Many lung cancer patients see improvement after just a couple weeks.
Treatments for lung cancer have improved significantly over the last decade. During the last 10 years, newer medications have emerged that are helping people live longer and better quality lives. One of those discoveries was targeted therapies.
How Targeted Therapies Treat Lung Cancer
As researchers have learned more about the changes in cancer cells that help them grow, they have developed targeted therapies to target those changes specifically. “Targeted therapies are really going after the specific cause, the specific molecule that’s abnormal and producing the cancer,” says Jorge Gomez, MD, a lung oncologist at Mount Sinai Hospital.
Targeted therapies work differently from standard chemotherapy (chemo) drugs. Chemotherapies are designed to kill any rapidly dividing cell (which tend to be cancer cells), but because they don’t have a specific target so they kill healthy cells as well. “[Chemotherapy] is a toxic drug that kills any cell, including normal cells that are dividing rapidly,” says Dr. Gomez.
Because targeted therapies focus on killing cancer cells and spare the healthy cells, they tend to cause less side effects than chemo.
The only drawback to targeted therapies, however, is that they can’t help all lung cancer patients. “There is a group of patients, approximately 15 to 20 percent of patients with lung cancer, who have a special type of lung cancer that can be treated with targeted therapies,” says Dr. Gomez.
Who Target Therapies Can Help
“Targeted therapies are appropriate for patients who have those activating mutations or changes in the cancer cell that can respond to those targeted therapies,” says Dr. Gomez. “So patients who have the target.”
Patients with these mutations are usually never smokers, says Dr. Gomez. “Their lung cancers are generally thought not to be related to tobacco, so for that segment of the population, this treatment is significantly better than chemotherapy.”
These mutations might include blood vessel growths in the tumor, and cells with EGFR, ALK, BRAF, RET, or ROS1 gene changes. Generally, a sample of the patient’s tumor is analyzed in the lab to learn whether or not they have any of these abnormalities, a process called genomic testing. “Genomic testing has significantly changed how lung cancer is treated,” says Dr. Gomez.
The presence of these abnormalities then help the doctor narrow down the best treatment option for the patient. “We talk about all of the drugs that are available for each of those mutations,” says Dr. Gomez. “[We] always choose the best drug looking at efficacy and looking at safety or toxicity.”
How Doctors Know Targeted Therapy Is Working
Targeted therapies tend to work very quickly. “It’s not uncommon for us to see patients whose symptoms have disappeared within a week or two weeks of treatment,” says Dr. Gomez. “We often know whether drugs are working even before we do the first scans.”
Alongside learning that a patient is feeling significantly better, doctors may perform imaging tests to check on the status of the tumor. “CT scans, MRI, and PET scans can tell us whether the tumor is shrinking,” says Dr. Gomez.
If the doctors notice that the patient’s current drug isn’t performing in the same way, they have a backup plan. One of the most important changes in targeted therapy treatment is that there are now drugs designed to attack specific targets that may arise after the first treatment. “So when these drugs stop working, we now have other third generation drugs and we are developing subsequent generation drugs that may affect or even attack second resistance mutations,” says Dr. Gomez.
“In those patients who have activating mutations in the cancer cells where we can use targeted therapy, the outcome is significantly better,” says Dr. Gomez. “For that population of 15 to 20 percent of lung cancer patients, this has changed their life significantly.”
Dr. Gomez is a hematologist and oncologist at Mount Sinai Hospital and an assistant professor of Medicine, Hematology, and Medical Oncology at the Icahn School of Medicine at Mount Sinai.
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In the past 15 years, lung cancer
treatment has changed significantly.
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The first thing that happened was
the discovery of targeted therapies.
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There is a group of patients,
approximately 15% or
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20% of patients with lung cancer,
who have a special type
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of lung cancer that can be treated
with pills, with targeted therapies.
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And those patients are usually
never smokers, but
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this can happen in smokers also.
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Their lung cancers are generally
thought not to be related to tobacco.
00:00:30,900 --> 00:00:32,927
And so for that segment of the population,
00:00:32,927 --> 00:00:35,870
this treatment is significantly
better then chemotherapy.
00:00:35,870 --> 00:00:40,701
00:00:40,701 --> 00:00:45,445
The difference between targeted therapies
and traditional chemotherapies is
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that targeted therapies really
are going after the specific cause or
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the specific molecule that is abnormal and
producing the cancer.
00:00:54,200 --> 00:00:58,180
Chemotherapies are just designed
to kill cancer cells, or
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any cell that's dividing rapidly.
00:01:00,800 --> 00:01:06,010
It's not going specifically to the cancer,
it's just a toxic drug that kills
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any cell, including normal cells
that are dividing rapidly.
00:01:10,000 --> 00:01:11,790
Targeted therapies are appropriate for
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patients who have those
activating mutations or
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changes in the cancer cells that can
respond to those targeted therapies.
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So patients who have the target.
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Patients who don't have the target, the
patients with the regular tobacco-related
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generally don't respond to these drugs.
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And so we don't use them for
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When we find patients with mutations,
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we look at each specific mutation and
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these are EGFR, ALK, ROS1, BRAF, and RET.
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And we talk about all of the drugs that
are available for each of those mutations.
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We talk about some of the clinical trials
that may suggest which is the best drug.
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Or we look sometimes at
their toxicity profiles,
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how much they produce in terms of side
effects, and discuss that with patients to
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see if that gives us a specific
direction in terms of which drug to use.
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But we always choose the best drug,
looking at efficacy and
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looking at safety or toxicity.
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Targeted therapies can act very quickly.
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It's not uncommon for
us to see patients whose symptoms have
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disappeared within a week or two weeks or
even three weeks of treatment.
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It's fairly common for patients to come
in two weeks after starting treatment and
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say you know, I feel significantly better.
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My breathing is better.
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My pain is better.
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And so we often know whether drugs are
working even before we do the first scans.
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CT scans, MRI, PET scans, these scans can
tell us whether the tumor is shrinking.
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So the treatment with targeted
therapies has changed over time,
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since we first discovered these mutations.
00:02:50,307 --> 00:02:54,387
One of the most important
things that has happened is
00:02:54,387 --> 00:02:59,209
that we are now developing drugs
to attack specific targets or
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mutations that may arise after
the first targeted treatment.
00:03:04,800 --> 00:03:11,610
And so when these drugs stop working,
we now have other third generation drugs,
00:03:11,610 --> 00:03:16,220
and we are developing subsequent
generation drugs that may affect or
00:03:16,220 --> 00:03:21,340
may attack even second
00:03:21,340 --> 00:03:25,330
Genomic testing has significantly
changed how lung cancer is treated.
00:03:25,330 --> 00:03:29,750
In those patients who have activating
mutations, or changes in the cancer cells
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where we can use targeted therapy,
the outcome is significantly better.
00:03:33,840 --> 00:03:37,516
And so for that population of 15% or
20% of lung cancer patients,
00:03:37,516 --> 00:03:39,857
this has changed their life significantly.
00:03:39,857 --> 00:03:47,454
Non-small cell lung cancer treatment; stage IV cancer (Beyond the Basics). UpToDate. (Accessed on October 17, 2018 at https://www.uptodate.com/contents/non-small-cell-lung-cancer-treatment-stage-iv-cancer-beyond-the-basics)
Overview of the initial treatment of advanced non-small cell lung cancer. UpToDate. (Accessed on October 17, 2018 at
Targeted Therapy Drugs for Non-Small Cell Lung Cancer. American Cancer Society. (Accessed on October 17, 2018 at https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/targeted-therapies.html)
Treatment Choices for Non-Small Cell Lung Cancer, by Stage. American Cancer Society. (Accessed on October 17, 2018 at https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/by-stage.html)