How is lung cancer curable

Lung cancer

Non-small cell lung cancer: treatment

In the treatment of non-small cell lung cancer, surgery and radiation are in the foreground.

  • surgery: The aim of lung cancer surgery is to completely remove the tumor and still cure the lung cancer. Doctors remove the entire lobe of the lung in which the tumor has developed. Lobectomy is called this intervention. Sometimes they remove just part of the lobe of the lung and some of the rest can be left. With larger tumors or multiple cancer foci in the lungs, surgeons remove the entire lung (Pneumectomy). They also remove lymph nodes in the area and a pathologist then analyzes himself for cancer cells in the laboratory.
  • Irradiation: It usually follows the operation. Sometimes radiologists do it before surgery to shrink the tumor. Radiation is also an option if an operation is not possible or desired. Radiologists use high-energy radiation to target cancer cells. These damage the genetic material of the tumor cells, which it is difficult to repair - then the cancer cells die. Doctors do not administer the entire radiation dose all at once, but rather in several sessions in smaller "portions".
  • chemotherapy: During chemotherapy, doctors use cell toxins (cytostatics) that work throughout the body. It usually follows an operation. Sometimes doctors treat their patients with chemo before the operation to shrink the tumor. Then he can be operated on better and doctors can get more lung tissue.

Advanced non-small cell lung cancer: treatment

If the lung cancer is more advanced and has metastasized, it is no longer curable. Then there are the following further treatment options:

Chemoradiotherapy: During chemoradiotherapy, doctors combine radiation with chemo. The combination has more impact than the respective treatments alone. It often slows down tumor growth and extends life expectancy.

Immunotherapy against lung cancer: In immunotherapy, doctors do not act against the cancer cells themselves, but rather sharpen the immune system. Cancer cells are smart: they put on a kind of magic hat, make themselves invisible to the immune system and thus evade its attack. They do this by developing certain protein structures (PD 1 ligands) and using them to occupy special docking points on the surface of the immune cells (PD 1 receptors). Now the immune cells do not recognize them as evil and do not attack them either - they multiply undisturbed. During immunotherapy, researchers keep an eye on these control points of the immune system, the so-called checkpoints. The new drugs block the contact point on the immune cell (PD-1) or that on the tumor (PD-L1). In this way, they expose the tumor cells and sharpen the immune defense against cancer. Examples of active ingredients in lung cancer are ipilimumab, nivolumab, pembrolizumab, atezolizumab or durvalumab. Checkpoint inhibitors also work against other types of cancer, such as black skin cancer.

Targeted therapy: About every tenth patient with non-small cell lung cancer has certain characteristics on the cancer cells. Then some signaling pathways that are important for cell division and reproduction are permanently active. One possibility is drugs that target these characteristics and interrupt the corresponding signaling pathways. your name is Kinase inhibitors. The aim is to reduce tumor growth.

Some examples:

  • EGFR mutation: Some patients have an alteration in the epidermal growth factor receptor (EGFR). In the case of an EGFR mutation, certain signaling pathways for the division and multiplication of cells are permanently activated. Then drugs from the group of tyrosinase inhibitors come into question. Examples of approved active ingredients are Afatinib, Erlotinib, Gefitinib and Osimertinib. They penetrate the cell, interrupt this signal chain and thus slow down the multiplication of cancer cells.
  • ALK translocation: In the process, genes rearrange and rearrange themselves - the tumor grows as a result. If the ALK gene is affected, ALK inhibitors such as crizotinib, alectinib or ceritinib are a possibility. Research is still ongoing into other drugs from this group.
  • BRAF mutation: This mutation is very rare. In these lung cancer patients, certain signaling pathways are activated that stimulate cell division and reproduction. One example is the BRAF V600 mutation. Doctors use a combination of two active ingredients: dabrafenib and trametinib. They belong to the group of so-called BRAF and MEK inhibitors.

The so-called pursue another starting point Angiogenesis inhibitors: The drugs ensure that the tumor can no longer form new blood vessels. So they cut off the oxygen and nutrient supply - and starve him. An important point of attack is the growth factor "Vascular Endothelial Growth Factor", or VEGF for short. There are drugs that target VEGF or its receptor. Examples of active substances are bevacizumab and ramucirumab.

Small cell lung cancer: treatment

Patients with small cell lung cancer are at high risk that the tumor will spread and metastasize to other organs. In many patients this is already the case at the time of diagnosis. An operation only makes sense at a very early stage, when the cancer has not yet affected any or only a few lymph nodes. There are the following options to treat lung cancer:

  • chemotherapy: It works better in patients with small cell lung cancer than in non-small cell tumors. Chemo is therefore the most important treatment method. Doctors usually combine two or three cytostatics (e.g. cisplatin, etoposide, carboplatin, anthracyclines)
  • Irradiation, also of the skull, to prevent brain metastases
  • combination of Chemo and radiation (Chemoradiotherapy)

In addition, doctors treat accompanying symptoms such as shortness of breath, chest pain or bone pain (due to bone metastases) with medication. Psycho-oncology is also an important component in cancer.

According to current knowledge, targeted therapies have no advantages in the case of small-cell lung cancer. Immunotherapy, for example with the antibodies pembrolizumab, nivolumab or ipilimumab, is still being tested for small-cell lung cancer.