[ Inglese] Understanding Treatment Modalities for Lung Cancer

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Topics include: Treatments

When diagnosed with lung cancer, patients can be enveloped and overwhelmed with many emotions and might find it hard to ground themselves in their personal fight. Treatment options are, most often, the next step that patients must center themselves around, which can be more overwhelming than the diagnosis itself. Patients must learn the modalities of their cancer and find the right treatment for their situation. Listen as Dr. David Carbone and Dr. Scott Antonia offer detailed and sound descriptions of targeted treatment. Dr. Carbone discusses the treatment that is offered and how it works systemically to fight the growth, and Dr. Antonia goes on to discuss treatment aids for common side effects. 

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Okay. I want to mention that in your packet, there’s a wealth of information. And there’s this really cool info graphic that Dr. Carbone reviewed for us. And so very graphically, if you look, it kind of shows you the different types of lung cancer, the incidents of lung cancer, and the different approaches that are developing.

David, take us through the treatment. Well, let’s just see, how many people here, Bob, I’m just going to see what’s going on with the audience here. How many people have had surgery? Lots of people. Okay. How many people have had radiation?  Lots of people. How many people have had chemo? And how many people have had immunotherapy?  Okay.  Did I get it right? Okay.

All right. David, so we’re going to talk about—and then I mentioned targeted therapy. Just so people know, when you were mentioning like the EGFR and different things, targeted therapy, angiogenesis, what would be some of those drugs just so people know?

Dr. Carbone:       

Well, those are different. So angiogenesis is that blood vessel therapy, the therapy directed at growth factors that grow blood vessels into tumors. So if you can affect the blood flow into the tumors, you can affect their growth.

So that’s a separate category.  And then there are the molecularly targeted agents.  And those are the ones that are directed at those specific mutations in those driver genes. Really, all of our treatment is targeted in some way.  So we really classify it as molecularly targeted therapy. And then separately, a separate modality, anti-angiogenic therapy, which is the anti-blood vessel therapy.

Andrew Schorr:                  

We have a list of these drugs you’re going to see. But I just want to skip back for a minute to the classes.  So people have had surgery, David.  A lot of people have had radiation. A lot of people have had chemo. A few people may be in trials.  They’re starting to have immunotherapy.  So does it all work together? Is there still a place for surgeries like cutting it out? Radiation is burning it out. And then you have chemo is kind of poisoning it. And then you have these other kinds of treatments.  But is there still a place for everything?

Dr. Carbone:       

So that list of treatment modalities that was on the screen a minute ago, you shouldn’t think of them as this one is better than that one. They’re all tools that we have available to treat lung cancer. And it’s up to people experienced in lung cancer oncology to use the right tools just like a mechanic would want to use the right tools in the right situation.  Sometimes surgery is the best treatment.

And it’s something to hope for. If you can take it out, and it’s gone, then that’s the best treatment of all because it’s done with. But very often, we use combinations of these tools, surgery and radiation, surgery and chemotherapy, chemotherapy and immunotherapy. And with increasing numbers of tools, treatment becomes increasingly complicated. And so that’s why referral to a specialist is a good idea.

Andrew Schorr:                  

Is chemo a dirty word? Or it still has a place? Because a lot of people say they suffered from side effects that have come from the chemo. Can I avoid that totally?

Dr. Carbone:       

Sometimes, you can. But if it’s recommended to you, it’s something that you should take.  I’ve been through multi-agent chemotherapy.  And I know there’s no way to convey how bad you feel sometimes during chemotherapy. We can talk about it as a doctor. But until you go through it, it’s difficult to understand. But the fact is that we’ve shown, over the years, chemotherapy definitely improves outcomes in specific situations such as when combined with radiation in stage III lung cancer. And so if it’s recommended and has been shown to be an improved survival, I think it’s an important part of our toolbox.

Dr. Antonia:        

Let me just add that part of what we’ve been doing in the past two decades is discovering chemotherapy drugs that have roughly the equivalent efficacy but much less toxicity.

So Evy here, Evy has been on chemotherapy for three years, two years, a long time, no side effects, feels well, and is living with stage IV lung cancer.  Lillian, lots of people here in the audience, very few side effects for some of these. David is absolutely correct.  There are some people who have bad side effects. But a lot of people don’t. And a lot of people derive huge benefit, the people I just pointed out in the audience living with this disease on chemotherapy for years.

Dr. Carbone:       

And we have much better drugs to control the side effects right now, too.  When I first started, cisplatin (Platinol®) was a terrible drug. And now, many people get it with very few side effects, because of the medicines we have.

Dr. Antonia:        

So you have nausea drugs. You have drugs to help people with weight loss where they don’t have an appetite, so now they’re feeling better. 

Dr. Carbone:       

So one point that was made a little earlier about calling your doctor is one that I make when I start my patients on chemotherapy. And that is if you’re feeling sick, call and talk to us because we have many drugs to help with those symptoms. And the worst thing you can do is sit at home and suffer with side effects and not call your doctor’s office.

Andrew Schorr:                  

Now, here’s a list of chemotherapy drugs we have on the screen now. So people may be familiar with some of these.  And sometimes it’s an alphabet soup. Let me ask you this, Scott.

Often people get more than one drug together. What’s the idea? Are they acting differently like one goes to the cancer cell and hits it in the mouth, and one hits it in the stomach? And you’re just trying to surround the cancer cell with this cancer-killing combination. 

Dr. Antonia:        

That’s exactly correct. So each of these classes of chemotherapy drugs has a different mechanism of action. It hits a different part of the cell to produce the death in that cell.

So a combination, not all the time, but combinations can be better. And we know, in lung cancer, it’s two drugs, at least in the first-line setting, that are best. And one of those drugs really should be platinum.  But also, single-agent drugs, single agents have activity as well and less toxicity. And it’s very common or most common that we just give single drugs after doublet drugs stop working.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on June 3, 2015