“40% of lung tumors are diagnosed in the metastatic phase”

J.P.R.
Lung cancer incidence and mortality continue to rise. It is already the leading cause of cancer mortality among women in a number of autonomous communities. One of the reasons is the late diagnosis of the disease. “More than 40% are diagnosed de novo in the metastatic phase (what we call stage IV), and 30% are diagnosed with locally advanced disease, most of which will progress.” Dr. Pilar Garrido, head of the medical oncology service at the Ramón y Cajal University Hospital, explains this in an interview with iSanidad. Given this situation, the specialist insists on the need to introduce screening among risk groups. At the same time, it is considered necessary to increase public awareness of the risks associated with smoking.

According to the SEOM report, lung cancer is the third most common in Spain, with 32,768 cases reported in 2024. How have morbidity and mortality rates developed in our country in recent years?
Of greatest concern in recent years is the increase in the number of women, which has become the leading cause of cancer mortality in some autonomous communities, such as the Community of Madrid. This trend repeats what happened many years ago in other countries such as the United States or the Nordic countries.

“A clearly defined risk group is the smoking population, since tobacco is the cause of more than 90% of cases.”

What percentage of lung tumors tend to progress to the metastatic phase?
More than 40% of cases are diagnosed de novo in the metastatic phase (what we call stage IV), and 30% are diagnosed with locally advanced disease, most of which will progress. Hence the importance of screening among at-risk groups, as is done in other countries, so that we can diagnose more patients in the early stages when a cure is possible.

Are there certain profiles or risk groups that are more likely to develop metastases from lung cancer?
A clearly identified risk group is the smoking population, since tobacco is the cause of more than 90% of cases. Hence the importance of screening with low-radiation CT in smokers or former smokers, which allows lung cancer to be detected at earlier stages.

What do you think are the major unmet needs of patients with metastatic lung cancer?
As a physician, I would say that improvements in treatment are leading to subgroups of patients for whom we currently do not have good outcomes, so that we are improving survival with good quality of life; On the other hand, patients with good treatment outcomes—what we call long-term survivors—have other issues to consider, including the potential long-term effects or toxicity of the treatments they received.

“We have an unresolved issue in terms of knowledge of health outcomes based on autonomous communities”

What are the biggest challenges these patients face in terms of access to treatment, diagnosis or psychological support?

In Spain, there is still a delay in deciding on funding for drugs after their approval by the EMA. We also have an unresolved issue in terms of knowledge of health outcomes depending on the autonomous communities or area of ​​residence. I also think that the opportunity to participate in a clinical trial or complete molecular diagnostics is not the same for all patients for whom it is indicated.

In recent years, immunotherapy and targeted therapy have revolutionized the treatment of this tumor. What role do they play in metastatic lung cancer and what are the future therapeutic targets?
Both treatment strategies are already applicable to some patients and in early stages, and numerous studies are being conducted to explore their role in other contexts.

What are the current main directions of open research in the treatment of metastatic lung cancer?
Indeed, there is a lot of research in the field of cancer and specifically lung cancer. Some examples are drugs with new mechanisms of action, such as bispecific antibodies, ADCs (antibody conjugates), or radionuclides that are being studied in clinical trials; as well as new targeted drugs aimed at eliminating resistance to modern treatments.

“Most people don’t know that more women die from lung cancer than from breast cancer.”

Do you think metastatic lung cancer is talked about enough?
No, and this is especially important for women who smoke; I think most people don’t know that in many places, including Madrid, more women die from lung cancer than from breast cancer. It is extremely important not to start smoking (because it is a supplement) and if you have already started, quit smoking as soon as possible; In my opinion, we should have zero tolerance to tobacco – not for smokers because, I repeat, it is an addiction and therefore we should help them quit smoking – as a first measure to get lung cancer at a less advanced stage.

Why do you think the visibility of this pathology is lower than other types of cancer?
Awareness and raising awareness are important to change the situation, but in my opinion, when citizens think of cancer, they first associate it with breast cancer and a pink ribbon; Perhaps it is time to change this perception among everyone: patients, healthcare professionals, administrators and the media.