Get to know lung cancer

Lung Cancer

When it comes to cancer, it is the most common and most popular news trend in recent years. There is no end to the topic of lung cancer.

Lung cancer is sad when it is, but the author thinks that the era of lung cancer as a plot to get rid of the hero or heroine is over.

However, currently. In terms of treatment and talk in the medical field, cancer healers. Lung cancer is a cancer that has a variety of treatment options. There is a clear treatment path. It brings more hope and choice for patients. The words that flow through the ears and through the eyes are increasing. In addition to “chemo” or chemotherapy. Radiation also targeted drug administration. Immunotherapy, cancer genetic testing, IMRT radiation, special PET scans. The cooperation of multidisciplinary teams at the meeting allows patients to hear a complete treatment plan or is the core of real life that is more important than the patient’s drama.

Lung cancer is divided into two major types: small cell lung cancer or non-small cell lung cancer.

The small cell type is an aggressive type that causes big problems. If it has not spread outside the lungs, there will be radiation along with it, but if it spreads outside the chest cavity, such as to the liver or the other lung, chemotherapy is recommended, which may include immunotherapy drugs, such as drugs called 1. Atezolizumab and 2. Durvalumab.

For non-small cell lung cancer, there are subtle treatments divided according to the stage of the disease. Lung cancer is a disease that requires long-term treatment. Now, every stage talks about cancer genetic testing from blood pieces, medications, radiation therapy and surgery.

For example, in the initial stage, we will talk about stage 1 or stage 2. It is necessary to give complementary drugs, that is, medication, which includes medication and chemotherapy, which is done after the surgery is completed, and then chemotherapy is performed. 4 rounds, and maybe follow. If a drug-responsive mutation is detected (EGFR exon19del, L858R) or the immunotherapy drug Atezolizumab without EGFR and ALK mutations, this is only the initial stage.

Moving on to stage 3, the author himself would like to say that it is a stage where cancer patients are very good at receiving treatment because there are 2 cases: cases that cannot be operated on. Patients need chemotherapy combined with radiation followed by chemotherapy. 2 cycles and some cases may be followed by immunotherapy. The second case is a case where it is possible to have surgery but the cancerous tumor is still large or spreads to many lymph nodes. Therefore, chemotherapy must be given first, and some patients may receive immunotherapy drugs along with chemotherapy. 3 cycles before surgery to make the lump smaller and possible cure of cancer before surgery (pathological completed response)

Phase 4, the last stage, and not the last because there are drugs and mutations that challenge the treatment to treat patients accurately. However, the patient and the doctor must plan the treatment sequence together in detail, for example, if the cancer has spread to multiple points of the brain. The patient needs to be irradiated to the brain first. It takes two weeks and requires a biopsy to see if there is a genetic mutation in the cancer used by the targeted drug. Currently, there are blood tests or biopsies, and the testing techniques that have been thought of are like dreams in futuristic movies where the genetic code is unfolded and the prediction of which treatment can be used. (Next Generation Sequencing Method) Once the radiation is complete, the patient will know the results and choose the treatment step by step, and the doctor can arrange the treatment appropriately to ensure that the patient has a quality and long life. An example of a patient who has already had radiation on the brain. After taking a genetic test for cancer with ALK mutations, she received ALK TKI, allowing her to live peacefully with stage 4 cancer for 5 years.

Examples, names, cancer genetics and pairings with targeted drugs

EGFR Ex19del – gefitinib, erlotinib, dacomitinib, afatinib & Osimertinib

ALK rearrangement (fusion gene) – brigatinib, ceritinib, alectinib & loratinib

NTRK fusion gene – entrectinib, larotrectinib

RET fusion gene – praseltinib

MET exon14 skipping – capmatinib

ROS1 – Crizotinib

BRAF v600e – Dabrafinib paired with trametinib

KRAS G12C – sotorasib

Exon Ex20ins – mobocertinib & amivantamab

HER2 – Trastuzumab deruxican

If there is no mutation with targeted drugs, Ask if there are alternatives to chemotherapy. If a biopsy is dyed with a “special color” called PDL-1, if 50% or more of the color is attached, there is a chance that immunotherapy alone can be used. For example, pembrolizumab or another drug called atezolizumab.

Chemotherapy is not the last option, but it may be the most suitable option for some patients who can calm down for a few years and be able to live a working life. By being careful about infection safety, cleanliness, hygienic food and communicable diseases such as COVID-19.

Although the names of various drugs, research data, and reading and interpreting the genetic code will make the ability of an oncologist to look like a witch with a charm. When he returned to the examination room. Lung cancer patients are the most important people in the family, and when they return home, they are also the most important people in the family. Therefore, patients and their families play an important role in making decisions about cancer treatment. Fight, embrace and be ready to go through the events of life. In addition to the advice and treatment of oncologists like the author, I would like to send encouragement to live through letters to cancer patients and their families with good hopes and good health.

Thank you for the information from :

Dr. Panuch Eiamprapaporn, Medical Oncologist