New hope for early-stage lung cancer

2023-06-06 01:25:25

On Sunday, June 4, the convention center on the shores of Lake Michigan in Chicago was abuzz with activity. Thousands of men and women – oncologists, researchers, pharmaceutical company employees – paced the corridors of the sprawling building, looking for a must-see presentation, a meeting to attend, a stand to visit. With 43,000 attendees, the American Society of Clinical Oncology’s (ASCO) annual cancer conference has regained the attendance levels of previous years, before the Covid-19 crisis.

What’s new in cancer care? Great things can come from small beginnings: The 2023 ASCO edition is a perfect illustration of this proverb. There will be no major revolution, but rather a number of “small steps forward” that will reinforce the interest in two fast-growing strategies. The first involves administering innovative treatments to patients with localized (non-metastatic) cancers at an early stage. The second involves personalizing therapies according to each patient’s tumor profile, especially in terms of molecular abnormalities.

This was demonstrated in Chicago, with a focus on the second most prevalent cancer worldwide: lung cancer, which accounts for 2.21 million new cases and 1.80 million deaths each year globally (more than 46,000 annual cases and 33,000 deaths in France).

At 2:00 pm on Sunday, the crowded hall was lit up by 10 massive screens that were broadcasting the opening presentation of the “plenary sessions” – the conference’s highlights. The eagerly awaited results of a study were unveiled by Roy Herbst, from the Yale School of Medicine in the United States.

The focus is on assessing the benefits of adding a targeted medication to the standard treatment regimen for certain patients with early-stage, hence operable, lung cancer. This medication specifically targets the molecular anomaly found in their tumor cells. It’s worth mentioning that this approach is applicable to “non-small cell” lung cancers, which are the most prevalent. At least 10% to 15% of patients (more in certain countries) carry a mutation in a gene encoding a protein called EGFR. Once this protein is mutated, it triggers uncontrolled, chaotic proliferation of the cancer cells.

A life expectancy that ‘increases from one to four years’

Pharmaceutical companies have consequently developed drugs that target and inhibit these mutated EGFR proteins. While the first two generations of these treatments lacked specificity (they also inhibited the normal EGFR protein present on the surface of all cells, hence their many side effects), the third is more selective. Its main representative, osimertinib (AstraZeneca laboratories), was the focus of attention that day. Thanks to this treatment, metastatic lung cancer with EGFR mutation has seen its life expectancy “increase from one to four or five years,” said Anne-Claire Toffart, a thoracic oncologist at CHU Grenoble. “This is impressive progress.”

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