Lung cancer

Mathilde Regnault
05/17/2017
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Lung cancer is one of the most frequent cancers: it is the second most-common cancer in men and the third in women, and increasing constantly. While surgery is often used, in the last few years progress has been made in radiotherapy and with the arrival of new drugs.
Cancer du poumon
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What is lung cancer?

In 2012 there were 39,500 new cases of lung cancer in France, of which 28,200 in men and 11,300 in women, with an increase due to female smoking, in particular among young women.

Smoking is one of the principal risk factors, but cancer can arise in patients who have never smoked. Other factors come into play: professional exposure (asbestos), cannabis and atmospheric pollution.

Two major types of lung cancer have been distinguished: small cell carcinoma and others called non-small-cell carcinoma. The latter are classed as adenocarcinoma, epidermoid carcinoma or undifferentiated carcinoma.

Non-small cell carcinoma are differentiated according to genetic alterations in the tumor; some of these alterations must be searched for systematically, since they will predict the effectiveness of targeted biotherapies.

Immunotherapy is a treatment that aims to stimulate the patient’s immune response against cancerous cells, and is part of the range of tools available to treat lung cancer.

Thus, lung cancer is a multiple entity, the prognosis and treatment of which will be very different from one patient to another since they are increasingly adapted to tumor characteristics and to the patient him/herself: this is the principle of personalized care.

Progress has been made in all oncology disciplines, requiring close collaboration among all specialties: for diagnosis, with progress in imaging (such as Positron emission tomography), in biology with precise characterization of molecular alterations, in interventional radiology (radiofrequency), for treatment, with mini-invasive surgery or surgery with several teams, with conformal and stereotaxic radiotherapy or targeted therapies and immunotherapy.

Treatment of lung cancer at Institut Curie

Treatment of lung cancer at Institut Curie is provided by a team comprising all specialties and using the most innovative diagnostic and therapeutic techniques.

At the Paris site, The Curie-Montsouris Chest Center (ITCM) includes the Chest Surgery and Respiratory Medicine departments of the Institut Mutualiste Montsouris and the Thoracic Oncology and Radiotherapy departments of Institut Curie. Its goal is to treat patients suffering from cancer or any other chest disease, by offering optimum quality of care with first-rate access to diagnostic and therapeutic innovations and research. The practitioners at the Curie-Montsouris Chest Center treat all chest diseases, including lung cancer, tumors of the mediastinum and the thymus, tracheal tumors, tumors of the chest wall and benign respiratory diseases.

At the Saint-Cloud site, a partnership with Hôpital Foch makes it possible to provide overall care.

Multidisciplinary consultation meetings (RCP) are held each week at the Paris and Saint-Cloud sites to decide on the best diagnostic approaches and most appropriate treatments. It is also during these meetings that, in collaboration with the other specialists, the treatments for patients who present pulmonary metastases from extra-thoracic cancers (breast, digestive, gynecological, and ENT tumors, etc.) are proposed.

The therapeutic decisions made during these multidisciplinary consultation meetings involve pneumologists, oncologists, surgeons, radiotherapists, radiologists, nuclear physicians and anatomopathologists. The aim is to individualize the treatment, by taking account of recommendations from national and international references, of the possibility of taking part in a therapeutic trial protocol, and of the patient’s overall state of health and wishes.

Institut Curie has one of the most complete technical radiotherapy platforms in France, which can be of benefit to patients with lung cancers at both the early and metastatic stages, alone or combined with chemotherapy and immunotherapy or biotherapies within clinical trial protocols.

Institut Curie also provides all patients suffering from lung cancer with a molecular diagnosis platform that uses high-throughput sequencing (NGS), which helps in understanding the mechanisms of cancer development, and in identifying the most appropriate treatments, using targeted biotherapies and immunotherapy, as part of a precision medicine strategy, which is adapted and individualized for each patient, incorporating standard treatment and assessed in clinical trial protocols. These complex analyses are discussed at the multidisciplinary consultation meetings involving biologists: the molecular RCP.

For overall healthcare, supportive care is essential and forms part of the treatment. Cooperation with the DISSPO’s doctors and caregivers helps to provide the best possible quality of life at all stages of the disease, right from the start of the patient’s treatment.

Research into lung cancer

At Institut Curie, all patients suffering from lung cancer may be eligible for clinical trial protocols; these protocols are offered at the start of treatment or as the disease progresses, and may allow patients to receive the most innovative treatments that are not yet on offer and still under assessment, or those that are most suited to a specific situation.

These trial protocols are often conducted by French or European cooperative groups; they are known as multicenter trials, which sometimes require the participation of several hundred patients.

Other trials are conducted directly by the teams of physicians and researchers in the laboratories of Institut Curie Research Center, using blood or tumor samples taken as part of normal treatment, in order to characterize the biological mechanisms of cancer. The benefits and risks are always explained to the patient by the medical team.

Participation in a clinical trial protocol is highly controlled, and the interests of each patient are paramount.