What will be the big challenges and changes for lung cancer treatment and research in 2018? we spoke to expert Professor Kwun Fong, Senior Staff Specialist/Clinical Manager Pulmonary Malignancy Unit, at The Prince Charles Hospital, Brisbane, to find out.
Combos and sequencing systemic therapies.
With the advent of immunotherapies effective for subsets of lung cancer, an upcoming challenge for 2018 will be selecting the optimal combination(s) and sequencing with conventional therapies.
Challenges may include chemo with immunotherapies, dealing with toxicity and how to afford increasingly costly treatments. Nonetheless, the future is bright for rational use of these strategies.
However, this has to be balanced by managing patient expectations because immunotherapies are still only effective in a proportion of patients and affordability/access.
Liquid biopsies for lung cancer treatment response
Liquid biopsies are emerging as a potential surrogate for tumour cell sampling predominantly for the purpose of detecting gene mutations that predict treatment response to targeted therapies.
This may have particular relevance in lung cancer where biopsy is often a challenge as our patients unfortunately have other comorbidities such as chronic lung disease coupled with the location of most lung cancers deep in the body.
Repeated testing also opens the door to monitoring for response and relapse. This was not practical previously. The challenge will be how to incorporate it into practice to ensure cost-effective use rather than an additional test adding little clinical utility.
Lung cancer screening by CT
2018 should see the results of the European NELSON trial, the only other RCT apart from the pivotal NLST trial powered to be able to demonstrate a mortality benefit. While the NLST was positive, implementation of CT screening is really only established in the US given concerns of cost, high false positives, and generalisability from a single high quality US trial. NELSON results are anticipated to be a game changer in public health policy.