“Lung Cancer” Statistics Revealed, 64 New Thai Patients Per Day, Second Highest Death Rate, Indicates “Immunotherapy Drugs” Can Be Used to Treat Both Early Stages and Metastases, Reveals There is a Subcutaneous Injection Type Approved by the FDA, Can Be Used Instead of Mixing with Saline and Dripping Intravenously, Drug Levels, Efficacy, and Safety Are Not Different, But Helps Reduce Treatment Time from 1 Hour to 7 Minutes
On July 12, at the Intercontinental Hotel in Bangkok, during the launch of a new type of lung cancer drug innovation, Prof. Dr. Wiroj Sri-Ularaphong, MD, a medical oncologist from the Faculty of Medicine, Chulalongkorn University, and chairman of the Thai Lung Cancer Working Group under the Thai Oncology Society, gave a special lecture titled “The Truth regarding Lung Cancer in Thailand: Statistics and Risk Factors You Must Know”:
Lung cancer is a major health concern in Thailand. It is the second most common cancer among men and the fifth most common among women. Annually, there are approximately 23,494 new cases, or 64 per day, with 15,200 cases in men and 8,294 cases in women. Sadly, around 19,864 people die from lung cancer each year, or 54 per day. This translates to the second highest mortality rate among all cancer types, with over 80% of lung cancer patients succumbing to the disease within 5 years. This high incidence and mortality rate makes lung cancer a major public health concern in Thailand that requires urgent attention.
Risk factors for lung cancer can be categorized into avoidable and unavoidable factors. Avoidable factors include smoking, the leading cause of lung cancer, responsible for 85% of cases. E-cigarettes, similar to traditional cigarettes, also cause lung inflammation and pose a long-term risk of cancer. Therefore, smoking both cigarettes and e-cigarettes should be avoided.
Other avoidable factors include air pollution, particularly PM 2.5 dust, which is currently under investigation for its potential link to cancer development. While the effects may not be immediate, high exposure to PM 2.5 is associated with increased lung cancer risk. Monitoring PM 2.5 levels and avoiding exposure to high levels, for example, by staying indoors in air-conditioned rooms or vehicles with air filters, is crucial. Exposure to certain workplace substances, such as burning charcoal, radon gas, and other carcinogens like asbestos, chromium, and radiation, also contribute to lung cancer risk.
Unavoidable factors include age, as older individuals have a higher risk of cellular deterioration, increasing their susceptibility to cancer. While lung cancer is not directly inherited, families of lung cancer patients may share similar environmental exposures and risk factors, leading to a phenomenon termed mild genetics.
Assoc. Prof. Dr. Wiroj explained that common lung cancer symptoms prompting patients to seek medical attention usually originate from the lungs, such as coughing, fatigue, shortness of breath, and chest pain. If the cancer spreads to other organs like the brain, bones, or liver, patients will experience various specific symptoms. Definitive diagnosis involves tissue biopsy to determine if the cells are cancerous. Lung cancer can also be diagnosed through imaging techniques, such as chest X-rays and computed tomography (CT) scans, which provide detailed information, while Positron Emission Tomography (PET) scans assess the extent of the disease throughout the body.
Currently, three primary methods are employed for treating lung cancer: surgery, radiation, and medication. Medications are divided into three categories: chemotherapy, targeted drugs effective for specific cancer types with known targets, and immunotherapy drugs.
Assoc. Prof. Dr. Wichian Srimuninnimit, a medical oncologist at Siriraj Piyamaharajkarun Hospital, spoke regarding the two main types of lung cancer: small cell lung cancer and non-small cell lung cancer. Treatment options vary depending on the type, stage, and patient’s overall health. While most Thais are familiar with surgery, radiation, and chemotherapy, treatment for non-small cell lung cancer has advanced, focusing on specifically targeting cancer cells and minimizing side effects associated with traditional chemotherapy. This has resulted in improved treatment outcomes, survival rates, and disease control, including:
1. Targeted therapy, or treatment with targeted drugs, primarily oral medications, utilizes drugs that specifically target cancer cells, leading to enhanced treatment effectiveness and fewer side effects on healthy cells. However, tissue and blood samples are required to determine the presence of gene mutations. If suitable mutations are identified, targeted therapy can be highly effective, efficient, and lead to better disease control and survival compared to chemotherapy, with fewer side effects.
2. Immunotherapy, a newer class of drugs, stimulates the body’s immune system to combat and eliminate cancer cells without directly destroying them. The body naturally recognizes and eliminates foreign substances like bacteria, viruses, and cancer cells. However, cancer cells have mechanisms to evade the immune system, such as producing PD1 proteins on immune cells and PDL1 on cancer cells. Binding of PD1 and PDL1 inhibits the immune system from destroying cancer cells, allowing the cancer to grow and spread.
“Immunotherapy drugs work by binding to PDL1 or PD1, preventing their interaction. This reactivates the immune system, enabling it to target and destroy cancer cells. Immunotherapy can be used as a single drug or in combination with other treatments like chemotherapy. Current findings suggest that immunotherapy has fewer side effects than chemotherapy and is typically administered intravenously through saline solution,” said Assoc. Prof. Dr. Wichian.
Dr. Yosawat Rungrojwattana, a medical doctor in the Department of Oncology, Faculty of Medicine, Vajira Hospital, highlighted that cancer treatment options include oral medications, intravenous medications through IV drips, and, more recently, subcutaneous injections. The choice of treatment is determined by considering factors like the type of cancer, medication, safety, and patient convenience, in consultation with the patient. Immunotherapy is indicated from the initial stages to stages 2-3. It is also used as an adjunct following surgery and chemotherapy. Administrated every 3 weeks for regarding a year (17-18 cycles), immunotherapy aims to achieve a complete cure. In metastatic stages, the focus is on improving quality of life and survival rates. Both immunotherapy and chemotherapy can be used together or separately. Treatment continues until resistance or non-responsiveness is observed, at which point it is discontinued. The maximum duration is 35 cycles (approximately 2 years).”
“The effectiveness of immunotherapy has significantly improved compared to the past, with some patients experiencing longer survival times. Immunotherapy’s side effect profile is generally milder than chemotherapy. Its applications extend beyond lung cancer, encompassing liver, breast, and colon cancer. However, it’s important to note that not all patients are suitable candidates. Testing is essential to determine a patient’s potential response to the drug, particularly their PDL1 level, which is evaluated through biopsy. Higher PDL1 levels, exceeding 50%, suggest a greater likelihood of a positive response to immunotherapy,” said Dr. Yotsawat.
Dr. Yotsawat mentioned that immunotherapy drugs were previously given intravenously, but a subcutaneous injection option, approved by the Thai FDA, is now available. Typically, 1-2 milliliters can be safely injected under the skin. Injecting larger amounts may cause swelling and pain. Subcutaneous immunotherapy utilizing Halozyme Therapeutics drug delivery technology, or Enhance, employs the enzyme “hyaluronic acid” to create a temporary gap beneath the skin layer, allowing the injection of larger volumes. This technology is suitable for immunotherapy, enabling the injection of 15 milliliters without causing swelling or pain. The drug’s side effect profile is minimal. This technology is also used in diabetes medications.
Clinical studies have shown that subcutaneous drug administration delivers comparable drug levels to intravenous administration, with no significant differences in blood levels, drug response, side effects, efficacy, or safety. Additionally, subcutaneous injections eliminate allergic reactions associated with saline tubes. This method offers greater convenience and shorter treatment times. While intravenous infusion requires mixing the drug with 100-250 ml of saline and takes approximately 1 hour, subcutaneous injection is user-friendly, taking 4-8 minutes (average 7 minutes), allowing patients to return home faster and resume their daily activities. This also reduces staff workload and increases the efficiency of patient care.
“While oncologists can prescribe immunotherapy, access is currently limited to patients who can afford the costs or civil servants who meet the Comptroller General’s Department criteria. Widespread use may need to wait for price reductions. Currently, intravenous and subcutaneous immunotherapy have similar costs, making subcutaneous injection an advantageous option due to its convenience,” concluded Dr. Yotsawat.
Lung Cancer Statistics in Thailand: A Growing Concern
Lung cancer is a significant health issue in Thailand, with alarming statistics highlighting its prevalence and impact. The Thai Lung Cancer Working Group, under the Thai Oncology Society, has revealed critical insights into the disease’s burden and the emerging treatment options.
Lung Cancer Statistics: A Stark Reality
Lung cancer ranks among the most prevalent types of cancer in Thailand, posing a serious threat to public health. Key statistics paint a grim picture:
- Second most common cancer in men: Lung cancer is the second most common cancer affecting men in Thailand.
- Fifth most common cancer in women: In women, it ranks as the fifth most prevalent cancer.
- New cases: Annually, approximately 23,494 new lung cancer cases are diagnosed, averaging 64 new cases each day. Of these, 15,200 affect men and 8,294 affect women.
- Deaths: Sadly, approximately 19,864 individuals succumb to lung cancer each year, or regarding 54 deaths per day.
- High mortality rate: The mortality rate from lung cancer is the second highest among all cancer types, with more than 80% of patients failing to survive beyond 5 years.
Understanding the Risk Factors
Risk factors for lung cancer can be categorized into two key groups:
Avoidable Risk Factors
- Smoking: This is the primary risk factor for lung cancer, contributing to 85% of cases.
- E-cigarettes: E-cigarettes mimic cigarettes in their harmful effects, triggering inflammation in the lungs and elevating long-term cancer risk.
- Air pollution: Specifically, PM 2.5 dust, a prevalent environmental concern, is under investigation for its link to cancer development. Exposure to high levels of PM 2.5 is associated with an increased risk of lung cancer.
- Occupational exposure: Certain work environments pose significant risks, including exposure to substances like burning charcoal, radon gas, asbestos, chromium, and radiation.
Unavoidable Risk Factors
- Age: As individuals age, the potential for cellular changes and deterioration increases, raising the risk of developing cancer.
- Genetics: Lung cancer is generally not directly inherited. However, family members of lung cancer patients may share similar environmental exposure patterns, leading to increased risks. This “mild genetics” concept highlights the importance of shared environmental influences.
Recognizing the Symptoms
Symptoms of lung cancer often manifest as respiratory issues. Patients may experience:
- Coughing
- Fatigue
- Shortness of breath
- Chest pain
If the cancer spreads to other organs, like the brain, bones, or liver, patients may develop various symptoms specific to those affected areas.
Diagnosis: Ensuring Accuracy
Accurate diagnosis is crucial in guiding treatment plans. Diagnosis for lung cancer involves a combination of methods:
- Tissue biopsy: This is considered the gold standard, where a tissue sample is examined to confirm the presence of cancer cells.
- Imaging: Chest X-rays and CT scans provide detailed visual information regarding the lungs, aiding in cancer detection.
- PET scans: This imaging technique helps assess the extent of cancer spread throughout the body.
Treatment Options: Advancements in Lung Cancer Care
Lung cancer treatment has evolved significantly in recent years, offering greater precision and personalized approaches.
- Surgery: This remains a key treatment option for early-stage lung cancer.
- Radiation therapy: This involves using high-energy rays to target and destroy cancer cells.
- Chemotherapy: Traditional chemotherapy uses drugs to kill cancer cells. This approach has been refined to reduce side effects and improve effectiveness.
- Targeted therapy: These medications focus on specific proteins or genes involved in cancer cell growth, offering targeted action and minimizing harm to normal cells.
- Immunotherapy: This innovative approach stimulates the body’s immune system to identify and eliminate cancer cells. Immunotherapy is often used alone or in combination with chemotherapy.
Types of Lung Cancer: Understanding the Variations
Lung cancer is broadly classified into two main types:
- Small cell lung cancer: This type of lung cancer tends to grow and spread more aggressively.
- Non-small cell lung cancer: This type accounts for the majority of lung cancers and exhibits a wider range of growth patterns and rates.
Immunotherapy: Targeting the Body’s Defense System
Immunotherapy offers a promising approach to treating lung cancer by harnessing the body’s natural defenses. The immune system normally identifies and destroys foreign substances like bacteria, viruses, and cancer cells. However, cancer cells have mechanisms to evade the immune system, particularly through PD1 and PDL1 proteins. These proteins interact to suppress the immune response, allowing the cancer to thrive.
Immunotherapy drugs disrupt this interaction by binding to either PD1 or PDL1, preventing them from attaching to each other. This reactivation of the immune system allows it to effectively attack and destroy cancer cells. There are two main ways immunotherapy is used:
- Single-drug therapy: Immunotherapy is administered as the sole treatment modality.
- Combination therapy: Immunotherapy is combined with other drugs, such as chemotherapy.
Subcutaneous Injection: A New Frontier in Immunotherapy Delivery
Historically, immunotherapy drugs were primarily delivered intravenously, meaning they were infused into the bloodstream through a vein. Recently, the focus has shifted toward subcutaneous injections, which involve injecting the medication directly under the skin. The Thai FDA has approved the use of subcutaneous immunotherapy, offering patients a new and convenient delivery option.
Subcutaneous injections can be administered with Halozyme Therapeutics drug delivery technology, known as Enhance. This technology uses an enzyme called “hyaluronic acid” to temporarily create a larger space under the skin, allowing for larger volumes of medication to be injected. This reduces the risk of swelling and pain associated with large injections.
Comparative Benefits of Subcutaneous Immunotherapy:
Clinical studies have shown that subcutaneous immunotherapy offers several advantages compared to intravenous administration:
Similar Efficacy and Safety:
- Comparable blood drug levels: The amount of medication delivered subcutaneously matches the levels achieved with intravenous infusion.
- Equivalent efficacy: Subcutaneous delivery shows similar effectiveness in controlling cancer growth and progression.
- No significant difference in side effects: Subcutaneous immunotherapy has comparable side effect profiles to intravenous immunotherapy.
Enhanced Convenience and Convenience:
- Reduced infusion time: Traditional intravenous infusions typically take 1 hour, as they require mixing the medication with saline and administering it slowly. Subcutaneous injections can be completed in 4 to 8 minutes, decreasing the overall treatment time to just 7 minutes on average.
- Increased patient comfort: Patients find subcutaneous injections less invasive and more convenient than intravenous infusions, allowing for greater flexibility in their daily lives.
- Reduced staff workload: The quick administration time and simpler process for subcutaneous injections free up staff time for other tasks, enhancing clinic efficiency.
Navigating the Costs of Immunotherapy:
While immunotherapy offers groundbreaking advancements, accessibility remains a challenge, particularly in terms of cost. In Thailand, immunotherapy treatments are primarily available to patients who can finance them privately or meet specific criteria for coverage by government health insurance programs.
As the technology matures and production costs decrease, the hope is that immunotherapy will become more affordable and accessible to a wider population in the future.
Final Thoughts:
Lung cancer presents a formidable challenge to public health in Thailand, demanding a comprehensive approach addressing prevention, early detection, and effective treatment. Continuous advancements in cancer research, including the development of cutting-edge therapies like immunotherapy, are offering new hope for patients. The emergence of subcutaneous immunotherapy further enhances convenience and accessibility, making critical therapies more readily available to those in need. As more research emerges, we can expect even more tailored treatments and strategies to improve outcomes for lung cancer patients in Thailand and beyond.
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