The future promises a more responsive approach to the care of lung cancer patients informed by closer patients monitoring.

There are tentative signs that new technologies are beginning to translate into better results for patients. “The latest data shows some improvement in one-year survival rates and there is some indication that five-year survival may also be improving,” says Dr Jesme Fox, Medical Director at The Roy Castle Lung Cancer Foundation, a UK lung cancer charity.

“This may be due to early detection and an increased number of surgical operations, as well as better treatment options: radical radiotherapy, targeted therapy and there is hope for future immunotherapies.”

Dr Fox says diagnostic biomarkers for EGFR and ALK are clinically relevant as there are inhibitors for both. Most patients do not have these mutations but as more biomarkers and treatments become available, outcomes could improve for many more people.

It’s the latest in a long line of advances. But what’s next and how will the molecular biology revolution impact cancer care?

“Looking ahead, a lot of the information about the disease will rely not only on one snapshot of a moment in time but on regular monitoring,” says Miro Venturi, Roche’s Global Head of Diagnostics Markers. “This will allow clinicians to select therapies for their patients after initial diagnosis, but also to adapt therapy in response to changes in the tumour.”

Liquid biopsies have the power to detect nucleic acid information – such as DNA and RNA – that tumours release into the blood stream. As tumours mutate, these changes can be picked up by analysing the patient’s blood.

Turning this vision into reality will require data from clinical trials on liquid biopsy but these new tools have the potential to run dozens of tests on a small blood sample. “We can look at more than 40 mutations that show sensitivity or resistance to treatment,” says Miro. “I would foresee a larger number of tests and determinations, and the derived data would guide treatment decisions.”

Sabrina Schilling, International Business Leader at Roche says “The task ahead is to explore how diagnostic tools – tissue biopsy, liquid biopsy, immunoassay and imaging technologies – can complement one another in an optimal way.”

“We want patients to get the best tools at every stage of the process” she adds. “Given the breadth of our expertise, it’s on us to bring more clinical knowledge and to educate clinicians on when to use each of these options.”

“New innovations have the potential to diagnose lung cancer earlier which is good for patients and health systems alike. The cost-benefit has to be proven with robust clinical data but we know that earlier diagnosis impacts outcomes,” states Sabrina.

The future, she suggests, will see more patients living with – and recovering from – lung cancer. “If we can diagnose people earlier we could see more patients in a chronic state; they could live for some time with their disease and eventually be cured. And that would be a most welcome progression.”

Screening could also become part of the picture in the years ahead. Dr Fox of The Roy Castle Lung Cancer Foundation comments that keenly-awaited results from a major European study could pave the way for screening high-risk patients such as those who have been heavy smokers. Read more onand find out whether it is the end of surgical biopsies.

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