Lung cancer may become a chronic, even curable, disease: a new chapter in the treatment of this cancer is opening
The key to victory in the fight against the most common malignant tumor in humans, lung cancer, is primarily its early detection, but also precise diagnosis, access to innovative therapies and an interdisciplinary approach to treatment - emphasized experts participating in the debate "The road to curing lung cancer - challenges and hopes", organized by the Polish Press Agency on the eve of World Lung Cancer Day on August 1.
Lung cancer remains the most common malignancy in Poland , with over 23,000 people diagnosed with it each year. For decades, the disease had a very poor prognosis, but experts emphasize that recent years have brought a breakthrough. Thanks to modern molecular diagnostics, targeted therapies, immunotherapy, and better treatment management, more and more patients have the chance for a long life and even a complete recovery.
This was the case for Piotr, a 57-year-old former Polish national hockey player who wore the eagle jersey 80 times over the years. Last year, he was diagnosed with small cell lung cancer (SCLC), a cancer considered exceptionally aggressive and difficult to treat.
"Looking back, I know I was incredibly lucky," says Piotr. "I didn't have any obvious symptoms. Just a cough, which my wife noticed. She was the one who insisted I see my family doctor. If it weren't for her perceptiveness, I would have ignored it for a long time."
The primary care physician ordered a chest X-ray. The test revealed a 6 cm tumor.
Experts participating in the debate unanimously emphasized that detecting lung cancer at an early stage significantly increases a patient's chances of both a longer life and a return to daily activities. Unfortunately, currently, only 15–20% of patients are diagnosed early enough to receive radical treatment (usually surgery). In most patients, the cancer is detected too late.
– Incorporating low-dose computed tomography (LDCT) into periodic occupational health check-ups – especially in long-term smokers – could significantly increase the detection rate of lung cancer – emphasizes Aleksandra Wilk, director of the office of the Federation of Amazon Associations.
In Mr. Piotr's case, time was of the essence. Despite a quick diagnosis, the full diagnostic process at the Military Medical Academy University Clinical Hospital took approximately two months. During this time, the tumor doubled in size—from 6 to 12 cm—which prevented simultaneous radiotherapy and chemotherapy. A staged approach was chosen.
"After two infusions of chemotherapy, the tumor shrank to less than 5 cm, which allowed me to begin radiotherapy. I had 40 chest radiation sessions and 10 head radiation sessions to minimize the risk of brain metastases," the patient reports.
Thanks to the support of the medical team, Mr. Piotr also received access to modern immunotherapy under the Emergency Access to Drug Technologies Program (EDTP). Two months later, a CT scan revealed the tumor had disappeared.
– Immunotherapy acts as a consolidation of the effects of radiochemotherapy – says Prof. Damian Tworek from the Clinic of General Pulmonology and Oncology, Medical University of Lodz.
As experts emphasized, this method – as a consolidation therapy – can almost double the overall survival of patients with limited-stage SCLC, from 33 to 56 months. This is the greatest progress in 40 years.
"We're at a turning point in SCLC," adds Dr. Katarzyna Stencel, MD, from the Greater Poland Pulmonology Center. "New opportunities are also opening up in non-small cell lung cancer (NSCLC). Consolidation therapy with a third-generation tyrosine kinase inhibitor in patients with an EGFR mutation can extend progression-free survival from 5.5 to 39 months."
– Lung cancer is not one disease, but a group of cancers with different genetic profiles – explains Prof. Andrzej Tysarowski, head of the Department of Genetic and Molecular Cancer Diagnostics at the National Institute of Oncology.
That's why it's so important to conduct comprehensive molecular diagnostics (CGP), preferably using NGS (next-generation sequencing) technology. Meanwhile, in Poland, single-gene diagnostics still dominate, which consumes tissue material, often preventing further analysis. An alternative might be a liquid biopsy (ctDNA)—a blood test that allows for qualification for targeted therapies. However, its potential remains untapped due to systemic barriers and funding issues.
Experts emphasize that access to modern therapies in Poland is improving, although many solutions still operate only within the framework of RDTLs or clinical trials. It is also necessary to formally recognize Multidisciplinary Therapeutic Teams (MDTs) as an element of active treatment and ensure their full availability, including in a hybrid format.
"I can't imagine treating a patient today without an MDT panel. Each case must be individually assessed by a thoracic surgeon, oncologist, radiation oncologist, geneticist, and pulmonologist," emphasizes Dr. Stencel.
Although representatives of the Ministry of Health did not participate in the debate, experts agreed that further progress in lung cancer treatment requires close cooperation with the Ministry of Health – especially in terms of faster diagnosis, financing of modern therapies and formalization of MDT.
First, prevention, then rapid diagnosis and access to effective therapies," concluded Aleksandra Wilk. "This is a path that offers a real chance of curing patients like Piotr."
She added that only about 15-20% of patients with lung cancer are diagnosed at an early stage, with the potential for radical treatment (surgery). In the remaining patients, approximately 80%, the disease is already advanced at the time of diagnosis.
According to Aleksandra Wilk, including LDCT in periodic examinations in occupational medicine – especially for long-term smokers and people occupationally exposed to contact with carcinogenic substances – could significantly increase the detection rate of the disease, reduce treatment costs and save the lives of hundreds of patients every year.
Lung cancer is not a single disease, but a group of tumors with different genetic profiles, which is why it is crucial to understand its molecular characteristics already at the diagnosis stage, explained Prof. Andrzej Tysarowski , head of the Department of Genetic and Molecular Cancer Diagnostics, National Institute of Oncology - National Research Institute in Warsaw.
In his opinion, genetic diagnosis should be a mandatory element of the treatment process, regardless of the stage of the disease.
"Unfortunately, the country still lacks systemic records that would require comprehensive molecular testing," noted Prof. Tysarowski.
In Poland, single-gene tests dominate, consuming valuable tissue material, often preventing further analysis. The solution is comprehensive genomic profiling (CGP) using NGS technology, which allows for simultaneous testing of multiple markers. In the absence of tissue material, a liquid biopsy (ctDNA) from blood can be performed, which may be the only chance of qualifying for innovative, targeted therapy. Unfortunately, as experts emphasize, due to problems with appropriate access and billing, the potential of this test remains untapped.
Experts agree that one of the key elements should be broader public funding for liquid biopsy. Using this method not only brings tangible clinical benefits but also enables more effective management of the patient's treatment process.
Although representatives of the Ministry of Health did not participate in the debate, experts unanimously emphasized that further progress in the diagnosis and treatment of lung cancer requires close cooperation with the Ministry of Health and that it is urgent to standardize the diagnostic process.
Mr. Piotr has just undergone a comprehensive diagnostic procedure. In the case of small cell lung cancer, it's particularly clear how crucial time is and how quickly the disease progresses.
"The diagnosis was performed at the Military Medical Academy University Clinical Hospital, where I am currently undergoing treatment. The full diagnosis took about two months, and the disease progressed until chemotherapy began," the patient explained.
During this time, the tumor increased in diameter from 6 to 12 cm, which disqualified Mr. Piotr from receiving the optimal combination of radiotherapy and chemotherapy. The decision was made to pursue chemotherapy alone.
"The initial chemotherapy proved effective. After two infusions, the tumor shrank from 12 cm to just under 5 cm. This allowed me to begin radiotherapy. I had 40 chest X-rays. Then, as a precaution, I had 10 head X-rays to minimize the risk of metastases. The doctor explained that this type of cancer often metastasizes to the central nervous system," Piotr reported.
Additionally, they continued to explore the possibility of incorporating additional treatment methods, such as modern immunotherapy, which, unfortunately, is not reimbursed in Poland. However, thanks to his doctor's support, Piotr gained access to this treatment through the Emergency Access to Drug Technology Program, and two months later, a CT scan revealed the tumor had disappeared.
"Immunotherapy really improves treatment outcomes. It sort of solidifies what we achieve with radiochemotherapy," said Dr. Damian Tworek, MD, PhD, professor at the Department of General Pulmonology and Oncology, Medical University of Lodz, who treated Mr. Piotr.
During the debate, it was agreed that modern therapies could transform patient outcomes. After decades of stagnation in the treatment of small cell lung cancer (SCLC), which accounts for approximately 15% of all lung cancer cases, a real opportunity has emerged to shift the treatment paradigm.
"The latest research results have shown that the use of immunotherapy as a consolidation treatment after radiochemotherapy for limited-stage SCLC almost doubles the overall survival of patients – from 33.4 to 55.9 months. This is the first such significant advance in almost 40 years, which can transform a diagnosis from a 'death sentence' into a disease that can be controlled or even cured," explained Katarzyna Stencel, MD, PhD, clinical oncologist and head of the Clinical Department with the Daytime Chemotherapy Unit at the Greater Poland Center for Pulmonology and Thoracic Surgery.
In the second subtype of lung cancer, non-small cell lung cancer, new curative options are also opening up for stage III patients with EGFR mutations. Consolidation therapy with a third-generation tyrosine kinase inhibitor demonstrated a nearly eight-fold increase in progression-free survival (from 5.5 to 39 months) and a significant reduction in the risk of brain metastases.
"These are long-awaited opportunities for curative therapy for patients who have not had such an option before. This is a therapeutic turning point for SCLC, while the results for NSCLC presented at the 2024 ASCO Congress were received with a standing ovation. This demonstrates the enormous hopes the medical community has for modern lung cancer therapies," emphasized Dr. Damian Tworek, MD.
According to Dr. Katarzyna Stencel, MD, PhD, access to modern therapies in Poland is quite good.
"When it comes to access to medicines in Poland, we have nothing to complain about, as most therapies are available, if not through drug programs, then in early access programs or through the Regional Drug Registry (RDTL), or we also have clinical trials. However, it would definitely be better if all therapeutic options were available through drug programs, because then access would certainly be faster and easier," the expert pointed out.
The importance of the Multidisciplinary Therapeutic Team (MDT) was also highlighted, where a team composed of a thoracic surgeon, oncologist, pathologist, radiotherapist, geneticist, and pulmonologist, among others, makes decisions about the optimal treatment path for the patient, ideally at each new stage of treatment.
Experts emphasize that for MDT to fully fulfill its function, it is necessary to formally recognize it as an element of active treatment, appropriate pricing of services and ensuring the availability of all necessary specialists - also in a hybrid formula, combining in-person and remote consultations.
"I can't imagine qualifying patients for treatment today without this consultation, because sometimes we have several therapeutic methods to choose from. You really have to consider which of these methods will be best for the patient, and each specialist, whether a thoracic surgeon, radiation therapist, or oncologist, can comment on whether they will use a given treatment option, but together we have to make the decision on which of these options will be most appropriate for the patient," said Dr. Katarzyna Stencel, MD.
"First, prevention, detecting as many cases as possible at an early stage, when we can cure the patient, then proper diagnostics, i.e. appropriate consultations, highly specialized centers that will accelerate the diagnostic process necessary to start treatment and, of course, expanding the drug program," summed up the discussion, director Aleksandra Wilk.
Source: PAP Health Service
Updated: 01/08/2025 18:30
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