Unlocking Hope: How close are we to a cure for Lung Cancer?

Diagnosing lung cancer early saves lives. Unfortunately, nearly three-quarters of lung cancers are found late, at stage 3 or 4. However, early diagnosis at any stage can lead to better treatment outcomes. A chest X-ray is usually the first test to indicate lung cancer, and if promptly followed by a CT scan, it can accelerate the diagnosis process. An ongoing trial involving 150,000 patients across six UK hospitals is investigating whether AI can expedite this process. The aim is to determine if AI can speed up chest X-ray results, leading to faster CT scans and diagnoses.

Previous research showed that immediate reporting of chest X-rays by radiographers nearly halved the diagnosis time from 63 days to 32 days. In the current study, AI analysis is being applied to chest X-rays for patients referred from primary care. Recruitment for the trial will conclude in July 2024, with results expected later that year. The hypothesis is that AI could identify lung cancer sooner and reduce diagnosis time by up to 50%. AI is already in use in hospitals, but its clinical impacts require careful analysis. If the trial demonstrates significant improvements, it could lead to the immediate inclusion of AI in the standard chest X-ray procedure.

Two large studies found that CT scans can lower deaths from lung cancer. Smaller studies showed similar results. But starting lung cancer screening may be slow and inconsistent. This is partly because nine out of ten initial CT scans show no cancer.

The 4-IN THE LUNG RUN trial will check if screening every two years works as well as yearly tests for people with clear first scans. This trial will screen 26,000 people in six European countries. If lung cancer screening is done well, many people could benefit quickly. This would also reduce harm and lower healthcare costs.

Dr. Roy Herbst, the principal investigator, stated this is the first proof that a targeted treatment impacts survival in early-stage lung cancer. The drug, osimertinib (Tagrisso), targets a specific receptor that promotes cancer growth. Herbst mentioned, “We’re really showing progress in lung cancer like never before.”

In the international study with 682 participants, half took the pill for three years while the others received a placebo. After five years, 88% of those on the pill were alive compared to 78% in the placebo group. The drug reduced the risk of death from lung cancer by 51%.

Tagrisso is approved in over 100 countries. Initially approved in 2015 for advanced lung cancer, it got approval in 2020 for early-stage disease. The trial included patients with stages 1, 2, and 3 non-small cell lung cancer with a mutation in the EGFR receptor. This mutation can cause excessive cell division leading to cancer, and the pill works by switching off this receptor. The trial was funded by AstraZeneca and included participants from over 20 countries.

Pfizer’s lung cancer drug (Lorbrena) can extend life for cancer patients with a rare form of the disease much longer than other drugs, according to new research. Lorbrena treats a type of non-small cell lung cancer with a genetic mutation called ALK. Non-small cell lung cancers make up about 85% of lung cancer cases, and ALK-positive cancers are about 4% of these cases, affecting over 70,000 people each year.

This cancer often occurs in younger patients who are nonsmokers. It is particularly deadly because ALK-positive lung cancers spread to the brain easily. About 25% of patients develop brain metastasis within two years of diagnosis. There is one thing to note: The drug Lorbrena was compared to, called crizotinib, is not used anymore in the U.S., according to Dr. Julie Gralow, who is a top doctor at the American Society of Clinical Oncology.

Both Lorbrena and crizotinib belong to a group of drugs called tyrosine kinase inhibitors, which fight tumor cells similarly. Crizotinib is an older, first-generation drug, while Lorbrena (lorlatinib) is a newer, third-generation version. Doctors typically use Lorbrena along with two other second-generation drugs, brigatinib (Alunbrig by Takeda) and alectinib (Alecensa by Genentech), as the standard treatment for ALK-positive lung cancers.

Number 5 on our list is MSK’s Combinational Therapy.

Sotorasib (Lumakras™) is a drug that targets non-small cell lung cancers caused by a mutation called KRAS-G12C. It got approval from the U.S. Food and Drug Administration in 2021 for treating advanced stages of the disease. The approval came after a successful clinical trial called CodeBreaK100, co-led by MSK’s lung cancer expert, Dr. Bob Li.

MSK has been crucial in developing sotorasib and other drugs that target KRAS, a mutation found in about one-quarter of lung cancers. Researchers are now expanding on this success by testing sotorasib earlier in the treatment process and combining it with other therapies. Dr. Bob Li, a medical oncologist at MSK, presented findings from a new trial, CodeBreaK101, indicating that sotorasib could be effective as a first-line treatment for certain lung cancer patients. In this trial, sotorasib was combined with chemotherapy drugs like carboplatin and pemetrexed, showing promising results.