Lung cancer: “An absurd world”
An international lung cancer congress will take place in Vienna from 4-7 December. The burning issues: early detection, diagnostics and new therapies, confirms congress president Robert Pirker.
Standard: What will the congress of the International Association for the Study of Lung Cancer (IASLC) focus on? Pirker: Lung cancer and other thoracic tumours – from a multidisciplinary viewpoint. We have three major focuses: active prevention, precise diagnosis and advanced therapy.
Standard: What are the latest developments in these three areas? Pirker: As far as diagnostics is concerned, tumour stages will be most precisely described in line with the TNM ( T - tumour, N - lymph nodes, M - metastases -ed) staging system from 2017. Therapy depends on it. Genetic properties of tumours and molecular biological changes are an additional topic.
Standard: Is a diagnosis of lung cancer now just the umbrella term applied to numerous diseases? Pirker: Precisely. There are increasing numbers of subgroups that call for different prognoses and therapies. Each year there are 4,000 new cases in Austria, 90 percent of which are attributable to smoking. The various toxic substances found in cigarettes change the tissue of the lungs.
Standard: How exactly? Pirker: Basic research is currently working to characterise these changes more effectively and make them verifiable. The aim would be to establish prognoses for certain types of lung cancer with a view to subsequently administering the relevant therapy. In an ideal world, these genetic changes would be identifiable in the blood. This liquid biopsy method is a promising area. It would simplify progress monitoring.
Standard: Lung cancer is notoriously difficult to treat. What progress has been made? Pirker: It all depends on when the cancer is discovered. Ideally, this would be in the early stages when the cancer can still be surgically removed. It’s all about early detection.
Standard: Do you mean routine check-ups for smokers? Pirker: That is an important but controversial subject. The question is whether it makes sense to regularly subject heavy smokers to computer tomography. A US study showed that this can reduce lung cancer mortality by around 20 percent.
Standard: And what’s to be said against this idea? Pirker: The large number of false positive results. Lots of smokers have nodules in their lungs, the majority of which are benign. If a screening programme were to be conducted among all smokers then it would throw up lots of abnormalities that could end up necessitating biopsies. And they take time and money. I think that early detection in concert with cessation makes the most sense.
Standard: So the focus in on smokers? Pirker: Cigarettes are killers. Every second smoker dies early. In Austria that’s 13,000 people a year, and six million worldwide. Compared to something like a plane crash, people appear to accept this with little fuss. Unfortunately, we live in an absurd world. Tobacco companies are global corporations, so I’m also concerned by trade agreements. Standard: What are the guidelines on lung cancer therapy? Pirker: Operation, radiotherapy and chemotherapy are still the main pillars. Chemotherapy has been established since the 1990s, with cytostatic drugs now more effective and tolerable. Antiemetics, the medicines used to combat the nausea caused by chemo, have also helped to reduce side effects.
Standard: Is chemotherapy still the treatment of choice?
Pirker: Yes, targeted therapies have also come along in the meantime that go to work directly on the receptors on the tumour. Blocking the EGF receptor keeps the tumour cells in check for a time. Immunotherapies that boost the immune system are another new development. We are currently considering the use of these medicines earlier rather than waiting until the advanced stages. The question is which patients benefit, and which do not. There are currently a whole host of studies looking into this which will be presented in Vienna.
ROBERT PIRKER is a lung cancer specialist at the University Department of Internal Medicine at Meduni Vienna and this year’s IASLC president.