Today lung cancer offers substantially better survival expectations than it did only a few years ago.
This said, we believe that the multidisciplinary approach, with the different services involved, is the guarantee of being able to offer the best treatment at all times.
Lung cancer is essentially divided into two sub-groups: Small Cell Lung Cancer (SCLC, 15%), and Non-Small Cell Lung Cancer (NSCLC, 85%). SCLC is characterised by its aggressiveness and excellent response to chemotherapy and radiotherapy. However, the responses are not lasting. NSCLC can be subdivided into two sub-groups: Squamous Cell Carcinoma (SCC) and Non-Squamous Cell Carcinoma (NSCC). Both sub-groups must be tested for mutations (EGFR), rearrangements (ALK and ROS1) and, finally, PD-L1 expression levels. The treatment and prognosis will differ substantially depending on the result of the mutations.
Treatments for this kind of cancer
Small tumours and without major mediastinal affectation must be assessed in order to carry out the curative treatment par excellence: surgery. The operation may involve a lobectomy (removal of a lung lobe), or a pneumonectomy (removal of the whole lung); but it must always be accompanied by a significant study of the mediastinal nodes.
Treatment with ionising radiation beams is a fundamental weapon in fighting lung tumours. It can have a curative intention for incipient tumours which cannot be operated on due to contraindication of the Anaesthesia Service and involves special techniques such as SBRT. It can also be used simultaneously or concomitantly with chemotherapy on tumours with affectation of the mediastinal nodes. And finally, it can be used to palliate the symptoms.
Chemotherapy is a fundamental weapon in lung cancer treatment and will have to be used in more than two-thirds of all patients. It can be administered complementarily after surgery, simultaneously or concomitantly with radiotherapy and for palliative care with a view to improving the symptoms and increasing survival.
These are medications which are administered orally and act on highly complex internal cell mechanisms. They are highly active and have few side effects in comparison to chemotherapy; however, they are only active in tumours with highly selective mutations (EGFR, ALK, ROS1).
Tumour cells have the ability to induce lethargy in immunocompetent cells (T lymphocytes) by secreting specific molecules such as PD-L1. Today drugs exist which have the capacity to revert this effect by means of monoclonal antibodies that block said action. These have shown themselves to be more effective than chemotherapy when the PD-L1 levels in tumour cells are high (>50%), meaning that an indication already exists for the first-line use of this type of drug, and that probably, in the very near future, they will also be administered to those that have levels lower than 50% together with chemotherapy.