Fighting Cancer Utilizing the Immune System
Prim.a Dr. Sylvia Hartl, Head of 2nd Department of Respiratory and Critical Care, Otto-Wagner-Spital Vienna, about new ways in the treatment of lung cancer.
Lung cancer is one of the most common cancer diseases worldwide. Why does the number of patients continue to rise?
Hartl: Lung cancer is one of the most common cancer diseases in industrialized countries: heavy metals, carcinogenic substances in ambient air, harmful components within the food chain and smoking are relevant factors of the development of lung cancer. Additionally, we notice an increase in the disease among women as well as young people at the age of 35. However, the early diagnosis does not only affect patients who smoke, but also people who were never smokers. Smoking as the only cause for lung cancer, would allow to target it preventively to avoid the disease.
Unfortunately environmental pollution and an unhealthy lifestyle also favour the development of lung cancer.
What are the major challenges in treating lung cancer?
Hartl: The upmost challenge for sure is early detection of lung cancer. Respiratory symptoms are very unspectacular and non specific as cough is very common in many lung diseases. Dyspnea is the other common symptom but pain as an alarming symptom is rather rare. Moreover tumorassociated respiratory distress in many cases indicates an advanced disease stage or a location in the
central airways. The comprehensive use of CT scans for cancer screening is not cost effective and put the burden of uncertainty on the patient. Future expectations rely on specific genomic cancer tests that will be specific and predictive for early lung cancer detection.
Is lung cancer a uniform disease? Hartl: Lung cancer classification depends on histological types of originating cells. Today, we are screening for specific gene mutations which allow a targeted tumor therapy. The benefit is an improved response to lung cancer treatment.
What is the definition of biomarkers and what is their role ?
Hartl: By definition, a biomarker is a measurable biological characteristic parameter. In lung cancer screening for new biomarkers at the surface of the cancer cells allow to predict more precisely responsiveness to immune treatment. These markers help us to better characterize the cancer and thus we are able to make the specific therapy decision for the individual patient. They allow to better anticipate how patients might respond to specific therapy in terms of mass reduction, the survival rate, but also when it would be time to adjust the therapy. This is a major breakthrough since we used to treat patients according to the „one size fits all“principle. Nowadays we are able to treat patients according to their individual medical needs.
The development of immuno-oncology therapeutics has been steadily increasing in recent years. What is the specific innovation of this therapy and which effect does it have on quality of life? Hartl: Tumor cells develop numerous protective mechanisms in order to survive within our body. They have the ability to express surface proteins that help to predict the treatment resonse rate.
Immune therapy enables our innate immune system to destroy degenerated cells. Immunotherapy is generally well-tolerated by patients and has less toxic effects than conventional chemotherapies. However, con- ventional chemotherapies still are very valuable for cancer treatment. The success of immunotherapy also depends on whether the patient is eligible in terms of responsiveness. If so the patients improve their good quality of life and struggle with less side effects and have better symptom control. Unrestricted daily life is the goal of any cancer tratment .