Advanced stage III and IV Lung Cancer: Can Patients Achieve Long Term Remission? Recent Research Findings
It is a well known fact that Locally Advanced or Metastatic Squamous or Adenocarcinoma Lung Cancer Carries an ominous prognosis with a very low to even non existing 5 years Survival or Disease Free Survival Rates .
In a recent research published at the Respiratory Research Journal 2019, researchers and Oncologists from Tokai University Japan performed a retrospective research on 164 stage III and 279 stage IV patients, including 37 (22.6%) and 51 (18.3%) long-term survivors and 12 (7.3%) and 5 (1.8%) Complete Responders (CR) patients, respectively.
The results showed that patients who achieved Long term survival or Complete Remission shared certain criteria that include : The use of combination chemotherapies known as Platinum doublets such as Pemetrexed Carboplatin or Gemcitabine Platinum in combination with either molecular targeted agents such as epidermal growth factor receptor-tyrosine kinase inhibitors (EGFRTKI), anaplastic lymphoma kinase-tyrosine kinase inhibitors (ALK-TKI), c-ros oncogene 1 (ROS-1) inhibitors, or v-raf murine sarcoma viral oncogene homolog B1 (BRAF) inhibitors. The other group of recently discovered agents are called ICIs (Immune Checkpoints Inhibitors) such as Pembrolizumab (Keytruda), Nivolumab (Opdivo), and Cemiplimab (Libtayo).
Not only choosing chemotherapy and targeted agents such as molecular targeted agents or ICIs was a game changer for these patients, but also how these patient’s distant metastases were treated. According to this research, All long term survivors or those how achieved complete remission were treated with radiation therapy (Mainly) and few of them were treated surgically. Also all of them had radiation therapy to the primary lung cancer as well.
Last, but not least, it was found that, there were numerous aggregates of inflammatory cells (such as Natural killer cells, Macrophages and Lymphocytes) around the primary or metastatic tumors of these patients on pathology analysis and testing which indicated that, not only the conventional chemotherapies and radiation were essential to achieve these treatment results, but also, the integrity of the immune system of these patients that played a role in getting a better response rate and survival.
In Conclusion: Patients with an advanced stage III and IV Lung Cancer represent a real challenge for the medical and radiation oncologists and many oncologists tend to refer them to a palliative care service after starting chemotherapy. Achieving a better response and may be survival can be an option when many measures are being considered such as starting a platinum doublet chemotherapy, molecular targeting agents or Immune Check Points Inhibitors, treating distant metastases with surgery or Radiation and last but not least empowering the Immune System to help them fight this aggressive disease.
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