Lung cancer treatments

Lung cancer treatments are based on surgery, radiotherapy, chemotherapy, targeted therapies and immunotherapy, alone or in combination. Institut Curie is a pioneer in the use of chemotherapy and immunotherapy prior to surgery: a technique that reduces the risk of relapse by 40% and improves survival rates. 30% of the Institute's patients are also included in clinical trials, enabling them to benefit from innovative solutions. 

Multidisciplinary consultation meetings (RCP), bringing together lung specialists, surgeons, radiotherapists, radiologists, nuclear medicine physicians and pathologists, are held each week to decide on the best diagnostic approaches and most appropriate treatments. The aim is to personalize treatment, taking into account recommendations based on regional, national and international guidelines, the possibility of participating in a therapeutic trial protocol, the patient's general state of healthcare and their wishes.

Lung cancer surgery

For non-small-cell lung cancer (NSCLC), excision surgery (removal of the tumour) remains the only curative treatment. It is recommended for lung tumors localized in the thorax (stage I, stage II and some stage III) in patients with good respiratory function and in the absence of general or anesthetic contraindications. 
Until now, the traditional route has been postero-lateral thoracotomy, but today, most patients can be first operated on through minimally invasive surgery (thoracoscopy, video-assisted surgery), with simpler postoperative recovery, and a faster return to normal. The extent of the excision depends mainly on the size of the tumor, its location and the extent of the spread to the lymph nodes or neighboring organs.

Peri-operative medical treatments (chemotherapy with or without immunotherapy, targeted therapy, radiotherapy) may be offered before and/or after surgery to reduce the risk of relapse and improve the survival of operated patients.  

Radiotherapy in lung cancer

In patients with NSCLC for whom surgery presents a high risk, stereotaxic radiotherapy can be used, involving radiation highly focused on the lung tumor; this is as effective as surgery in this context. Institut Curie has one of the most comprehensive radiotherapy technical platforms in France.

For inoperable stage-III tumors, the use of chemotherapy combined with radiotherapy is the current standard treatment. Most patients can benefit from additional immunotherapy for up to a year after radiotherapy, to reduce the risk of recurrence.  

Chemotherapy, immunotherapy and targeted therapies in lung cancer

In stage IV NSCLC, treatment is general, using chemotherapy, immunotherapy (depending on the level of expression by the tumor cell of an immunotherapy target marker, PD-L1), and, when a particular DNA alteration is found, targeted therapy. Targeted therapy is usually administered orally, either as a first-line treatment or after chemotherapy and/or immunotherapy.

In the case of small-cell bronchial carcinoma (SCC) located in the thorax, treatment is based on chemotherapy and radiotherapy. But two-thirds of these cancers are diagnosed at the metastatic stage: chemotherapy combined with immunotherapy is therefore the treatment of choice. Given rapid cell growth the existence of concealed metastases is likely, hence chemotherapy is used regardless of the stage.

There are very few surgical indications and no targeted therapies in small cell cancers to date.