Clinical trials for new lung cancer treatment
Access innovative therapies compatible with your diagnosis
Today there are 235 clinical trials for lung cancer in Spain:
How is lung cancer treated?
Lung cancer is widely researched because it is the leading cause of cancer-related deaths worldwide, which has led to several therapeutic options widely used in clinical practice. The treatment applied will depend on the type and stage of the tumour, as well as the patient’s general health and lung function. Two main types of tumours are distinguished: non-small cell carcinoma, which accounts for approximately 85% of cases, and small cell or microcytic carcinoma, which accounts for the remaining 15%.
Treatment of small cell lung cancer
Small cell lung cancer is usually classified as limited stage or extensive stage. Chemotherapy is the main treatment, with further treatment depending on the stage of the disease.
- Limited stage (no distant metastases): the cancer is localised in the lung where it started to form, occasionally spreading to the area between the lungs or to the lymph nodes above the collarbone, so radiotherapy may be a treatment option. Surgery to remove the tumour and lymph nodes is rare and is performed only in very favourable cases, usually followed by chemotherapy. Conventional treatment involves chemotherapy combined with chest radiation given at the same time (concurrent chemoradiation).
- Extensive (metastatic) stage: the cancer has spread beyond the area between the lungs to other parts of the body such as the bones, brain or bone marrow. The treatment plan may include surgery, chemotherapy, and radiotherapy. Chemotherapy, possibly combined with immunotherapy, is usually the first treatment. If the cancer responds favourably to the initial treatment, chest radiation may be given. If cancer growth in the lungs causes symptoms such as shortness of breath or bleeding, radiation therapy or other types of treatment, such as laser surgery, may be helpful in some cases.
In about half of people with small cell lung cancer, the cancer will eventually spread to the brain if preventive measures are not taken. For this reason, radiation therapy to the head (prophylactic cranial irradiation or PCI) may be given to try to prevent this spread.
Non-small cell lung cancer treatment
Treatment options for non-small-cell lung cancer are based primarily on the cancer stage (extent), although other factors, such as the person’s general health and lung function, as well as certain characteristics of the cancer itself, are also important.
- Occult stage: these are small carcinomas, not visible on radiographs and superficial endoscopically, with a surface area of less than 2 cm and well demarcated. They are usually early stage and do not invade beyond the bronchial cartilage. Bronchoscopy and other studies are performed periodically to detect the presence of tumours. Treatment will depend on the stage of the tumour.
Stage 0 (carcinoma in situ): the cancer is localized and is usually treated with surgery. Treatment options include:
Surgery (wedge resection or segmental resection).
There are alternatives to surgery for tumors located in or near a bronchus such as photodynamic therapy, electrocautery, cryosurgery or laser surgery.
Stage I: The tumour is less than 3 cm and has not spread to lymph nodes or other organs. Treatment options for this stage include:
Surgery: is the main treatment and may be by lobectomy, segmentectomy or wedge resection, depending on the size and condition of the patient.
Adjuvant chemotherapy: given after surgery to reduce the risk of recurrence in patients at higher risk.
Second surgery or radiotherapy: if positive margins are found in the removed tissue or to ensure complete removal of the cancer.
Immunotherapy and chemotherapy before surgery: for stage I cancers with a 4 cm width. Additional therapy may be required after surgery depending on the findings during the operation.
Stereotactic body radiation therapy (SBRT) or radiofrequency ablation: are options for patients not suitable for surgery.
Stage II: the tumor has reached the lymph nodes close to the tumor (in the root of the lung itself). After surgery, treatment will be given, which may consist of immunotherapy or a combination of chemotherapy with radiotherapy.
Surgery: lobectomy, sleeve resection or pneumonectomy is performed to remove the cancer and affected lymph nodes.
Adjuvant chemotherapy: given after surgery to kill any remaining cancer cells. Immunotherapy may also be an option.
Immunotherapy and chemotherapy before surgery: for tumours larger than four centimetres.
Targeted therapy: is a treatment that targets proteins that regulate the growth and spread of cancer cells. As researchers better understand the changes in DNA and proteins that trigger cancer, the ability to design targeted treatments for these proteins is improving. These therapies may be an option for treating early-stage cancer, such as EGFR inhibitors that work on tumours with mutations in the EGFR gene.
Radiotherapy: if the patient is not suitable for surgery, radiotherapy may be used as the main treatment.
- Stage III: The tumour has spread to lymph nodes distant from the tumour or has invaded nearby non-pulmonary tissues, such as vessels between the lungs, heart or oesophagus. Treatment may include a combination of radiotherapy, chemotherapy and/or surgery. Other therapeutic options may include immunotherapy or targeted therapies.
- Stage IV: The disease has spread to other parts of the body, metastasising to organs such as the brain, bone, adrenal glands, opposite lung and liver. Treatment options are similar to stage III, but may include photodynamic or laser therapy to relieve symptoms.
For cancers that have spread widely throughout the body, the tumor is tested before any treatment is started to identify certain genetic mutations (such as in the EGFR, ALK, ROS1, BRAF, RET, MET or NTRK genes). If any mutations are found in the cancer cells, the first line of treatment is likely to be a targeted therapy drug.
In most other cancers that have spread, chemotherapy is usually part of the main treatment, as long as the person is healthy enough to receive it. This chemotherapy may be combined with immunotherapy or targeted therapy.
Leaders in clinical research, such as Dr Javier Cortés, believe that clinical trials may be the best therapeutic option available in many cases. Research continues to advance, developing new treatments with the aim of providing more precise and personalised care for each patient. Although many of these treatments are not yet approved for standard lung cancer treatment, clinical trials provide the opportunity to access and benefit from these innovative therapies.
The clinical trial: the chance for a new lung cancer treatment and its metastases
Clinical trials play a crucial role in lung cancer research, as they contribute to increasing our understanding of lung cancer. Identifying new tumour types would allow the development of more precise drugs and provide the most appropriate current treatment for each patient. As these cancers are difficult to treat, participating in clinical trials with novel chemotherapy drugs and combinations, as well as other recent treatments, could be a beneficial option for some people. Many of these therapies are not yet approved as a standard of care, so clinical trials represent an opportunity to access a new lung cancer treatment.
Patients participating in clinical trials, at any stage of treatment, may benefit from having access to new therapies or receiving closer follow-up by medical staff.
New lung cancer treatment under investigation
Clinical research is constantly seeking to improve treatments for lung cancer, in all its types and stages. Studies evaluate new drugs, approaches and prevention methods.
Participating in clinical trials provides the opportunity to access promising new lung cancer treatment before it becomes available in healthcare services. Some of the lines of research are:
- Targeted therapy: this is the foundation of precision medicine. This has led to the development of new targeted therapy drugs, some of which are already being used to treat non-small-cell lung cancer. Brain metastases are common and often have unfavourable outcomes. However, new drugs tested in clinical trials show promising results in patients with non-small-cell lung cancer who have a change in the EGFR gene and brain metastases. It has been observed that these drugs can cross the blood-brain barrier. In the coming years, gene targeted therapies for lung carcinoma will be available, with lower toxicity and higher efficacy against the tumour.
- Immunotherapy: shows promising results in lung cancer and research continues to strengthen the immune system against the disease. To avoid being attacked, cancer cells use certain “checkpoints” that keep the immune system in check. However, new drugs that block PD-L1 or PD-1 proteins, found on immune cells called T-cells, may help the immune system recognise and attack cancer cells. Some of these drugs, such as pembrozulimab or durvalumab (among others), are already approved for use in advanced non-small-cell lung cancer.
- Improvements in surgery: the aim is to increase efficacy and reduce side effects. Doctors are studying the feasibility of using video-assisted thoracic surgery (VATS) for larger tumours. In addition, they are evaluating whether robotic-assisted surgery is more beneficial than current traditional surgery for lung cancer.
- Advanced detection and localization methods: detecting lung cancer at earlier stages allows for more effective treatment. Better techniques, such as genetic testing and blood tests, are being investigated to diagnose it at this stage.
In addition, researchers are studying the use of new imaging techniques, such as four-dimensional computed tomography (4DCT), to improve treatment. 4DCT helps doctors deliver radiation more precisely by determining the exact location of the tumor during each phase of the respiratory cycle.
Clinical trials aiming to improve current lung cancer treatment
An additional objective of these trials is to improve the efficacy of lung cancer treatments. This is achieved by combining different drugs aimed at improving the quality of life and life expectancy of patients. An example of the latter would be the administration of several targeted therapies in the case of non-small-cell lung cancer, in which the combination of two targeted therapies is being studied to block EGFRm and MET mutations and aiming at slowing the progression of the disease.
Clinical trials are also underway to find better ways to reduce symptoms and side effects of current lung cancer treatments, with the aim of improving patients’ well-being and quality of life.
Clinical trials to find your best treatment for lung cancer
As a general rule, conventional treatments are considered effective and are administered to most patients. However, human beings are unique and this differential trait also applies to tumours and metastases. These singularities that differentiate us drive trials that do not seek to compare drugs, but rather to administer the most precise and adapted treatment to each patient. More personalized therapy means longer survival and better quality of life.
American Cancer Society, 2023: Tratamiento del cáncer de pulmón microcítico, Tratamiento del cáncer de pulmón no microcítico, Opciones de tratamiento para el cáncer de pulmón no microcítico según la etapa, Opciones de tratamiento para el cáncer de pulmón microcítico según la etapa, Opciones de tratamiento para el cáncer de pulmón microcítico según la etapa, Medicamentos de terapia dirigida para el cáncer de pulmón no microcítico, ¿Qué avances hay en las investigaciones sobre el cáncer de pulmón?
Instituto Nacional del Cáncer, 2023: Tratamiento del cáncer de pulmón de células no pequeñas (PDQ®)–Versión para pacientes, Tratamiento del cáncer de pulmón de células pequeñas (PDQ®)–Versión para pacientes, Terapia dirigida para tratar el cáncer
American Society of Clinical Oncology: Cáncer de pulmón de células pequeñas: Últimas investigaciones, Cáncer de pulmón de células no pequeñas: Últimas investigaciones