Targeted Therapy in Lung Cancer
Dr. E. Prasad is a Medical and Radiation Oncologist trained at Christian Medical College, Vellore and Madras Medical College, Chennai. He is also actively involved in clinical research activities including studying molecular pathways in brain tumours and clinical trial of targeted therapy drug Trastuzumab in advanced breast cancer. He provides medical care for cancer patients at various hospitals at Chennai including Comprehensive Blood and Cancer Centre, Billroth Hospitals and HCG-Kavery Oncology Institute.
Today’s interview is about the role of targeted therapy in lung cancer.
1) What is targeted therapy and how has it improved outcomes in lung cancer?
Targeted therapy of lung cancer refers to using drugs specifically targeting molecular pathways responsible for, or those substantially drive, the growth of lung cancer cells, and as a consequence cause fewer toxic effects on normal cells.
2) How is targeted therapy different from conventional chemotherapy?
As of now, there are available as injectable and as oral drugs with least or minimal side effects. Moreover since these drugs are specifically targeting, cancer cell kill is relatively greater compared to normal cell kill.
3) Who are the candidates for targeted therapy?
Generally, non-smokers and females are the ideal candidates for starting targeted therapy. However, patients need to be selected based on molecular analysis of expression of specific markers before starting therapy. Patients with EGFR mutations, ALK gene rearrangements, BRAF, HER 2, ROS 1, RET and MET gene amplifications are candidates for targeted therapy.
4) To what extend does targeted therapy improve survival in advanced stage 4 lung cancer?
The median overall survival achieved with commonly used targeted therapy is 9 - 12 months.
5) Is there any role for targeted therapy in early stage lung cancer (stage 1 and 2)?
Presently targeted therapy is indicated only in stage 4 disease. Clinical trials are under way to demonstrate role in early stages.
6) How much does targeted therapy cost per month in India?
It varies from Rs 4000 per month to Rs 150,000 per week depending upon the chosen drug.
7) How long do you continue with targeted therapy?
Targeted agents are usually continued until disease progression or intolerable drug toxicity is encountered.
8) What options do we have if resistance develops to first line of drugs used in targeted therapy?
A second line agent is chosen depending upon the disease status, performance status and molecular changes.
9) What are the future prospects in the field of targeted therapy?
There are numerous drugs which are being experimented in clinical trials.
10) What are the common adverse effects of targeted therapy?
Like chemotherapy, the side effects of targeted therapy depend on the drug and dose. Side effects can differ even when treating the same target. Common and rare severe side effects are documented for treatments that target EGFR, ALK, and VEGF. All the possible side effects of targeted therapy cannot be listed here. You may ask your treatment team for a complete list of common and rare side effects. If a side effect bothers you, tell your treatment team. There may be ways to help you feel better.
M.B.B.S., D.M.R.T., M.D (Rad Onc)., D.M (Med Onc)
Fellowship in Brachytherapy (USA)
International Gynec Oncology Fellow (IGCS, USA)
Consultant Medical Oncologist
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