Lung cancer

Hello, my name is Jacques Cadranel. I am the medical director of the pneumology unit at Tenon Hospital and of the advanced center of thoracic oncology of the East-Paris Hospital Group.  I am also a member of the Scientific Board of APREC.

Today I will talk to you about lung cancer.  There are about 39,000 new cases in France every year.

An extensive study by Euroscope – Cancer has been published, stating that between 2000 and 2007 only 13% of patients diagnosed with lung cancer in Europe could be cured.  And so there is obviously a need to improve the way this cancer is taken in charge.

The approach to this is, of course, first a battle against tobacco use, since smoking is responsible for 80% of lung cancer cases.  This battle is conducted on two fronts:

First, the political front: increasing the cost of tobacco, restricting the use of tobacco in public places, but also treating nicotine withdrawal with the use of nicotine substitutes such as the e-cigarette, for example.

The second front is that of early detection: we need to be able to detect lung cancer earlier, since deaths can be attributed to the fact that in 80% of cases, by the time a patient is first diagnosed, the cancer has already reached an advanced stage with spread-out of metastasis.

One approach is detection using a low-dose CT scanner.  This has proven effective in the U.S., as shown in an extensive study, reducing cancer deaths by 20% when the cancer was detected early.

In France today we are unable to offer this form of cancer detection, but there is a lot of momentum in our attempts to put into place very early lung cancer detection methods in France. Most patients, then, will be treated essentially with surgery, radiotherapy, chemotherapy, and other new therapies.

Surgery and radiotherapy are prescribed for small cancers, and improvements have been essentially technological with semi-invasive surgeries using thoracoscopy, and radio-surgery that can be extremely focalized.  Chemotherapy remains the primary means of treatment of lung cancers.  It has been improved by the use of new molecules, better combinations of drugs, and above all, by the ability to prolong treatments by reducing their toxicity and intensity, which allows increasing treatment duration beyond what had been possible in the past.

The great therapeutic revolution, of course, has involved what we call targeted therapies.  These targeted therapies have two objectives. The first objective is to attack the environment of the cancer and in particular the vascularization of the cancer by administering drugs that will decrease vascularization; and to achieve anti-cancer immunity by encouraging it, either through vaccination, or by increasing the anti-cancer immune capabilities of the patient.  The second objective of these targeted therapies is in fact to kill the cancer cells that are dependent on certain biological anomalies that we can determine and study when the patient is diagnosed.

Today, we are capable of dealing with seven biological anomalies.  If a person presents one of these, it will lead to the prescription of targeted therapies.  The advantage of targeted therapies is that they are most often administered orally, they are often less toxic than chemotherapy, and they are more powerful when the patient presents an anomaly since the anti-cancer response will be more than 50%, even 80%. They can be effective for longer periods, a year or more, and of course the side effects will be less  than those induced by chemotherapy.  But even if patients have a biological anomaly and are to receive targeted therapies, they will also require conventional chemotherapy within the framework of the treatment of their illness over the long term.

You can see that there have been many advances in the handling of diagnosis, in prevention, in early detection, and also in the treatment of lung cancer, but there is still a great deal of progress to be made in this area.