Molecular revolution stopped lung cancer
The numbers leave no room for doubt. Cancer in Spain is increasing due to several factors that work against us, such as aging population and impact risk factors such as tobacco, alcohol, obesity and sedentary lifestyle. In particular, the Spanish Society of Medical Oncology (SEOM) estimates that in our country there will be 286,664 cases of cancer in 2024, an increase of 2.6% compared to 2023. And of all of them, lung cancer will be one of the most common as it is expected to be diagnosed 32,768 new casessecond only to colon and rectal cancer and breast cancer.
However, there are statistics in which lung cancer comes out on top because it the tumor that causes the most deaths in our country: about 23,000 deaths per year and a survival rate of only 15% at five years.. “The reason for such a dramatic figure is that more than 70% of cases are at an advanced stage at the time of diagnosisbecause lung cancer usually does not show warning symptoms until it is too late,” warns Dr. Mariano ProvencioHead of the Department of Medical Oncology at the Puerta de Hierro Hospital in Madrid and President of the Spanish Group for Lung Cancer (GECP). In this context, there are many reasons to delve into awareness of this tumor, as discussed in World Lung Cancer Daywhich is celebrated around the world every year on November 17th.
A statement to which a psychosocial aspect is added, since, as stated, Bernard GaspardPresident of the Spanish Association of Lung Cancer Patients (AEACaP), ” brand which accompanies patients with this disease remains very strong. In this case, to uncertainty and fear Having such a diagnosis, blame in case he was a smoker and misunderstanding understand why in those who have never smoked. This emotional burden is difficult to bear, and that is why More support and social awareness needed with the victims. We want to make the disease visible so that the rest of society can see it. Lung cancer is not always synonymous with death“
Bright horizon
Despite the difficult scenario portrayed by the statistics, the reality is that the outlook for lung cancer is promising, thanks to the research revolution that has occurred in recent years, which allows us to look to the future with optimism. For this, Molecular diagnostics and biomarker identification are essential to improve therapeutic decisions.which revolutionizes the approach to the disease, despite the fact that, as GECP experts condemn, access to these tools is still unequal across Spanish territory.
“Currently, survival rates for this tumor remain very low. Only 30% of those diagnosed will be alive after five years, but a gradual increase in survival of 1.5% per year is achieved across all stages of the disease.personalization and integration of care are essential. We must continue to improve diagnostic and treatment tools, especially for patients with advanced disease,” says Dr. Provencio. After all, as the specialist insists, “the increase in survival rate observed in recent years in the most advanced stages of lung cancer is due, among other things, development of targeted therapy. “Identification of the active genes is essential in lung cancer for proper treatment practices.”
Give the tumor a last name
If there is one thing that has revolutionized the lung cancer landscape in our country, it is the introduction of the latest scientific advances. In this sense, Dr. Provencio emphasizes “identifying molecular markers with targeted therapy specifically against certain tumors because it radically changed the treatment and prognosis of patients.both when it is a localized tumor or an early diagnosis, and when we are talking about a widespread or metastatic tumor, when targeted therapy is already included in the treatment in such situations.
The reality is that lung cancer is not a separate disease. Quite the contrary, as each subtype has been shown to require a different approach. “The fact that we identify different molecular biomarkers, that is, we give the tumor a specific surname, makes them disappear creating different subtypes of cancer. This is very good because it has helped us to better identify tumors with their own characteristics and therefore act much more precisely according to the characteristics of each of them.. These are different tumors with different behavior, so there is no point in attacking them all in the same way. The presence of molecular biomarkers allows us to more effectively target a specific target.“, explains the GECP President.
In this sense, according to the latest report prepared by the GECP at the Lung Cancer Observatory (OCP), 81.2% of patients in advanced stages have access to one or another type of genetic determination.. “Despite the fact that there was no regulatory framework until a few months ago and that its inclusion in the NHS portfolio of services is recent, our country is on par with neighboring countries in the use of biomarkers. . Of course, most of our patients have accessed it through a voluntary approach by professionals, without uniform access guidelines,” explains Dr. Provencio, emphasizing that “there is still a group of patients in whom biomarkers are not studied, and this needs to be improved. Its use should be included as another question, just as a general analysis is done to find out if anemia exists, biomarkers should be studied accurately to know what type of lung tumor a person has and how to deal with it. And this is how he condemns it too Gaspard, who reminds that “there are patients with biomarkers who still do not have the opportunity to access drugs that could improve their prognosis. “This creates great inequality and uncertainty, which reduces the quality of life of those affected.”
Another important pillar of the revolutionary clinical development of lung cancer is based on the use immunotherapy“because there are many drugs aimed at modifying the immune system and turning it into a weapon against tumors, which have managed to change the paradigm of the disease,” says the President of the GECP. And it doesn’t end there, because, as Dr. Provencio explains, “in recent years Bispecific antibodies were developed which improved upon previous results. Despite all this, the truth is that there has been a real therapeutic revolution that allows us to be optimistic.
Advances are removing stones from the difficult path that lung cancer patients go through, but this path still remains difficult and very sacrificial. “The scientific part is more or less covered, but there is no support to improve the emotional, social, work part… All these issues are not being addressed properly by SNS and we are patient associations that cover the needs of cancer patients while trying to ensure that those affected do not see their quality of life deteriorate. That’s why associationism must also be prescribed“, insists the AEACaP president.
Early diagnosis
The remaining challenge is to improve early diagnosis. He Smoking causes more than 85% of lung tumorstherefore, its reduction is a priority for disease prevention. “You need to quit smoking and for this Improved education and awareness needed to prevent young people from starting to smoke,” advocates the AEACaP President. This public health policy with preventive measures must be complemented by screening programs that allow these tumors to be diagnosed at an early stage to improve survival rates because: “In a patient diagnosed at the early stage, the five-year survival rate may exceed 90%, while at stage IV it may be less than 10%. Therefore, early diagnosis is very important for lung cancer patients. Every minute counts to improve the forecast,” insists the GECP President. In this sense, Dr. Provencio recalls the potential of the Cassandra project, “which combines primary prevention through smoking cessation and secondary prevention through screening programs using low-dose radiation computed tomography for smokers and ex-smokers meeting inclusion criteria.
To sustain optimism in the fight against this disease, progress must also be made on two critical issues: quick access to innovative medicines for patients after approval at European level. This is very important because it saves lives. And secondly, that the healthcare system adapts to change, because it is necessary to understand that the bet on these new diagnostic and therapeutic tools is not an expense, but an investment.” says Dr. Provencio. An idea supported by Gaspard, who insists that “we know that Research is what truly gives us hope in life. We believe that new treatments will make the disease chronic.but to do this we need to advance science and increase the research budget.
More years to live
Lung cancer survival may have increased more in the past 10 years than in the four decades from 1970 to 2010, according to the GECP. While in 1973 only 10% of patients with these tumors survived more than five years, in 2010 the percentage was 19%, some studies estimate. Currently, almost 40% (37% of men and 41% of women) of patients survive more than five years after diagnosis.
The X-ray study performed by GECP paints a very convincing profile of a patient with lung cancer. In particular, data from the Thoracic Tumor Registry, with clinical data from 31,587 patients from 89 hospital centers throughout Spain, suggest that male, smoker, average age 60 years and advanced disease at diagnosis. “However, we have observed some worrying trends that we often see every day in consultations, such as an increase in incidence among women, a higher percentage of middle-aged patients and the year-on-year prevalence of smoking as a major toxic agent. associated with this pathology,” laments Dr. Provencio. Thus, analysis of the patient profile included in the Register allows us to highlight There was an increase in the incidence of pathology in women.. Although the majority of cases occur in men (73.6%), they They already represent one in four cases of lung cancer (27%).along the growth path predicted by experts. An increase that GECP specialists attribute to women’s smoking habits.