●Molecular diagnosis has increased the control rate of advanced lung cancer to more than 90%, and the sensitive people of molecular targeted therapy only need to take a pill at home every day and follow the doctor’s instructions for regular checkups ●Targeted therapies are effective but expensive, and those who are eligible can apply for medical insurance (with a monthly reimbursement of up to 15,000 yuan) and charity drug grants ●There are currently five designated hospitals in Guangzhou that can apply for medical insurance ●Patients need to be rechecked every two months during the period of taking the medication, and also regularly undergo chest CT. During this period, patients need to be re-examined every two months, as well as undergoing regular chest CT, blood tumor markers, etc. 7 years ago, 48-year-old Ms. Han was diagnosed with advanced lung cancer, and at that time, the doctor told her that she could only live for a few months, while she was at the peak of her career, she suffered a blow, and was devastated; today, 7 years later, 55-year-old Ms. Han is still a patient with advanced lung cancer, however, she has survived for 7 years, and her career has been doing well. and works and lives normally every day. Cancer is as well managed for her as diabetes and hypertension. “In my clinical practice, Ms. Han’s case is not a rare one. With the deepening of the research on individualized comprehensive treatment of lung cancer, there are more and more such miracles, and they should not even be called miracles anymore. In the future, it is entirely possible for lung cancer to be ‘chronicized’, and patients taking medication at home under the guidance of doctors will be able to get long-term control of their condition and have normal work and life.” Dr. You Changxuan, deputy director of the Department of Oncology of Nanfang Hospital of Southern Medical University, depicted a very bright prospect for lung cancer patients – as long as the treatment is proper, patients with advanced lung cancer can survive with tumor for a long period of time, and can work and live normally. Typical Case: Advanced Lung Cancer Patient Survived with Tumor for More Than 7 Years In October 2004, Ms. Han from Sichuan was diagnosed with advanced lung cancer because of coughing and found out that there was a 4cm tumor in her left lung, which had metastasized to mediastinal lymph nodes and supraclavicular lymph nodes, and she was treated with chemotherapy and radiotherapy locally, but her condition still progressed rapidly, and she was told by doctors that she could only live for a few months. At that time, 48-year-old Ms. Han’s career was at its peak and her life was in full swing, but the blow was too much for her and her family to bear. In March 2005, Ms. Han came to Nanfang Hospital, and You Changxuan gave her a supraclavicular lymph node biopsy, which led to a clear pathological diagnosis of “poorly differentiated cancer”. Considering the advanced stage of the disease, Ms. Han should not be operated, and Ms. Han is not sensitive to chemotherapy and radiotherapy, You Changxuan decided to give Ms. Han molecular targeted therapy. Now, Ms. Han has been living with the tumor for more than 7 years, her condition has been well controlled, and her work and life are completely normal. In the past: there is a “trial and error mode”, only 30% of those who are effective According to You Changxuan, lung cancer is a malignant disease with a very high mortality rate, and is the world’s number one cancer killer. China’s annual deaths due to lung cancer more than 600,000 people, of which non-small cell lung cancer accounts for about 80%. At the same time, due to 80% of lung cancer patients are already in advanced stage when they are diagnosed, losing the opportunity of surgical treatment, even if the patients can be operated, they are also prone to recurrence and metastasis, coupled with the less obvious efficacy of radiotherapy and chemotherapy, so the survival period of the patients is not ideal, and the median survival period of late-stage lung cancer is generally only 8~10 months, and a lot of patients, once they are diagnosed, have entered into the life of the ” countdown”. “In the first-line chemotherapy for advanced non-small cell lung cancer, even with the standard platinum-containing two-drug regimen, the actual effective rate is only about 30%, meaning that nearly 70% of the patients’ treatment is not effective.” You Changxuan said, in the treatment of lung cancer, in the past, there has been a “trial and error mode”, that is, in the case of unclear genotyping of tumors, chemotherapy is given to advanced lung cancer in a uniform way, and after using a drug is ineffective, only another drug can be tried until a drug that can have an inhibitory effect on the cancer cells is tried out. This model not only has poor efficacy and high adverse reactions, but also causes excessive waste of medical resources. Now: Genotyping followed by treatment 90% of patients with controllable disease “Now this situation has been well changed, for advanced lung cancer, we are no longer at our wits’ end.” You Changxuan pointed out that in recent years, the emergence of molecular targeted drugs is a revolutionary progress in the treatment of advanced lung cancer, and several large-scale clinical studies have confirmed that for patients with advanced lung cancer carrying sensitive mutations in the EGFR gene, choosing targeted therapy, the rate of disease control is as high as 90%, and there are few adverse reactions. Compared with traditional chemotherapy, the progression-free survival time of targeted therapy is significantly longer, and the quality of life of patients is significantly improved. “Although targeted drugs can’t cure lung cancer, they can control the disease well, and some patients can even survive with tumor for a long time.” You Changxuan said. “The key to targeted therapy is to choose the right people, and to choose the right targeted drugs according to the different targets of lung cancer patients.” You Changxuan introduced that at present, there are different therapeutic targets for advanced lung cancer, and there are different targeted drugs for different therapeutic targets. At present, there are two types of targeted drugs that have been approved and marketed: one type of targeted drugs for EGFR gene mutation, the other for EML4-ALK fusion, and the drugs for other targets are also under research. “For advanced lung cancer patients in China, the sensitive population of the two types of targeted drugs is close to 50%, and these sensitive patients only need to take a pill at home every day and follow the doctor’s instructions for regular review, and they can work and live normally. At present, selecting the right targeted drugs, 9 out of 10 sensitive patients can be well controlled.” You Changxuan especially mentioned: “Among my patients, there are many advanced lung cancer patients who survive with tumor for a long time, and many of them have already survived more than 3 years, and more than 5 or 6 years, and the quality of life is very high, and advanced lung cancer is gradually turning into a ‘chronic disease’. ” Charitable grants and medical insurance can solve the cost Although the effect of targeted therapy is good, but the price is expensive, 500 yuan or even more than 600 yuan a capsule price is by no means ordinary Chinese people can afford in the long term. Secondly, not all lung cancer patients take it are effective. As a result, many patients are forced to choose to give up treatment. “But now there are already two ways to help patients solve this problem. The vast majority of patients who receive targeted therapy in my place end up getting free drug supply, which ensures the efficacy of the treatment while avoiding the heavy financial burden.” You Changxuan introduced that advanced lung cancer patients who cannot undergo surgery, cannot tolerate chemotherapy or are not sensitive to chemotherapeutic drugs, if they meet the guarantee standard of the medical insurance center – that is, the patients are Guangzhou medical insurance participants, diagnosed with advanced non-small cell lung cancer, and at the same time, the EGFR gene test result is positive, then they can apply to the Guangzhou medical insurance The designated hospitals for “Outpatient Specific Program of Molecular Targeted Therapy for Non-Small Cell Lung Cancer” can apply for medical insurance, and eligible patients can get a maximum reimbursement of RMB 15,000 per month. At present, the designated hospitals include: Nanfang Hospital of Southern Medical University, Guangdong Provincial People’s Hospital, Affiliated Cancer Hospital of Sun Yat-sen University, Affiliated Cancer Hospital of Guangzhou Medical College, Affiliated First Hospital of Guangzhou Medical College, and the Affiliated First Hospital of Guangzhou Medical College. Currently, the designated hospitals include: Nanfang Hospital of Southern Medical University, Guangdong Provincial People’s Hospital, Affiliated Cancer Hospital of Sun Yat-sen University, Affiliated Cancer Hospital of Guangzhou Medical College, and Affiliated First Hospital of Guangzhou Medical College. The second way is charity drug donation, which is a patient assistance program under the auspices of China Charity Federation. If an advanced lung cancer patient taking a targeted drug is effective and has not experienced disease progression after six months of continuous medication, the patient can apply for a charitable drug grant from the China Charity Federation through the hospital’s experts in charge of the drug grant program. Future: Immunotherapy may be able to cure advanced lung cancer You Changxuan introduced, 2011 Nobel Prize in Medicine winner Ralph? One of the clinical applications of Ralph Steinman’s and others’ research, which is a key principle of immune system activation, is a therapeutic vaccine. Therapeutic vaccines are used to cure diseases by inducing a specific immune response that removes pathogens or diseased cells in organisms already infected with pathogenic microorganisms or suffering from certain diseases. Dendritic cell vaccine (DC vaccine for short) is a therapeutic vaccine, and in September 2010, the U.S. Food and Drug Administration (FDA) approved the first DC vaccine for the treatment of metastatic prostate cancer, You Changxuan explained. “The fact that it was approved by the demanding FDA for clinical use in advanced tumors shows that DC vaccines are really promising.” The tumor DC vaccine research conducted at the Department of Oncology of Nanfang Hospital has also received funding from the National Natural Science Foundation of China and the Natural Science Foundation of Guangdong Province. The results of the previous study confirmed that the immune cells induced by the lung cancer DC vaccine can specifically kill lung cancer cells. “And in clinical treatment, we have also found that for patients with advanced lung cancer, targeted therapy and cellular immunotherapy have synergistic effects, and patients with good immune status have a longer remission period with targeted therapy. Therefore, on the basis of targeted therapy, combined therapeutic vaccine and immune-targeted therapy (anti-PD-1, PD-L1, CTLA4) will be a good treatment model, and once successful, patients will be able to completely rely on their own immunity to cure the disease.” You Changxuan is optimistic that this prospect will likely be realized in our lifetimes. SPECIAL REMINDER: REVIEW EVERY TWO MONTHS WHILE TAKING THE DRUGS You Changxuan emphasizes the need for patients to have close follow-up and review while taking the targeted drugs. “Follow-up is once a month, and review is usually every two months, the purpose is to assess the efficacy of the drug and toxic side effects.” You Changxuan said that timely detection of changes in the condition is critical to treatment. There is an advanced lung cancer patient, after treatment, tumor-free survival has reached 3 years, thought it was fine, the home began to renovate, a busy and tired, coupled with frequent exposure to harmful gases, appeared weakness, lethargy, coughing and other symptoms, after examination, the lung cancer recurred. Therefore, even if lung cancer patients get satisfactory curative effect, they should still stay away from cancer-causing factors, such as quitting smoking, avoiding exertion, avoiding exposure to harmful substances and so on. Even if the tumor recurs or progresses, most of them can still be effectively controlled if they can be detected and treated early. “Patients should undergo regular examinations such as chest CT and blood tumor markers according to specific conditions, especially when symptoms such as unexplained weakness, emaciation and worsening of cough occur, they should go to the hospital for follow-up in time.” You Changxuan said.