When it comes to lung cancer, there is a disparity in gains that research is bringing to us. In some of the diseases we are desperately searching for alternative therapies but so far, we are far from finding new solutions. In lung cancer, immunotherapy offers us hope. Our aim is not only to control the disease process but also offer potential cure to such patients or make it a chronic disease.
Lung cancer continues to be an aggressive disease worldwide and is one of the leading causes of deaths all around the world. The advent of immunotherapy brings us new hope.
One begins to wonder how does it work to bring such amazing results and how can we utilize it to its maximum potential. Immunotherapy uses body’s own immune system. It activates the immune system by activating immune cells that have been put to sleep by cancer cells. There are different ways of doing it. But most common is by immune check point inhibitors (for example Nivolumab, Pembrolizumab and Atezolizumab). These drugs have revolutionized the treatment of lung cancer and now first time in my career I have seen such patients surviving beyond 3 years.
Since chemotherapy can offer only a limited amount of help in fighting lung cancer, a growing emphasis on prevention, as well as on the development of immunotherapy will be extremely important here in India over the next couple of years. We will continue our research in this field.
A 60 year old male patient, ex serviceman presented to us in 2016 .He was diagnosed in 2015 and his cancer was progressing after 2 lines of chemotherapy. Examination revealed fluid around his heart along with an extremely poor lung function. He was referred to cardiologist who removed the fluid from around his heart. Coincidentally in the same year immunotherapy also got approved in India for lung cancer treatment. He was started on Nivolumab and after receiving 4 cycles of nivolumab he started responding to the drug. Can you guess the response? You guessed it right. It’s been 3 years since he was started on nivolumab and the response has been extremely good so far. On comparison to a 6-12 month survival with chemotherapy in a patient with an aggressive biology lung cancer, this seems to be magic and almost impossible. Although every patient may not respond the same way, this definitely gives us a strong reason to have more aggressive research on immunotherapy.
This response was not just seen with one patient. With the passage of time, we have come across many such long term survivors, plenty enough to dig deeper in the understanding of immunotherapy.
Most lung cancer patients become symptomatic and are diagnosed, only when the disease has advanced to a late stage (at stage IIIb/IV or higher). This is another major issue usually faced with lung cancer patients. At such a stage we are left with minimal options. With surgery, chemotherapy and radiation being minimally effective in advanced lung cancer patients, we are stuck in a difficult spot. Therefore, new and more effective, long-lasting treatments are needed for patients facing such a challenge. Hence it makes lung cancer one of the major cancer types for which, new immune-based cancer treatments are making an impact on the survival of such patients.
Here is a small drawing I made to make it easier for you to understand.
For better understanding or if you want to know more contact Dr Waseem Abbas. I, being a keen researcher would welcome thoughts and doubts.