Preventing recurrence of lung cancer, preventing recurrence after lung cancer surgery, how to prevent recurrence of lung cancer, how to prevent recurrence of lung cancer.
Lung cancer is the leading cause of cancer-related mortality worldwide. For patients with early (stage I and II) non-small cell lung cancer (NSCLC) and some suitable patients with locally advanced (stage IIIA) non-small cell lung cancer, complete surgical resection of tumor lesions is the best treatment method. Although advances have been made in early diagnosis and treatment and have effectively improved survival rates, postoperative recurrence remains an important issue.
After surgical resection, 30% -75% of lung cancer patients will relapse, including about 15% of patients with stage I lung cancer. Most recurrent tumors occur in distant lesions, and more than 80% of recurrent lung cancers occur within the first two years after resection.
Recurrence is an important reason for the failure of many lung cancer patients to fight against cancer. How to avoid recurrence after surgery is a topic of concern for every patient and family.
What is cancer recurrence ?
Cancer recurrence is defined as the recurrence of cancer in a treated cancer patient after a period of remission or no signs of cancer. Cancers that are found within three months of the original diagnosis are generally considered cancer progression. Cancer metastasis refers to the phenomenon that cancerous tissues metastasize from the primary lesions in the lungs to other organs, and grow and proliferate in the organs.
Recurrence can be divided into three cases according to the different locations of recurrence:
1. Local recurrence-the lesion is still in the lungs, next to the original lesion;
2. Regional recurrence-when the lesion recurs in the lymph nodes near the original tumor;
3. Distal recurrence-when a lung cancer relapses in the bones, brain, adrenal glands or liver.
What are the causes of lung cancer recurrence ?
The chance of lung cancer recurring depends on many factors, including the type of lung cancer, the stage of lung cancer when it is diagnosed, and the treatment of the original cancer.
After the diagnosis of lung cancer, the first treatments play an important role, such as surgery and radiotherapy, which are considered local treatments, which can treat cancers that exist around the original tumor site. Sometimes the cells in the original tumor spread farther through the bloodstream or lymphatic channels, but these cells are too small to be detected by imaging. Chemotherapy is a systemic treatment that mainly treats cancer cells that may be present throughout the body. Unfortunately, chemotherapy has large side effects and is prone to drug resistance. Even with chemotherapy, cancer cells may survive and continue to grow in the future.
What are the symptoms of lung cancer recurrence ?
The symptoms of lung cancer recurrence depend on where the cancer recurs. If it is a local recurrence, or in a lymph node near the original tumor, symptoms may include cough, hemoptysis, shortness of breath, wheezing, or pneumonia. Recurrence of the brain may cause dizziness, decreased vision or double vision, weakness or loss of coordination on one side of the body. Recurrence in the liver may cause abdominal pain, jaundice (yellowing of the skin to yellow), itching or confusion. Bone recurrence is most common with deep pain in the chest, back, shoulders, or limbs. More common symptoms such as fatigue and unexpected weight loss may also be predictive of cancer recurrence.
How to prevent recurrence of lung cancer ?
Periodic review
Since lung cancer has no reliable and early-predicted signals for recurrence and metastasis, in order to detect recurrence or metastasis early, close monitoring and follow-up of the disease are needed.
Generally speaking, the first year after the operation is reviewed every three months; the second year, the operation is repeated every six months, and the cyclical examination is continued.
Strictly follow the doctor’s advice and review regularly and on time. When the patient has symptoms, a corresponding chest and abdomen CT, craniocerebral CT or MRI, bone scan, fiberoptic bronchoscopy, etc. should be performed.
After treatment, patients with lung cancer may develop complications or other symptoms due to their own conditions and other reasons. Therefore, regular review should not be ignored and should be paid great attention.
Biomarker detection
An important tool for predicting the risk of recurrence is the use of molecular biology techniques. Lung cancer is a highly invasive tumor. Pathological classification (histological differentiation, vascular infiltration, lymphatic infiltration, and pleural infiltration), tumor TNM stage, and genotyping are all closely related to prognosis. Genetic testing and immunohistochemistry can be combined to use genetic mutations, such as KRAS status, and CEA and Ki-67 expression levels to predict risk of recurrence.
Strengthen nutrition and prevent colds
For patients with lung cancer, nutrition should be guaranteed to avoid colds, and special attention should be paid to diet. Food choices should be rich and varied, with fruits and fresh vegetables. For older patients, eating more porridge and soup foods will be better digested. At the same time, we must pay attention to nutritional guarantee and high-quality protein intake.
Patients with lung cancer must pay attention to keeping warm, preventing colds and avoiding infection. Whether it is a viral or bacterial infection, it will cause the body’s immunity to decline, and it is easy for cancer cells to proliferate and relapse.
Improve your lifestyle and stay happy
Quit alcohol, quit alcohol, quit alcohol, important things are said three times, you must quit alcohol. In addition, don’t smoke, don’t overwork, pay attention to emotional regulation, and maintain a happy mood.
Appropriate exercise, 2-3 months after surgery, you can do gentle exercises, such as walking, and gradually increase from 15 minutes to 40 minutes; you can also exercise qigong, Tai Chi, radio exercises and other gentle exercises.
Special attention should be paid to the diet, do not eat moldy food, barbecue, bacon, tofu and other foods containing nitrite, and do not eat traditional Chinese medicine and health products.
Treatment of lung cancer
Surgery
The best way to treat lung cancer is to remove the recurring lesions to achieve the goal of radical cure. If the surgical criteria are met, all tumors can be removed surgically.
If there are multiple lesions, the invasion area is relatively large, or distant metastases, tumor resection can be selected according to the situation. In the case that the benefit of surgery is not guaranteed, other treatment methods can be selected.
Proton therapy for treatment of lung cancer
Radiotherapy is an adjuvant treatment for many patients with postoperative lung cancer. However, in traditional radiotherapy, X-rays or photon beams are inevitably transmitted to the tumor site and the surrounding healthy tissues. This can damage nearby healthy tissue and can cause serious side effects. Proton therapy can perfectly avoid these side effects.
In contrast, proton therapy uses proton beam irradiation and can stop at the tumor site without leaving a radiation dose behind the tumor, so it is unlikely to damage nearby healthy tissue. Some experts believe that proton therapy is safer than traditional radiation therapy.
Cancer patients have low immunity, high-intensity radiation exposure can easily cause damage to normal organs, cause serious adverse reactions, and bring a serious burden to the already weak body. Especially for lung cancer, tumor lesions are next to many important organs, such as liver, heart, esophagus, etc., as well as brain metastases common to lung cancer. Choosing proton therapy can effectively avoid damage to surrounding healthy tissues and achieve the same killing effect as traditional radiotherapy.
Lung Cancer Drug Treatment
With the continuous advancement of precision medicine and the continuous advent of various targeted drugs, the front-line treatment of non-small cell lung cancer (NSCLC) has changed from chemotherapy to the preferred targeted treatment.
These six key driver gene mutations in non-small cell lung cancer targeted drugs: EGFR (exon 19/21), ALK, BRAF V600E, ROS1, RET, and NTRK are important for patients with lung cancer because they already have Very effective targeted drugs can be used for treatment, replacing traditional chemotherapy.
EGFR mutation-positive lung cancer:
Choice of first-line treatment drugs: gefitinib, erlotinib, afatinib, dacotinib, ositinib, and ectinib (domestic drugs).
Follow-up treatment options: Oxitinib.
ALK rearrangement-positive lung cancer:
First-line treatment options: crizotinib, ceritinib, aletinib, and bugatinib.
Follow-up treatment: Aletinib, Bugatinib, Ceritinib, Lauratinib.
ROS1 rearrangement-positive lung cancer:
First-line drug choices: ceritinib, crizotinib, emtricinib.
BRAF V600E mutation-positive lung cancer:
First-line treatment options: Dalafenib + Trametinib
Follow-up treatment: Dalafenib + Trametinib
NTRK gene fusion positive lung cancer:
First-line treatment options: Larotinib, Emtricinib.
Follow-up treatment: Larotinib, Emtricinib.
Are there so many mutation targets that lung cancer can detect? Of course not. In addition, there are some emerging target mutations such as MET, RET, HER2, etc. TMB is also becoming a predictive marker for immunotherapy. If these emerging target mutations are detected, you can choose the corresponding targeted drug therapy (see the table below) ).
Emerging gene targets and targeted drugs for non-small cell lung cancer
| Mutation target | Available targeted drugs |
| MET amplification or exon 14 mutation | Crizotinib (NCCN); Capmatinib, Tepotinib (ASCO) |
| RET rearrangement | Cabozantinib, Vandetanib (NCCN); LOXO292, BLU667 (ASCO) |
| HER2 (ERBB2) mutation | Trastuzumab-Metasin conjugate (NCCN) |
| TMB (tumor mutation load) | Nivolumab + Ipilimumab, Nivolumab (NCCN)
|
Drug selection for lung cancer when there is no genetic mutation
For patients with non-small cell lung cancer without genetic mutations, an important biomarker still needs to be detected, that is PD-L1. PD-L1 is up-regulated in many tumor cells. 1 combination, can inhibit the proliferation and activation of T cells, make T cells in an inactive state, and finally induce immune escape, tumorigenesis and development.
The FDA-approved PD-L1 companion diagnostic method can guide paimumab in the treatment of NSCLC patients, based on the tumor proportion score (TPS). TPS is the percentage of viable tumor cells showing partial or full membrane staining at any intensity.
Non-small cell lung cancer with PD-L1 expression of TPS ≥1%
First-line treatment options:
Paimumab monotherapy
2. Non-squamous cell carcinoma: (carboplatin / cisplatin) + pemetrexed + paimumab
3. Non-squamous cell carcinoma: carboplatin + paclitaxel + bevacizumab + atejuzumab
4.Squamous cell carcinoma: (carboplatin / cisplatin) + (paclitaxel / albumin paclitaxel) + paimumab
If both gene mutations are detected and PD-L1 expression is elevated, targeted drug therapy is preferred.
First-line drug selection for squamous non-small cell lung cancer (no genetic mutations, no immune contraindications, PD score 0-1)
| PD-L1 TPS (tumor ratio score) | First-line medication options | Level of evidence | Recommended strength |
| ≥50% | K drug single drug | high | Strong |
| ≥50% | K drug + carboplatin + paclitaxel or albumin paclitaxel | in | Strong |
| ≥50% | No other evidence of immune checkpoint inhibitors combined with first-line chemotherapy | high | Strong |
| 0,1-49% | K drug + carboplatin + paclitaxel or albumin paclitaxel | in | Strong |
| 0,1-49% | Immune contraindications, platinum-containing treatments possible | high | Strong |
| 0,1-49% | Immune contraindication, not suitable for platinum therapy, non-platinum two-agent chemotherapy can be selected | in | weak |
| 0,1-49% | Reject K drug combined chemotherapy, but K drug single drug | low | weak |
Remarks: K drug is paimumab, T drug is atezumab, both drugs have been marketed in China
First-line drug selection for non-squamous n
on-small cell lung cancer (no genetic mutations, no immune contraindications, PD score 0-1)
| PD-L1 TPS (tumor ratio score) | First-line medication options | Level of evidence | Recommended strength |
| ≥50% | K drug single drug | high | Strong |
| ≥50% | K drug + carboplatin + pemetrexed | high | Strong |
| ≥50% | K drug + carboplatin + paclitaxel + bevacizumab | in | in |
| ≥50% | T drug + carboplatin + albumin paclitaxel | low | weak |
| ≥50% | No other evidence of immune checkpoint inhibitors combined with first-line chemotherapy | high | Strong |
| 0,1-49% | K drug + carboplatin + pemetrexed | high | Strong |
| 0,1-49% | T to + carboplatin + paclitaxel + bevacizumab | in | in |
| 0,1-49% | K drug + carboplatin + albumin paclitaxel | in | in |
| 0,1-49% | Refuse immunotherapy, platinum-containing two-drug chemotherapy | high | Strong |
| 0,1-49% | Immune contraindications, not suitable for platinum-containing treatment, non-platinum dual-drug chemotherapy is optional | in | weak |
| 0,1-49% | Reject K drug combined chemotherapy, but K drug single drug | low | weak |
Remarks: K drug is paimumab, T drug is atezumab, both drugs have been marketed in India.
Lung cancer vaccine
In 2008, Cimavax-EGF, the world’s first protein-peptide vaccine for the treatment of stage III and IV lung cancer, was successfully developed; in 2012, Cuba successfully developed the second lung cancer vaccine, Vaxira.
The world’s first marketed protein peptide vaccine-Cimavax-EGF
Indication: IIIB, IV non-small cell lung cancer.
Time to market: 2011 (listed in Cuba)
After 25 years of research, Cuban researchers have succeeded in preparing a vaccine that can stop the progression of lung cancer.
Test Data:
CIMAvax-EGF in patients with advanced NSCLC (Phase III clinical trial) proves that the vaccine is safe and effective in patients with advanced NSCLC.
In the phase III trial, the 5-year survival rate of the vaccinated subjects was 14.4%, compared with only 7.9% in the control group, almost doubling!
Suitable for patients:
Lung cancer vaccines are not effective in all patients. The most suitable population is: only for patients with advanced non-small cell lung cancer lung cancer, lung cancer patients with stable disease after first-line chemoradiation and no brain metastases If the patient is in advanced disease, the vaccine is not suitable.
Researchers are confident that one in five of these patients will succeed. Most tumors disappeared, and some patients completely disappeared! 23% of patients survived more than 5 years. Although they are advanced lung cancer, after receiving vaccine treatment, they can work and live normally, and their quality of life is very high, effectively delaying the progress of the disease.
Note, however, that CimaVax EGF cannot stop the development of cancer, let alone cure it. Instead, a mechanism was initiated, through which the uncontrolled growth and division of cancer cells was more restricted, thereby transforming advanced invasive lung cancer into a chronic disease. At present, the Cuban lung cancer vaccine has been approved in more than 80 countries around the world, and domestic patients can also apply to purchase the vaccine for treatment from Cuba by calling at +91 96 1588 1588.
