Lung cancer is one of the most common forms of cancer worldwide and was considered virtually incurable for decades. However, medical advances in recent years – particularly in personalized medicine – have fundamentally changed this diagnosis. New approaches in diagnostics and therapy are increasingly making it possible to treat lung cancer as a chronic illness treatment.
Modern drug-based tumor therapies, targeted treatment approaches based on molecular markers and the integration of innovative procedures such as immunotherapy have significantly improved the prognosis for many patients. With the right therapy, patients can not only survive for a long time, but in many cases lead an almost normal life.
This article highlights the latest developments in the diagnosis and treatment of lung cancer – with a particular focus on predictive markers, targeted therapies and the role of personalized medicine.
Lung cancer: A new era of personalized treatment
From universal therapy to individualized medicine
Lung carcinomas are no longer a homogeneous disease, but a spectrum of different subtypes defined by their molecular characteristics. Thanks to the analysis of predictive markers, it is now possible to develop tailored therapies that specifically target the genetic changes in the tumor.
Predictive markers in lung cancer
Molecular tests enable the identification of specific genetic changes or proteins that serve as predictive markers. These markers determine which therapies are most effective and have a positive influence on the prognosis.
EGFR (Epidermal Growth Factor Receptor)
- Mutations in the EGFR gene are detectable in around 10-15% of NSCLC (non-small cell lung cancer) patients.
- Therapy options: Tyrosine kinase inhibitors (TKIs) such as osimertinib, gefitinib and erlotinib block the EGFR signaling pathway and inhibit tumor growth.
- ALK (Anaplastic Lymphoma Kinase)
- ALK translocations occur in about 5 % of NSCLC patients.
- Therapy options: ALK inhibitors such as crizotinib, alectinib and lorlatinib show high efficacy in ALK-positive tumors.
ROS1
- ROS1 rearrangements are rare, but important markers for targeted therapies.
- Drug: Crizotinib is particularly effective in ROS1-positive tumors.
KRAS
- KRAS mutations, in particular KRAS G12C, are found in around 25 % of NSCLC patients.
- therapy option: Sotorasib is a specific KRAS-G12C inhibitor.
PD-L1 (Programmed Death-Ligand 1)
- PD-L1 expression on tumor cells correlates with the response to immunotherapies such as pembrolizumab and nivolumab.
BRAF, MET, HER2 and NTRK
- Other markers such as BRAF V600E mutations, MET exon 14 skipping mutations or HER2 amplifications enable targeted therapies. TRK inhibitors (e.g. larotrectinib) are used for NTRK fusions.
Modern drug-based tumour therapy: individualized approaches
Targeted therapies
The introduction of targeted drugs has revolutionized the treatment of lung cancer. These therapies specifically target molecular changes that drive tumor growth.
- Tyrosine kinase inhibitors (TKIs): Block signaling pathways that are activated by mutations in genes such as EGFR, ALK or ROS1.
- Angiogenesis inhibitor: Bevacizumab prevents the formation of new blood vessels that tumors need for their growth.
Immunotherapies
Immunotherapies use the body’s own immune system to attack cancer cells. Checkpoint inhibitors such as pembrolizumab, nivolumab or atezolizumab inhibit the immune blockade of tumor cells and thus strengthen the body’s natural defences.
Advantages:
- Extended survival times, even in metastatic lung cancer.
- Fewer side effects compared to classic chemotherapy.
Chemotherapy
Although chemotherapy is increasingly being supplemented by targeted therapies and immunotherapies, it remains an important part of treatment – especially for patients without specific molecular markers.
- Platinum-based regimens: Cisplatin and carboplatin are proven standard therapies in first-line treatment.
Diagnostics: the key to personalized treatment
The choice of optimal therapy depends on precise diagnostics. Modern methods make it possible to characterize tumours at a molecular level and adapt targeted therapies individually.
Important diagnostic procedures
Imaging
- Low-dose CT, PET-CT and MRI for staging and monitoring.
Tissue and liquid biopsies
- Tissue sampling for histological and molecular analysis.
- Blood tests (liquid biopsies) that analyze circulating tumor DNA (ctDNA) offer a non-invasive alternative.
Biomarker testing
- Tests for EGFR, ALK, ROS1 mutations and PD-L1 expression.
Combination therapies: The interdisciplinary approach
The best results are achieved through a combination of different therapies. Interdisciplinary teams develop individually tailored treatment plans that combine surgical, medical and radiotherapeutic approaches.
Examples of treatment strategies
- Early stage: Minimally invasive surgery (e.g. Uniportal-VATS) with adjuvant therapy.
- Advanced stage: Immunotherapy plus targeted drugs.
- Oligometastasis: Combination of surgical resection, drug-based tumor therapy and radiotherapy.
Living with lung cancer: Chronic, not fatal
Thanks to advances in therapy, many patients with lung cancer can lead an active life. Long-term aftercare and supportive measures are crucial:
- Respiratory therapy: Promotes lung function.
- Psychological support: Reduces anxiety and strengthens resilience.
- Nutritional advice: Supports regeneration and strengthens the immune system.
Conclusion: hope and prospects
Lung cancer is no longer a death sentence. Advances in personalized medicine and targeted therapies have sustainably improved the prognosis. With interdisciplinary approaches and the use of predictive markers, patients can lead long and fulfilling lives.
