Akciğer kanserinde yeni tedaviler

Geçtiğimiz aylarda Dünya Kanser Kongresi’nde de açıklandığı gibi, akciğer kanseri tedavilerindeki gelişmeler sağ kalım oranlarını arttırıyor.

Geçtiğimiz aylarda Dünya Kanser Kongresi’nde de açıklandığı gibi, akciğer kanseri tedavilerindeki gelişmeler sağ kalım oranlarını arttırıyor. Anadolu Sağlık Merkezi Medikal Onkoloji Uzmanı ve Onkolojik Bilimler Koordinatörü Prof. Dr. Necdet Üskent, “Pek çok branşın birlikte hareket ettiği akciğer kanseri tedavilerinde yeni immünoterapi ajanları, adoptif hücre tedavisi, aşılar ve akıllı ilaçlar olmak üzere çok sayıda yenilik mevcut” açıklamasında bulundu. Prof. Dr. Necdet Üskent konuyla ilgili önemli bilgiler verdi...

Akciğer kanseri hem kadınlarda hem de erkeklerde en sık görülen ilk üç kanser türünden biri. Kansere bağlı ölümlerde ise kadınlarda ve erkeklerde akciğer kanseri ilk sırada yer alıyor. Uzmanlara göre oluşumunda çevresel (hava kirliliği, pasif sigara içiciliği gibi) ve genetik faktörlerden çok daha güçlü olan risk faktörü, tütün ve tütün mamulleri kullanımı. Özellikle genç yaş gruplarında sigara içiciliğinin artması, akciğer kanserinin görülme sıklığını da yükseltiyor. Pandemi döneminde ise bir başka artış gözleniyor. COVID-19’un akciğerlerde zatürre gibi sonuçlar doğurması, hastanelerdeki tomografi çekimini de artırdığı için, bu sayede teşhis edilen pek çok akciğer kanseri vakası var. Tedavi tarafında ise büyük ilerlemeler söz konusu. 

How High is the Success Rate of Lung Cancer Treatment?

With recent technological and medical advancements, lung cancer is no longer as difficult to treat as it once was. The scientific community is now able to better identify tumor cells with innovative medical technologies, leading to more successful outcomes in lung cancer compared to the past.

How Are Cancer Cells Destroyed?

Cancer cells take advantage of evolutionary survival mechanisms and can evade treatments like chemotherapy that target proliferating cells. To do this, they have the ability to slow down their division, or even enter a resting phase known as the G0 phase, where they do not divide at all. Cancer cells in this dormant state are not affected by chemotherapy and can even develop drug resistance and undergo mutations during this phase. As a result, they begin to divide again, contributing to the spread of the disease. This is the main mechanism behind the recurrence of tumors that initially shrink with chemotherapy.

As seen in breast and lung cancers, a cancer cell that has remained dormant for years can suddenly become active. Dormant cancer cells consume their own cellular components or proteins to survive (a process known as autophagy). However, the scientific community has developed solutions to target this dormant state of cancer cells as well. With new drugs that block autophagy, it is now possible to eliminate these dormant cancer cells.

Ways to Activate the Immune System Cells

Immunotherapy, which is based on directing immune system cells towards tumor cells, has been one of the major treatment approaches for many years. Many cancer cells use checkpoint molecules to evade the immune system, preventing warrior cells (T lymphocytes) from attacking normal body cells. Since cancer cells do not look different from normal cells, warrior cells do not recognize them as threats and do not attack. However, scientific studies since 2011 have made it possible for warrior cells to bypass these checkpoints and attack cancer cells. Seven immunotherapy drugs, known as "Immune Checkpoint Inhibitors," are now successfully used in many cancers, including lung cancer.

Adoptive Cell Therapy in Treatment

Adoptive cell therapy is a treatment approach based on increasing the recognition of cancer cells by immune cells. This involves placing genetic material into T-cells, which are then multiplied in the laboratory and returned to the patient. Known as CAR-T cell therapy, this method has led to significant successes in treating resistant lymphomas and leukemias, and trials have begun for lung cancer as well. These T cells, containing Chimeric Antigen Receptors (CAR), can recognize and destroy tumor-specific antigens. Another treatment option is Tumor-Infiltrating Lymphocyte (TIL) therapy. TILs are lymphocytes collected from around the cancer cell, which can be isolated from the patient, activated to recognize the tumor in the laboratory, and then returned to the patient.

How Effective Are Cancer Vaccines and Personalized Vaccines?

If a cancer-specific, recognizable antigen is present on the surface of the cancer cell, it is possible to activate the body’s immune system against that antigen. Vaccines developed against the NeuGmc and EGFR antigens found on the surface of cells in lung cancer are recognized by some national health ministries and are used as maintenance therapy in selected cases where tumor load has been reduced through chemotherapy. In addition, various peptide vaccines and messenger RNA vaccines are in Phase 1 and Phase 2 trials.

Smart Drugs Targeting Tumor-Specific Mutations

Lung cancers, particularly non-small cell lung cancers such as "Adenocarcinomas," often have genetic changes that are the treatment targets. These genetic mutations and changes are found in 1 to 35% of cases, and once identified, they can usually be blocked by orally administered tablet-form drugs. By targeting the genetic drivers of the tumor, these drugs help shrink the tumor. While initially, only smart drugs targeting genetic targets like EGFR, ALK, and ROS-1 were available, the number of available smart drugs has been increasing, and new targets are continuously being identified. With these drugs, patients with specific mutations can have their tumors controlled, even in advanced stages, thus extending their lifespan.