The management for lung cancer progressed dramatically in the past decade
The therapeutic strategy for lung cancer shows significant improvements with the introduction of new drugs that employ novel mechanisms. One example is molecular targeted therapy. Some patients with non-small cell lung cancer (NSCLC) harbor genetic mutations, named as “driver mutations”, which lead to develop cancer. For patients with these mutations, the molecular targeted drugs dramatically show the anti-tumor response. Another example is immune-checkpoint inhibitor (ICI). In cancer patients, immune cells, which are supposed to eliminate cancer cells, are often inhibited by signals from cancer cells. ICI suppresses these inhibitory signals, resulted in the activation of immune cells. Notably, ICI sometimes shows the durable response which never be achieved by cytotoxic chemotherapies or molecular targeted drugs.
In addition to the chemotherapy, there have been significant advancements in diagnostic techniques for lung cancer. To achieve the accurate diagnosis, it is essential to biopsy the cancer tissue. Recently, it is well recognized that the guide sheath combined with endobronchial ultrasound (EBUS)1 enable us to confirm whether the bronchoscopy reaches the tumor tissue, resulted in improving accuracy of the diagnosis. Furthermore, it is now essential to perform the genetic test to identify the driver mutations for NSCLC. Recently, the novel technique, known as next-generation sequencing, is widely applied in the real-world clinics which enable us to evaluate many genetic mutations simultaneously.
As mentioned above, we have to evaluate not only the detailed information about the cancer cells, but also the spread of cancer (stage) and the patient’s condition comprehensively. Based on this information, it is now essential to discuss in the conference where not only pulmonologist/medical oncologist but also surgeons or radiologist join to decide the optimal treatment for each patient.
The novel chemotherapy for lung cancer based on the global clinical trials
We actively participate in the global clinical trials (mainly sponsor-initiated clinical trials), which is one of the features in our department. The MYSTIC and NEPTUNE trials for immune checkpoint inhibitors ahead of them. Furthermore, we recently have conducted many trials like the MK-3475-A86 trial, MK-7684A-003 trial, PACIFIC-9 trial, and trials related to molecular targeted drugs and antiemetic drugs (drugs prescribed to suppress vomiting) under a support of Clinical Research Center for Developmental Therapeutics in our hopital. These achievement makes us a top-runner in advancing clinical trials in our hospital.
Participating in the global clinical trials allows us to learn the protocols2 of internationally standardized chemotherapy and provide global standard level of chemotherapy for the patients with lung cancer in our real clinics. We continue to participate in global clinical trials to provide new treatments to patients and to improve the quality of our medical practice.
The endeavor to develop a next-generation therapeutic strategy for lung cancer
Although the current advancement of chemotherapy for lung cancer improves the prognosis of the patients with lung cancer, there are still many challenges. Therefore, our department performs various initiatives to develop next-generation therapeutic strategies. We participate in nationwide clinical trial groups such as the Japan Clinical Oncology Group (JCOG), the North East Japan Study Group (NEJ), and CS-Lung, which focuses on the Chugoku and Shikoku regions, conducting investigator-initiated clinical trials. Additionally, through personnel exchanges with the Pharmaceuticals and Medical Devices Agency (PMDA), which manages the safety and development of pharmaceuticals, we try to conduct high-quality clinical trials.
Furthermore, we have actively performed the basic research to develop the novel therapeutic strategies for lung cancer, resulted in publishing the results in academic journals such as ‘Nature Communications’ and ‘Cell Reports’. We continue to perform the translational research with the support from the Japan Agency for Medical Research and Development (AMED) to further improve the prognosis of the patients with lung cancer (Fig. 1).
Our department are actively engaged in basic research and translational research to develop novel therapeutic strategies based on the scientific findings. We also actively participate in the sponsor- and investigator-initiated clinical trials. These initiatives enable us to provide the novel and globally standardized chemotherapy for lung cancer in Tokushima University Hospital.