Identifying the Treatment Landscape for Advanced Lung Cancers

Patients with stage I lung cancers have the option to undergo minimally invasive, lung-sparing, robot-assisted surgery through the ambulatory precision lung-sparing surgery (A-PLUS) program, according to Ankit Bharat, MBBS.

CancerNetwork® spoke with Bharat, chief of Thoracic Surgery in the Department of Surgery, Harold L. and Margaret N. Method Professor of Surgery, and professor of Pulmonary and Critical Care at Northwestern Medicine Feinberg School of Medicine, about the current treatment landscape available for patients diagnosed with advanced lung cancers.

He began by highlighting the A-PLUS program, which is a minimally invasive, lung-sparing approach that prevents the need to spread ribs or cut muscle. Furthermore, for stage II or III disease, a combination approach combining surgery and the use of immunotherapy or targeted therapy is deployed. In this approach, the cancer is downsized using therapies customized to treat cancers based on their genetic profile, and then the downsized tumors are resected.

Lastly, Bharat suggested that while chemotherapy, immunotherapy, and targeted therapies may be employed for the treatment of stage IV cancers, he suggested that they frequently fail. As an alternative, he stated that at Northwestern Medicine, patients may be enrolled in the Double lung transplant REgistry Aimed for lung-limited Malignancies (DREAM) program, which he states is viable for patients with lung-confined advanced cancers. Furthermore, in the event of metastasis beyond the lung or ineligibility for surgery, patients are considered for radiotherapy.

Transcript:

Lung cancer has 4 stages. For stage I, the best treatment is surgery. Northwestern [has] pioneered something called the “A-PLUS” program, which stands for ambulatory precision lung sparing surgery. Simply put, it's minimally invasive, meaning we do not have to crack the chest open and spread the ribs or cut the muscle. We can do 2 or 3 tiny incisions using [robot-assisted surgery], and we do it in a manner that preserves lung capacity, so it’s lung sparing.

For the more advanced [lung cancers], stage II and III, we typically combine surgery with either immunotherapy or targeted therapy. What I mean by that is we will biopsy the tumor, we will study the genetic profile and see if we can design a therapy customized to that cancer. We will treat it; often, we are able to downsize it, and then we can perform removal with surgery. Then, for stage IV cancers, we have different types of chemotherapy, immunotherapy, and targeted therapies, and all of these fail. If the cancer is limited to the lungs, then we offer the DREAM Program, that double lung transplant. Finally, when patients cannot [undergo] surgery, we introduce radiation.