is one of the most common types of cancer in the world. Approximately 63,000 new lung cancer cases are reported each year in India.

Early diagnosis of lung cancer, coupled with the recent advanced targeted lung cancer therapy, can help save lives. Unfortunately, signs of lung cancer are not noticeable in the initial stages.

Advanced genetic studies have brought about a paradigm shift in the management of lung cancer. The most advanced personalised targeted therapy for cancer is based on the clinical characteristics of patients and the genetic abnormalities of their tumours. It consists of cancer drugs that target and inhibit specific genetic abnormalities in cancer tumours. Two abnormal genes (EGFR mutations and ALK fusions) in lung cancer currently have targeted treatments approved by the US Food and Drug Administration.

The 2013 National Comprehensive Cancer Network guidelines for oncologists, which are the gold standard of cancer treatment in the US, now state all patients diagnosed with lung cancer be routinely tested for EGFR.

QUICK TIPS

• If you observe any of the signs below, be sure to consult your doctor:
• If you are a smoker with chronic cough, stay alert for cold and cough that lingers.
• Pain in the chest, shoulder, or back area for an unusually longer period of time is another unnoticed symptom.
• Change in depth or hoarseness in voice if not accompanied with cold.
• Coughing up blood or rust-coloured spit.
• Shortness of breath, weakness and fatigue.
• Loss of appetite and weight.
• When airways become blocked, or inflamed, the lungs produce a wheezing sound when you breathe.
• Pain in the bones if the cancer has spread to the bones. Keep an eye out for body aches.
• Headaches are also observed if the cancer spreads to the brain
• Yellowing of the skin if cancer spread to other parts such as the liver.

Rajesh Mistry
Director, department of oncology, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai