Unlocking the dawn of treatment for small cell lung cancer! Immunotherapy PD-L1 inhibitor combined with chemotherapy has been included in health insurance in December
More dangerous than cancer! Small cell lung cancer has a 5-year survival rate of less than 2%
According to the latest cancer registration report released by the Ministry of Health and Welfare, Health Promotion Administration, the number of lung cancer cases in Taiwan will reach 16,880 in 2021, surpassing colorectal cancer for the first time to become the top ten cancer cases. Among the pathological types of lung cancer, “small cell lung cancer” has an average 5-year survival rate of less than 2%. Current clinical trials have proven that immunotherapy combined with chemotherapy can significantly improve disease progression-free survival, with the 5-year survival rate significantly increased to 12%! The National Health Insurance Administration has included immunotherapy PD-L1 inhibitors combined with chemotherapy into the scope of payment for the treatment of small cell lung cancer in December 2023, benefiting more patients with small cell lung cancer.
Common pathological classifications of lung cancer include: lung adenocarcinoma, squamous cell carcinoma, large cell lung cancer, small cell lung cancer and other types. Among them, small cell lung cancer (SCLC) often grows in the central hilar position, and its growth rate is It is the fastest and easy to spread. It can be divided into “limited stage” and “diffusion stage” according to the progression of the disease. Once it enters the spread stage, the average 5-year survival rate is less than 2%, and its danger level even exceeds that of the “king of cancers” pancreatic cancer.
Dr. Zeng Zhengsen, director of the Lung Cancer Integrated Care and Research Center of Taichung Veterans General Hospital, said in an interview that small cell lung cancer accounts for about 6-7% of all lung cancers. It seems to be decreasing year by year, but the number of new diagnoses every year is still close to 1,000. The reason for the decrease is that Other pathological types of lung cancer are increasing. About 85-90% of small cell lung cancer is related to smoking. Literature research points out that small cell lung cancer has neuroendocrine characteristics, and its growth rate and malignancy are much higher than other types of lung cancer. More than 70% of small cell lung cancer has already spread when first diagnosed. “stage”, due to limited treatment options and unsatisfactory prognosis, it is regarded as one of the most malignant lung tumors.
Chemotherapy is only effective in the first line but relapses quickly! Small cell lung cancer faces treatment bottleneck
“Many small cell lung cancers are already in the metastasis stage when they develop, and often metastasize to the brain or other organs. Since emerging cancer treatments such as targeted drugs and anti-angiogenesis inhibitors have no significant effect on small cell lung cancer, first-line treatment is It is still mainly chemotherapy. Although the response to chemotherapy is good at first, once the disease relapses, the chemotherapy will almost lose its effectiveness. The tumor will grow quickly and start to spread everywhere. The survival time after recurrence is only about 4-5 months. "
Less than 5% of small cell lung cancer can be operated on. Except for a very small number of patients who have the opportunity to undergo surgery, most small cell lung cancer adjusts the treatment sequence based on whether it has spread. Dr. Zhengsen Zeng said that for limited-stage small cell lung cancer, the standard treatment is chemotherapy plus radiotherapy; while for diffuse-stage small cell lung cancer, chemotherapy is the main treatment, and adjuvant radiotherapy will be added as appropriate. Currently, nearly three-quarters of clinically diagnosed patients have spread-stage small cell lung cancer.
Dr. Zhengsen Zeng further explained that the priority options for chemotherapy for small cell lung cancer are mainly platinum-based drugs and another type of chemotherapy drugs that act on DNA isomerase, with an average response rate of about 60% to 70%; most small cell lung cancers will undergo chemotherapy after chemotherapy. , the tumor will have a significant shrinkage in response to treatment, but it does not last long, and drug resistance will soon appear. Once it attacks again, the response rate to later-line chemotherapy drugs will be very low.
The dawn of treatment for diffuse stage small cell lung cancer! Immunotherapy PD-L1 inhibitors will be covered by health insurance
“In the past, small cell lung cancer was only treated with chemotherapy. After the emergence of immunotherapy PD-L1 inhibitors and being covered by health insurance, a new dawn finally dawned! If there is no drug resistance problem after the standard course of treatment, it can also be used as continuous maintenance treatment, extending the anti-cancer front, and after passing the health insurance, eligible patients can receive help from immunotherapy without any burden!”
Dr. Zeng Zhengsen explained that the role of immunotherapy is to improve one’s own immunity, while the role of PD-L1 inhibitors is to block the binding of PD-L1 of cancer cells to the PD-1 receptor of immune cells, allowing immune cells to reactivate and destroy Tumor immune evasion awakens immune T cells to attack cancer cells, thereby slowing tumor growth.
Dr. Zhengsen Zeng pointed out that clinical studies have found that when small cell lung cancer receives chemotherapy combined with immunotherapy PD-L1 inhibitors, the response rate can be maintained at 60% to 70%, and it can effectively improve the survival rate, disease progression-free survival and prolong survival time. . According to recently updated research data, the five-year survival rate of chemotherapy combined with immunotherapy PD-L1 inhibitors can reach nearly 12%. Compared with the past five-year survival rate of less than 2%, the immunotherapy combination can bring significant benefits. The five-year survival benefit and the safety of continued medication are the most significant treatment advances for small cell lung cancer in the past two decades.
Combining chemotherapy with PD-L1 inhibitor to extend effective treatment time for small cell lung cancer benefit conditions
Dr. Zeng Zhengsen said that a patient with small cell lung cancer was admitted to the clinic. Because the tumor invaded the trachea and affected breathing, he first underwent surgery to remove part of the tumor and performed a tracheotomy to maintain breathing. Then he continued to use PD-L1 inhibitors and chemotherapy to help the patient. He recovered to the point where he could swallow normally and breathe on his own smoothly, and has been living a normal life for more than 3 years.
“Judging from the current clinical trials, PD-L1 inhibitors combined with chemotherapy for small cell lung cancer can be used as maintenance treatment as long as no drug resistance develops, prolonging the effective treatment time and affecting the patient’s long-term survival and quality of life. , have been significantly improved and helped!”
Dr. Zhengsen Zeng explained that the National Health Insurance Administration has started to include PD-L1 inhibitors combined with chemotherapy into the scope of payment for the treatment of small cell lung cancer on December 1, 2023. For patients with metastatic small cell lung cancer who have not previously received chemotherapy and are brainless, Small cell lung cancer patients with local or spinal cord metastasis will have the opportunity to apply for medication if they meet the qualifications. Patients with small cell lung cancer are encouraged to seize the opportunity to inquire with their attending physician.
Small cell lung cancer is highly related to smoking! Doctors reveal that improving physical strength and immunity is the key after diagnosis
The number of lung cancer cases ranks first among the top ten cancers, and it has been called the “new national disease”. Dr. Zhengsen Zeng emphasized that the vast majority of small cell lung cancer is related to smoking, and called on those with smoking habits to quit smoking as soon as possible. If they meet the risk factors of smoking history, family history of lung cancer, etc., they can use the early lung cancer detection program to receive low doses. Computed tomography scans can help detect small cell lung cancer or other early-stage lung tumors early.
If pathological biopsy and imaging examination confirm that it is small cell lung cancer, you should cooperate with your doctor’s advice as soon as possible and receive appropriate treatment. Dr. Zhengsen Zeng said that after PD-L1 inhibitors are included in the first-line health insurance benefits, in addition to encouraging patients to take active treatment, they also remind patients that the fight against cancer still relies on good physical support. Therefore, patients should pay attention to nutritional supplements and exercise appropriately, while maintaining good habits such as diligence. Wash your hands, wear a mask, and consult a doctor to evaluate influenza vaccine, pneumococcal vaccine, and shingles vaccine to reduce the risk of infection.
References:
Trends in incidence of small cell lung cancer and all lung cancer
Characterization of the cell of origin for small cell lung cancer
Research Progress of Immunotherapy and Prognostic Markers in Small Cell Lung Cancer
Institutes of Health: “TCOG Clinical Treatment Guidelines for Small Cell Lung Cancer”, page 14
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