In India, lung cancer constitutes 6.9 percent of all new cancer cases and 9.3 per cent of all cancer related fatalities. On the occasion of the lung cancer awareness month observed from November 1 to 30, oncologists see oral drugs replacing surgeries, but its prohibitive costs are a deterrent.

Two types of lung cancer, which grow and spread differently are small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). Cigarette smoking is the principal risk factor. Immunotherapy with checkpoint inhibitors that target the PD-1 and PD-L1 pathway are major therapeutic breakthroughs. These drugs improve the survival of NSCLC patients, not responding to traditional therapies. The challenge is when patients come in the 3rd/ 4th stage, said Dr. C N Patil, Consultant Oncology, Apollo Hospital, Bengaluru.

“There is a paradigm shift in treatment from surgery to newer molecules for some varieties of lung cancer. These EGFR Receptors: Erlotinib, Gefitinib, crizotinib Afatinib or Anaplastic Lymphoma Kinase (ALK) mutations consumed orally are less toxic compared to chemotherapy. Targeted therapies like angiogenesis inhibitors, poly ADP-ribose polymerase (PARP) inhibitors, Bcl2 inhibitors, histone deacetylase inhibitors, proteasome inhibitors work well as second-line therapy”, said Dr Madhu Y C, Senior Consultant, Surgical Oncologist, BGS Gleneagles Global Hospitals.

Dr Ashish Kaushal, Director, Medical Oncology, HCG Cancer Centre, Ahmedabad, said that 80 percent of NSCLC histology present with advanced stage (IIIB/IV) at the time of diagnosis but are managed non-surgically. Challenges are misdiagnosis for tuberculosis, poor health awareness and lack of good screening tests. HCG has initiated smoking cessation programs and awareness camps. The strategy to improve survival is early diagnosis and timely referrals to comprehensive cancer care centres.

According to Dr. Vijay Chandru, CMD, Strand Life Sciences said lung cancer is the fourth major cancer in India and 30 percent manifest with mutations in the EGFR gene and treated successfully with new-generation drugs. Moreover the drug response on patients can be tracked using our liquid biopsy which helps oncologists make rapid changes to manage the therapy effectively.

Dr Chirantan Bose, Vice-President, Clinical Services, MedGenome said besides smoking, inherent and acquired genetic predispositions are implicated in the etiology of lung cancers. Our ‘Oncotrack’, helps identify genetic alterations, treat and monitor cancers of lung and colon. It indicates drug resistance, tumor burden and recurrence, much earlier than conventionally detected by radiological scans.

Dr. Neelesh Reddy, Senior Consultant Medical Oncologist, Columbia Asia Hospital, Bengaluru said that the main challenge is to perform tests like, Immuno histochemistry, EGFR, ALK, PDL1, ROS1. If patients are positive to these markers, chemotherapy is avoided and targeted treatment is administered. Another issue is the exorbitant treatment cost for each immunotherapy session.

Dr Niti Raizada, Senior Consultant Medical and Haem – Oncologist, Vikram Hospital, Bengaluru stated that screening of healthy but chronic smokers is important, because this subset has proven scientific evidence in favour of performing ‘Screening Low Dose HR-CT scan of chest’ to detect suspicious lesions.

According to Dr Gaurav Thukral, Executive Vice President and COO, HealthCare atHome, in advanced lung cancer who opt for healthcare at home, they need assisted ventilation. In early stages, for those showing improvement but need oxygen therapy, we provide light weight aluminium oxygen cylinders allowing patients to move around. We conduct health checks at companies for early detection. However the need of the hour is to ban smoking, make cigarettes expensive and unaffordable.