How they affect lung cancer


When you hear the word “gene”, you might think about the genes inherited from your parents.But when genes and Lung cancer It does matter. Few known genes have a higher chance of transferring lung cancer from parents to children.

“We can’t see those [people] Because many times [people] There is no genetic cause of lung cancer,” said study leader Kerry Kingham (Kerry Kingham) cancer Genetic consultant at Stanford Health Care.

She said there are some exceptions.Multiple members of a family have lung cancer with no obvious external cause (e.g. smokes), you may need to see a genetic counselor.

“But even in those [people], We rarely find the reason. “

Only about 1% of these cases show genetic mutations.

Kingham said: “And when we do find genetic mutations and we can test other family members, there is no really good guide that can tell us what to do for them outside of more careful screening.”

She said that it is more important to test cancer cells after diagnosis.

More common tie

Previously healthy tiny genetic material (your doctor may call it “protein”) lung Tissue cells can change or “mutate” to form cancer cells. As cells divide, they continue to pass on these changes or “mutations” to new cells that form tumors.

Doctors don’t know what causes these mutations. But you cannot inherit them from your parents, nor can you pass them on to your children. It’s not your fault if you get them. Kingham said these mutations are “just happening.” They are not because of something you did or did not do.

“It’s not anyone’s fault. It’s not what you eat. For most people, it’s not because you misread the moon or lead an unhealthy lifestyle.

“It’s just that sometimes, mistakes are made when cells divide.”

When genetic testing is most important

Some lung cancer gene mutations can help doctors develop treatment plans. Doctors call these mutations “biomarkers.”

Dr. Heather Wakelee, a thoracic oncologist, professor and head of the Department of Medical Oncology at Stanford University Medical Center, said that certain lung cancer biomarkers are important for understanding and treatment methods.

EGFR (Epidermal Growth Factor Receptor) is probably the most common one. About 10%-15% of non-small cell lung cancers are EGFR positive, which means they have cancer mutations in the EGFR gene.

This is what doctors call “driver mutation”, which is why there is no cancer at all. This mutation usually occurs in certain lung cancer patients, such as:

  • Non-smoker
  • female
  • People of Asian or East Asian cultural heritage
  • Those with lungs Adenocarcinoma (A type of lung cancer)
  • Young people have lung cancer (half of them are EGFR positive.)

Wakelee said, but everyone diagnosed with non-small cell lung cancer (NSCLC) should be tested for EGFR, not just those in these high-risk groups.

She said: “For every non-small cell lung cancer tumor, regardless of its stage, it is vital that EGFR must be tested.”

Not limited to EGFR. If the doctor diagnoses that you have lung cancer, at least seven more genetic biomarkers should be checked.

They include:

  • Alk
  • ROS1
  • Correct
  • MET
  • Bluff
  • NTRK
  • HER2

Each case accounts for up to 5% of NSCLC cases.

The reason these tests are so important for patients with non-small cell lung cancer is that scientists have designed Targeted cancer therapy Tumors with mutations in these specific genes.

“If we find a tumor mutation, we can treat it in a better way. drug -In addition to being more effective, it is usually a better tolerated drug. “Wakelee said. “It is now correct for eight different genes, so it is important that, where possible, the tumor is tested before treatment begins.” “

In short, these drugs target a protein that gets stuck in the “on” position and then turns it off.

You can take most of the target drugs as pills at home instead of Chemotherapy In the hospital through an intravenous injection. Not only are they more effective, Wakelee says, they are generally much easier on your system than other cancer treatments.

When there is a viable gene as the target, these therapies can shrink tumors, rather than chemotherapy or Immunotherapy, And treatment usually lasts longer.

For people with early surgery for NSCLC, an EGFR drug called osimertinib (Tagrizo) May delay the recurrence of cancer and reduce the possibility of cancer spreading to cancer patients. brain.

People with stage IV EGFR-positive NSCLC can also get Tagrisso because it is more likely to shrink the tumor and work longer than any other type of treatment.

However, there is no approved targeted therapy for small cell lung cancer Clinical Trials Continue to explore the possibilities.

The importance of patience

In addition to your genetic testing program (sometimes called “molecular testing”), your doctor should also test for another biomarker, PD-L1.The level of this protein indicates whether you are more likely to respond to the following medications Immunotherapy drug.

Wakelee said this will make things more complicated, because PD-L1 results usually precede the mutation results.

High PD-L1 usually means Immunotherapy It can be successful.

Wakelee said: “So it’s tempting to take action on this.” But this is not always the best approach. If you have certain mutations, such as EGFR, immunotherapy can do more harm than good. And it may make future targeted therapies more toxic to your system.

That’s why, Wakeley said, it’s important to wait until you come back All Check the results before making any decisions.

This is just one example of possible complications. In some cases, there are too many complicated tumor factors, health care The research team will convene a group called the Molecular Oncology Committee, which consists of a combination of:

  • Expert doctor
  • Medical oncologist
  • Surgeon
  • radiation therapist
  • Researchers
  • Geneticist
  • Pathologist

“For just being diagnosed with Stage IV lung cancer, Waiting will bring great pressure. Wakelee said. “Most people want to start treatment right away.” However, it is important to wait for the complete story about the tumor to understand the best option. “

Not just smokers

There may be an ugly stigma. If you have lung cancer, it must be caused by smoking.Yasir Y. Elamin, MD, said that it’s unfortunate Medical oncologist Assistant Professor of Thoracic Tumor Oncology at the University of Texas MD Anderson Cancer Center (University of Texas MD Anderson Cancer Center).

He said this is also wrong.

Although smoking remains the biggest risk factor for the disease (beyond age), as many as one in five people who die of lung cancer each year have never smoked. Among people who have never smoked, lung cancer has become the most deadly cancer in the United States.

“I think that no one should get lung cancer, whether they are smokers or non-smokers. But I think we have to learn more and more that lung cancer is not just a disease related to smoking.” Elamin said.

This is especially true for lung cancer that responds to targeted therapy.

“In most cases, they have nothing to do with smoking.” Elam said. “I think this is a very painful reminder that lung cancer is not only related to smoking. Therefore, I hope it will help us eliminate some of the stigma surrounding it.”

The future of targeted therapy

Targeted therapy can improve the quality of life, reduce side effects, and improve prognosis. However, these treatments are frustrating. One of them is that people tend to build resistance against them.

“This is one of the tragic realities of targeted therapy,” Elamin said.

This may take 2 to 3 years, but in the end, almost all people receiving targeted therapy will develop resistance, especially those who start treatment in the later stages of the disease. Many new researches focus on how to overcome this problem.

“We are paying attention to how and why the resistance is developing,” Elamin said.

The hope is to come up with some method to delay or overcome resistance, or better prevent it.

Overall, Elam is very promising. He pointed out the latest research on the drug alectinib (Alecensa), this is a targeted therapy for ALK biomarkers. The study found that more than 60% of patients with advanced non-small cell lung cancer who received treatment lived for at least 5 years.

“Imagine the difference,” he said. “When I was training, the 5-year survival rate for the same group was 5 to 6%. This is incredible.”

Of course, not the 60% target, but Elamin is still encouraged.

“We hope to reach 90% or 100% one day. But I think we have made progress. In this case, the numbers speak for themselves.”

source

source:

Heather Wakelee, MD, thoracic oncologist and professor of medicine at Stanford University Medical Center.

Yasir Y. Elamin, MD, intrathoracic oncologist, MD, assistant professor of intrathoracic oncology at Anderson Cancer Center.

Kerry Kingham, chief cancer genetic counselor in Stanford University’s Department of Health Care.

American Cancer Society: “Lung cancer risk for non-smokers”, “Lung cancer test”.

CDC: “Lung cancer among never-smokers.”

American Lung Cancer Foundation: “What is EGFR-positive lung cancer and how is it treated?”

Sloan Kettering Memorial Cancer Center Memorial: “Lung Cancer Genome Testing (EGFR, KRAS, ALK).”

UC San Diego Health: “Molecular Oncology Committee, Center for Personalized Cancer Treatment.”


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