In the matter of the top causes of cancer mortality in the world, lung cancer is among the leading ones. By the time the disease becomes Stage IV, the cancer has already spread to distant organs such as the liver, bones, brain, or adrenal glands making treatment not easy. Even though late-stage lung cancer has for many years been subjected to chemotherapy and immunotherapy, the development of precision medicine has reduced the prognosis dramatically for patients with precise genetic mutations. Unlike conventional chemotherapy, targeted therapy is less toxic and more potent because it targets specific genetic abnormalities responsible for the abnormal growth of the cancer cell. In this post, we will focus on how targeted therapy is shaping the treatment of Stage IV lung cancer, available targeted therapies focus drugs, and their effects on life expectancy and patient’s quality of life.
What to Know About Stage IV Lung Cancer
Also referred to metastatic lung cancer, stage IV lung cancer is characterized by the presence of lung cancer that has spread beyond the lungs to other organs. It can be sub classified into:
- Stage IV A: The cancer has reached the opposite lung, pleural effusion, or area lymph nodes.
- Stage IV B – Cancer has spread to distant organs such as liver, brain, or bone locations.
By this stage, the disease can no longer be cured, but through accurate procedures such as specific drugs therapies, life expectancy and quality of life of the patient can be enhanced.
What is Targeted Therapy?
Targeted therapy is an approach that involves aiming for a specific genetic mutation or certain proteins which are responsible for cancer development. As opposed to chemotherapy that is both toxic and damaging to healthy cells in addition to cancerous cells, targeted therapy only influences cancer cells, thereby creating a better response with less toxicity.
Molecular testing (biomarker testing) is conducted on the tumor for specific mutations before one starts prescribed targeted therapy, and is required to identify a patient with a targeted mutation.
Targeted Therapies and Common Genetic Mutations in Lung Cancer
Targeted therapy is best for patients with non-small cell lung cancer (NSCLC) that accounts for 85% of lung cancer. The most frequent mutations and targeted therapies are:
1. EGFR Mutations (Epidermal Growth Factor Receptor)
Mutation: If the cell has the protein EGFR, then it copies itself and grows. A mutation enables cancer due to cells multiplying uncontrollably. Targeted Therapies First - Generation: Erlotinib, Gefitinib Second - Generation: Afatinib, Dacomitinib
Third-Generation: Osimertinib (best for hard-to-treat EGFR mutations).
Impact: EGFR-directed drugs are far more effective at reducing tumor size and slowing down the disease than chemotherapy does.
2. ALK Rearrangements
Mutation: The alteration of the ALK gene can lead to the formation of a tumor that grows in an uncontrolled manner.
Targeted Therapies
Crizotinib, Alectinib, Brigatinib, Lorlatinib
Impact: ALK inhibitors have been very successful in reducing tumors and increasing life expectancy for patients with ALK positive lung cancer.
3. ROS1 Rearrangements
Mutation: As with ALK, tumors with ROS1 mutations grow uncontrollably.
Targeted Therapies
Crizotinib, Entrectinib
Impact: These are long-lasting drugs that enhance overall survival probabilities.
4. BRAF Mutations
Mutation: BRAF V600E leads abnormal cell communication which results in cancer cells.
Targeted Therapies
Dabrafenib + Trametinib (combined therapy).
Impact: In lung cancer patients, BRAF mutations greatly increase response rate when treated.
5. MET Exon 14 Skipping Mutations
Mutation: MET mutations facilitate the proliferation and metastasis of tumors.
Targeted Therapies
Capmatinib, Tepotinib
Impact: These medicines are showing good response rates in MET altered lung cancer patients.
6. RET Rearrangements
Mutation: RET gene fusion is a driver in carcinoma progression.
Targeted Therapies
Selpercatinib, Pralsetinib
Impact: RET, especially in the advanced stage, provides strong response and great parole responsiveness.
How Targeted Therapy Works For Stage IV Lung Cancer
1. Targeted Therapy
For patients with EGFR mutations, ALK, ROS1, and other changes, targeted therapy is the preferred initial treatment since it offers:
- Better results than chemotherapy.
- Increased progression-free survival (PFS).
- Reduced side effects compared to other therapies.
2. Combination Therapy
Targeted therapy can also be used simultaneously with immunotherapy or chemotherapy in order to control the disease more effectively. In example:
EGFR Inhibitors + Chemotherapy in resistant cases.
ALK Inhibitors + Brain radiation for AGK positive lung cancer with brain metastasis.
3. Getting Around Drug Resistance
Over time cancer cells can become resistant to targeted medications. When this occurs:
New generation inhibitors such as Osimertinib for EGFR resistance are applied.
Combination approaches may be used to postpone the onset of resistance.
Advantages of Targeted Therapy for Stage IV Lung Cancer
- Precision-based treatment: Utilizes fewer healthy tissues while thoroughly targeting cancer cells.
- Fewer side effects: It is not as toxic as chemotherapy, therefore the patients have a better maintained health.
- Enhanced survival: Some targeted therapies can help patients to survive longer with good quality of life.
- Convenience: Targeted therapies are mainly in the form of an oral tablet, hence the drug is easily administered.
Disadvantages of Targeted Therapy
- Not all patients suffering from lung cancer will have the required targetable mutations – molecular testing is needed.
- After some time, there is a chance that some drugs won’t be as effective, and a new treatment may be needed.
- Some therapies are costly, especially drugs that are specially designed for treatment.
Future of Targeted Therapy in Lung Cancer
Newer targeted medication and next generation inhibitors are under development to improve survival rates; research is progressing rapidly. Along with this, clinical trials are testing personalized combined medicine to try and improve results too.
Conclusion - Optimal Treatment For Stage IV Lung Cancer
The introduction of targeted therapies have shifted the treatment for stage IV lung cancer. Now, patients whom possess specific genetic mutations are treated on a precision basis which is both effective and less toxic. Oncologists conduct tests on the mollecules to identify the most effective targeted treatment which leads to better survival rates and patient’s quality of life.
Dr. Pooja Babbar is one of the best medical oncologists in Gurgaon who has helped countless lung cancer patients undergo advanced targeted therapy and precision oncology. She specializes in EGFR, ALK, and other molecular driven therapies and provides personalized treatment to patients for optimal results.
If you or someone close to you is battling with Stage IV lung cancer, make an appointment with Dr. Pooja Babbar now for the newest available treatment options and brighter tomorrows.
Don’t wait any longer; a timely step can be beneficial in fighting cancer. Book your consultation now!
