Clinical trials for new 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.