Good news: a Nantes biotechnology company (OSE Immunotherapeutics) presented on September 11, the positive results of its therapeutic vaccine called Tedopi, in patients with advanced lung cancer. “VS’is the first cancer vaccine to show positive results on survival in patients with advanced or metastatic “non-small cell” lung cancer”, announces Professor Benjamin Besse, director of clinical research at Gustave Roussy (IGR, Villejuif).
Tedopi is what we call a “therapeutic vaccine”: cThese are immunotherapy injections that boost the immune system and help it defend itself against cancer cells. It is not intended for all patients who are diagnosed with lung cancer but for those who recur, with metastases that are resistant to existing treatments and who have already responded positively to immunotherapy.
The phase 3 clinical trial, the results of which were presented in the magazine Annals of Oncology show that this “vaccine” reduces the risk of death by more than 40% compared to chemotherapy. This represents an average survival gain of around 3 and a half months.
Lung cancer: how many cases in France?
Lung cancer is not uncommon; it is even the third most common cancer in France, with 46,363 new cases recorded in 2018. But be careful: “there is not one lung cancer, but several: it is a very heterogeneous disease“, immediately warns us Professor Nicolas Girard, pneumo-oncologist at the Institut Curie.
Indeed: if, as their name suggests, all lung cancers initially develop in the lungs, “the cancerous tumor itself can develop from different lung cells, which gives rise to very specific “types” of cancers” notes the specialist.
What are the types of lung cancer?
The most common lung cancer (it represents approximately 85% of cases in France) is non-small cell lung cancer : the malignant tumor then develops thanks to the anarchic multiplication of the cells of the glandular epithelium of the lung tissues (which are located on the exterior surface of the lung) or of the epithelial cells of the lung tissues (which line the interior of the lung ).
Then comes the small cell lung cancer (which represents 15% of cases in France and which is also called Small Cell Bronchial Cancer or SCLC) which develops from the neuroendocrine cells of the bronchi.
Lung cancer: what are the risk factors?
To know. Lung cancer affects a majority of men.although this disease is on the rise in women” notes Professor Nicolas Girard. The age at diagnosis is approximately 67 years for men, 65 years for women. “Lung cancer is very rare in children” specifies the pneumo-oncologist.
What are the risk factors for lung cancer? Unsurprisingly, “the” main risk factor for lung cancer, it’s tobacco. “Smoking is involved in approximately 80% of cases, and is the cause of the vast majority of small cell lung cancers.” underlines Professor Nicolas Girard.
“In smokers, the risk of developing lung cancer increases exponentially and is acquired over time. In short: stopping smoking “blocks” the progression of the risk but does not allow it to go down again” explains the specialist.
However, in France, 15% of lung cancers occur in non-smokers: “there are other risk factors which are rarer, notably occupational exposure to certain heavy metals, asbestos, arsenic, etc.” notes Professor Nicolas Girard.
Lung cancer: symptoms?
Unfortunately, in the majority of cases, lung cancer starts silently: there are no symptoms. Rarely, we may observe the appearance of a chronic cough, sometimes bloody sputum (hemoptysis), difficulty breathing (dyspnea or shortness of breath), repeated respiratory infections (bronchitis, pneumonia, etc.), loss of breath. appetite or even weight loss.
“In approximately 70% of patients, lung cancer is diagnosed at the metastatic stage, that is to say late, when the cancer has spread to organs other than the lungs.” explains Professor Nicolas Girard. In the case of lung cancer, we can thus observe the development of metastases in the brain, liver, bones or even the adrenal glands.“These metastases give symptoms”depending on their location“: it may in particular be a question of bone pain, convulsive attacks, paralysis, etc.
Lung cancer: towards organized screening?
“In France, there is unfortunately no organized screening for lung cancer: this is however the case in England, the Netherlands, Belgium, Canada and the United States.” notes the pneumo-oncologist.
“The French health authorities tend to adhere to this old belief according to which patients are “responsible” for their lung cancer because they smoked: however, we now know that smoking is an addiction, and therefore an illness.“According to the specialist, this organized screening would make it possible to reduce lung cancer mortality by around 25% in men and 40% in women.
Professor Nicolas Girard recommends lung cancer screening to people at risk: “You are at risk if you are over 50 and have smoked for/have smoked for over 25 years.“This screening takes the form of a chest scan.
Read also: Lung cancer: specialists call for the generalization of screening by scanner
Lung cancer: how is it diagnosed?
The diagnosis of lung cancer takes place in several stages: in addition to chest scan (“chest x-ray is useless in case of lung cancer” underlines Professor Nicolas Girard), the doctor will prescribe an extension assessment in order to know if there are metastases: these can be observed using a PET scanpossibly supplemented with a Brain MRI. “The diagnosis of lung cancer is confirmed using a biopsy” adds the specialist.
Lung cancer: what treatments?
If the cancer is detected before the metastatic stage, a surgery can be considered:concretely, this consists of removing the tumor and completing with chemotherapy” explains the specialist. The risk of relapse is high (it is around 50% within 5 years) but the survival rate is high; around 60% – 70% at 5 years.
“In case of metastatic lung cancer, genetic testing is absolutely essential” says Professor Nicolas Girard. The objective is to know if there is a targetable anomaly in the genes of the cancerous tumor: “if the genetic test highlights a targetable abnormality, we will be able to resort to a targeted treatment which will “turn off” the effects of the genetic mutation. If no particular abnormality is highlighted, treatment consists of immunotherapy which will “reactivate” the patient’s immune defenses against cancer. This immunotherapy can be supplemented with chemotherapy.“
Attention ! “When there is a targetable anomaly, immunotherapy is ineffective: that’s the whole point of genetic testing! The problem is that you have to look for genetic abnormalities to identify them. Currently, health authorities recommend looking for at least 4 anomalies out of the ten most common anomalies. Thus, too many patients are still treated with immunotherapy when targeted treatment could have been possible.“
[Mise à jour, 12 avril 2022] For the first time, an international phase 3 study (CheckMate-816) carried out in 358 patients with non-metastatic “non-small cell” lung cancer, shows the benefits of a combination of immunotherapies with chemotherapy, administered before surgery. Approved in March 2022 in the United States by the FDA, this new treatment significantly improves survival and reduces the risk of recurrence and death by almost 40%. Learn more about this major advance against lung cancer.
Lung cancer: what is the life expectancy?
Good news, two-year mortality has decreased in Francegoing from 79% in 2000 to 74% in 2010, then to 52% in 2020, according to results, not yet consolidated (study KBP-2020-CPHG), presented on Sunday January 29, 2023, during the French-language Pneumology Congress in Marseille. One-year survival increased from 40% in 2000 to 55% in 2020.
The rate of survival of lung cancer patients depends on the stage of the disease. “It is approximately 30 % if the cancer is metastatic and treated with immunotherapy; he is a bit higher in case of targeted treatment” replies the pneumo-oncologist.
Thanks to Pr. Nicolas Girard, pneumo-oncologist at the head of the Institut du Thorax Curie – Montsouris.
Sources:
- National Cancer Institute
- H. Hartmann Institute for Radiotherapy and Radiosurgery
- Randomized open-label controlled study of cancer vaccine OSE2101 versus chemotherapy in HLA-A2-positive patients with advanced non-small-cell lung cancer with resistance to immunotherapy: ATALANTE-1Annals of oncology, September 2023
Read also :
- Lung cancer: a web series to better understand the disease
- Blood test could predict lung cancer 5 years before diagnosis
