Advances in the treatment of lung cancer

  Primary lung cancer (hereinafter referred to as lung cancer) is one of the most common malignant tumors worldwide and in China. With the increase of smoking and environmental pollution, the incidence of lung cancer has increased significantly, and it is a malignant tumor that people are afraid to talk about. However, compared to 20 years ago, we have accumulated more experience in diagnosis and treatment and have more weapons to treat lung cancer through our efforts. As a result, lung cancer patients today have longer survival and higher quality of life than before.  For the treatment of lung cancer, we advocate comprehensive treatment and individualized treatment mode is the higher level we pursue. In other words, according to the patient’s general condition, pathological type, gene expression type and mutation status, stage, tumor location and development trend, we adopt a combination of surgery, radiotherapy, chemotherapy, targeted therapy and Chinese medicine treatment, and also formulate a treatment plan suitable for each patient according to the patient’s specific economic condition. Our goal is to maximize the quality of life and prolong the survival time of patients.  First of all, for patients with suspected lung cancer, doctors should make accurate pathological diagnosis and staging examination for patients. Different pathological types and stages mean very different treatment modes. For this reason, the doctor has to do sputum examination, heart, lung, liver and kidney functions, bronchoscopy or ultrasonic bronchial endoscopy, bone scan and brain MRI or PET-CT after the patient is admitted to the hospital to finally clarify the pathological type and stage.  Lung cancer is roughly divided into small cell lung cancer and non-small cell lung cancer according to pathological types, and the proportion of the former is about 15%. Except for stage I patients for whom surgery is recommended, patients with II-III are treated with chemotherapy and radiotherapy-based comprehensive treatment, while stage IV patients are treated with chemotherapy-based treatment.  The treatment for non-small cell lung cancer is more complicated. For patients who are early or partially intermediate stage (IA-IIIA), because of the localized lesion,, the preferred treatment is surgery, of course, only if the patient’s lung function allows it. In addition to stage IA and some IB patients who do not require conventional postoperative adjuvant chemotherapy, another part of both IB and stage II-IIIA patients need to receive adjuvant chemotherapy, and some of the stage IIIA patients also need to receive adjuvant radiotherapy. That is, local therapies are combined with systemic therapy. If patients are inoperable, they may receive radical radiotherapy or gamma knife.  The main systemic treatments are targeted therapy, chemotherapy and Chinese medicine treatment. Since there is a high percentage of epidermal growth factor receptor (EGFR) gene mutation rate in Eastern ethnic groups, especially in adenocarcinoma, non-smoking female patients, the mutation rate is up to 60% or more, and of course squamous cancer patients also have less than 10% mutation rate, patients with EGFR gene mutation are recommended to use targeted therapy with EFGR tyrosine kinase inhibitors (EFGR-TKI, such as Troche or Erythroid) . If the patient does not have EGFR gene mutation, combination platinum chemotherapy is used. This should be selected according to the pathological type, if it is squamous cancer, gemcitabine combined with platinum chemotherapy; if it is non-squamous cancer, pemetrexed combined with platinum chemotherapy is recommended first, and vincristine, paclitaxel, polyene paclitaxel and gemcitabine combined with platinum chemotherapy are all options. Chemotherapy cycles are around 4, and if the efficacy is fair (i.e., no progression), maintenance therapy with either the original drug or a drug change can be used.  Of course, the specific choice of individualized treatment regimen for each patient needs to be guided by oncologists with extensive experience in lung cancer treatment.  In addition, new drugs such as anvitin (an anti-tumor angiogenesis drug) and targeted drugs targeting the EML4-ALK fusion gene, as well as irreversible tyrosine kinase inhibitor of EGFR (BIBW2992) and many other drugs are being clinically started in our hospital, so we also hope that more suitable patients can participate in such clinical studies.  It is the dream of every oncology clinician to overcome lung cancer. We believe that in the near future, through our efforts, it is expected that lung cancer patients can survive with tumor for a long time.