JULIA ROTOW: The current lung cancer screening guidelines, and here I'm quoting the US Preventive Services Task Force guidelines, recommend lung cancer screening for people at high risk, defined by cumulative years of tobacco use and age. The current guidelines, published in 2021, recommend screening for people aged 50 and over, so 50 to 80 years, with at the least 20 pack-years of tobacco use. And which means either one pack of cigarettes a day for 20 years, two packs a day for 10 years, and so forth.
And that's considered high risk, and annual low-dose CT screening is really helpful. We know that by doing this screening, we will reduce the danger of death from lung cancer by detecting lung cancer early when it's more treatable. This improves the probabilities of survival.
Unfortunately, lung cancer screening could be very low on this country. And many studies show that only 15 to 30 percent of people who find themselves eligible for lung cancer screening actually participate. That's a missed opportunity to detect lung cancer at an early stage, especially given the various advances we're seeing in treating early-stage lung cancer.
RAMI MANOCHAKIAN: My name is Dr. Rami Manochakian. I’m a thoracic oncologist and associate professor of drugs on the Mayo Clinic in Florida. We are here today on the ASCO annual meeting. This is the annual meeting of the American Society of Clinical Oncology, where annually recent developments and advances in cancer research and cancer treatment are presented.
I'm here today to let you know a couple of large clinical trial, the outcomes of which the investigators presented yesterday in what’s generally known as a plenary session, some of the vital sessions of this conference. This trial is taking a look at patients with early-stage lung cancer, specifically stages one to a few, when the cancer remains to be curable.
It's a gaggle of patients whose cancer has a specific cancer driver. We call it a mutation, specifically an EGFR mutation. It's considered the driving force of cancer growth. And for those patients, this trial checked out whether or not they could possibly be given targeted therapy after surgery to remove their tumors, a drug called osimertinib, which is already approved and used for patients with advanced lung cancer with this mutation. But it checked out whether it could possibly be given to them early on, after they have early stage cancer and are having surgery, to see if it could actually make a difference.
It's a big study with a whole bunch of patients. This study tried to present these patients either this drug or a placebo over a three-year period to see if it made a difference. The study results were actually published a couple of years ago and it showed a difference. It showed a major difference. It showed that it delayed the cancer coming back after surgery.
But yesterday the outcomes focused on updated overall survival data. So did giving this drug make a difference in whether patients live longer? And indeed the study results were positive and exciting. They showed that once we have a look at all of the statistics and evaluation, patients who take this drug do higher. And this drug is definitely effective in prolonging life.
JULIA ROTOW: The first step is to refer to your primary care physician. That's a terrific opportunity to speak about whether lung cancer screening is likely to be helpful for you as a person. And our physicians really wish to refer to their patients about that to lower their risk, identical to you’d speak about colonoscopies or mammograms or prostate cancer screenings.
Our current guidelines for lung cancer screening don’t capture all the individuals who could also be at high risk, and there are some abstracts and presentations at ASCO this yr that address this point. For example, we all know that there are racial and ethnic disparities in each access to lung cancer screening and eligibility for screening under the present guidelines. And there are ongoing efforts to supply more risk-adaptive scores or more risk-adaptive strategies to know lung cancer risk.
I need to spotlight a lung cancer screening study being presented at this yr's ASCO, led by Dr. Elaine Shum at NYU. This study is taking a look at implementing lung cancer screening with three annual CT chest scans in young Asian women who’ve never smoked, so starting at age 40, which is even sooner than our standard guidelines, and in individuals who have never smoked or smoked little or no – again, an unusual population for our broader national guidelines.
And that speaks to the high risk of lung cancer in Asian Americans. Lung cancer is the leading reason for cancer death on this population. They have the next rate of those effect-dependent driver mutations, similar to EGFR.
And at this ASCO, Dr. Shum will likely be presenting in one among the following sessions some preliminary results from the primary 200 patients who were within the trial. And here they found a 1.5% lung cancer rate on this young, nonsmoking patient population. And all the lung cancers that they identified were EGFR-mutated and will receive adjuvant EGFR-targeted therapy. That shows how vital it’s to think not only about our traditional high-risk patient population that absolutely should get 100% screening if we could achieve it, but additionally about these other, less common patient populations that may still profit from potential screening strategies.
JULIA ROTOW: EGFR is a protein that sits inside tumor cells. It's called epidermal growth factor. When it's energetic, it tells cells to grow and divide. In lung cancer cells, a mutation could make it abnormally energetic, turning it on when it shouldn't. And that, we all know, contributes to lung cancer development and growth and survival. And by targeting EGFR with EGFR inhibitors that may turn off this protein and stop this survival signal, you possibly can improve the prognosis for patients with this subtype of lung cancer.
People diagnosed with early-stage lung cancer—lung cancer that may potentially be surgically removed and thus cured—have quite a lot of treatment options available before or after surgery to scale back the danger of reoccurrence and improve the prospect of survival.
This includes so-called neoadjuvant therapy, i.e. preoperative therapy, often chemotherapy or immunotherapy, for instance with immune-stimulating drugs, or adjutant therapy. And that is postoperative therapy, i.e. therapy after recovery from the operation, which can also be intended to scale back the danger of a relapse in the longer term.