LUNG CANCER – what does the future hold, with more research leading to unfolding the enigma of the cause

Lung cancer is no more an exclusive smoker's disease, though we see it predominantly in smokers. Till date it is a male dominant disease, but future might have equal incidence owing to rapid change in lifestyle and environmental factors. Though we don't have a structured reporting mechanism in India , the statistics are scary. Every year 1.8 million people fall prey to it, and 1.6 million die due to it. In India, the number of new cases increased from around 65,000 in 2009 to 90,000 in 2013, registering 15-20% increase annually. The biggest concern is that the dreaded disease often goes undetected due to

1.      Lack of awareness among afflicted patients.

2.      Symptoms are quite non specific like persistent cold, cough, accompanied by sputum or blood, and signs of breathlessness

3.      Once symptomatic, the disease is often advanced and non curable

4.      Most of the patient often attributes these symptoms to changing weather, prompting home remedies or over-the-counter antibiotics.

5.      Even at the medical professional level, the common disease like TB tops the differential diagnosis, leading to delay in treatment initiation

Timely corrective action and suitable treatment facilities may help tame the ill effect of this disaster waiting to happen. The silver lining is “Significant advancements were made in the understanding of the disease and the mystery/ enigma of its root cause is getting slowly unfolded, paving path for new treatments and longer& better lives.”

The highlights of medical advancements making the life better are

1.      More precise diagnosis with advanced imaging like PET, where invasive surgical tests like mediastenoscopy can be avoided

2.      Better decision making with help of genetic profiling – “more of customized therapy- not one size fits all”

3.      Even without tissue biopsy, we can get this profiling with liquid biopsies in most of the cases (we just draw few ml of blood and can tell fairly accurately the disease charecters- no more cutting the lung or piercing the chest wall)

4.      More options of treatment – classical first and second line chemotherapy is extendable to 6 or more lines making the patient live longer and better

5.      Earlier, chemotherapy was given to patients every three weeks, but now we will only give it once a week. It's more effective, less toxic and has fewer side-effects.

6.      If biologically disease is good (cancer is caused by few gene aberrations and mutations, which are druggable) we can avoid non palatable chemo and simply take a pill and achieve better results. Patients with stage 4 EGFR /ALK positive are living for more than 48 months

7.      Immunotherapy, where your own body cells fight with cancer and eliminate them. (Though it's expensive at the moment, we expect some companies will be coming out with the cost effective product within couple of years.)

8.      More players making the cost of drugs like gefitinb come down and more persons are affording the same

9.      There are now drugs to combat the side-effects of chemotherapy, like vomiting

Overall in nut shell, though we could avoid majority of cases by avoiding or quitting the smoking, better awareness and early intervention go long way in making peoples life better.