Personalized Medicine Lung Treatment
Professor Nir Peled, an oncologist & pulmonologist is sure that the new approach will increase the chances of recovery by 20%.
In recent years, the world’s leading oncologists have been calling lung cancer an epidemic. The reason for this is the rapid increase in the incidences which claim the lives of millions of people.
World statistics show that in 100% of cases of lung cancer, only 15% of patients were diagnosed at an early stage, and in 53.4% of the cases detection occurs only at later stages.
Only in 3.4% of patients who come to the doctor for help at a later stage, is there a chance of recovery.
Lung cancer is characterized by its aggressiveness: within one month the tumor may increase in size by half, and the symptoms that bring discomfort and force the patient to see a doctor only appear at later stages. Unfortunately, the majority of the population believe that the diagnosis of lung cancer at an early stage is not possible.
An editorial for our official website hmcisrael.com asked Professor Peled for clarifications.
Professor Nir Peled, a leading oncologist pulmonologist at "Herzliya Medical Center" private hospital and the chairman of the International Association of Lung Cancer (World Lung Cancer Association) claims that the survival rates and the recovery of this disease can be increased by 20% thanks to timely survey types, as well as the achievements of pharmacology, research and nanotechnology.
An interview with Professor Nir Peled, a leading oncologist, pulmonologist;
Professor Peled, what has changed in recent years in the approach to the treatment of lung cancer in Israel?
20 years ago, the average survival rate for lung cancer was 4 months from the date of diagnosis. Today, this figure rose to 10.5 times, that is, patients live an average of 3.5 years, and we are talking about patients who have been diagnosed at later stages of lung cancer. This is a great achievement, because along with the increased life expectancy, we have significantly improved the quality of life of sick people.
In the past, the approach to any kind of lung cancer was one, it did not take into account the now widely – available histological qualification treatments. For example, therapeutic methods with respect to adenocarcinoma or squamous cell lung cancer were identical. At the same time, experience has shown that the response of different types of cancer to the same treatment differs. Therefore, we have concluded that the choice of drug therapy should be individualized.
Now we have come to the topic of personalized medicine
Yes. Personalized medicine is the development of an individual treatment for each patient; the expected therapeutic effect on certain qualifications and type of cancer genes that were found in a single patient. Personalized medicine is a revolution in the understanding of the development of cancer at the molecular level.
What results have personalized medicine achieved at this stage?
Thanks to bimolecular histological analysis of tumor material and biological targeted therapy, the life expectancy of more than 50% of patients with lung cancer has reached far beyond 3.5 years.
For suspected lung cancer, an endoscopic bronchoscopy is performed. The main indication for bronchoscopy in Israel is the differential diagnosis of volume processes (tumors) of the lungs. A research process takes a week. Upon confirmation of a mutation, for example: ALK, EGFR and KRAS, we know how to proceed further to appoint a super-efficient biological treatment.
Tell us more about biological therapy
These drugs specifically affect the genetic structure of the cancerous cells, they block the receptors that receive the signal and triggering mechanisms of malignant transformations of cells. Due to this we are now able to stop at the molecular level mechanism of gene mutation. On average, within 3-4 months we destroy the tumor.
How often should you take these drugs, and what are their side effects?
One tablet per day orally. Biologicals do not affect healthy cells and tissues, as it happens with chemotherapy. They hit the target. A minimum number of patients experience side effects manifested as skin rash, diarrhea, constipation, or vice versa. Effects such as nausea, vomiting, hair loss and neuropathy which are characteristic for chemotherapy, are not inherent for biological treatment. Most of my patients do not complain at all about side effects.
How long do you need to take the drug, and does it lose its effectiveness over time?
A patient needs to take the medication all his life. However, the medicine loses its effect after a year or two because the receptors of the cancerous cells develop resistance to the active ingredient of the drug. We do however have other medications to prevent tumor resistance to the effects of drug therapy.
What is the mechanism of action of these drugs?
There are two types of drugs, their mechanism of action is different, but the final effect is the same.
The first of these comprises of tumor antigens to receptors located on the surface of cancer cells and neutralizes their resistance to the effects of the drug.
The second type - its inhibitors, penetrating directly into a cancer cell, suppress process phosphorus cells, resulting in apoptosis (programmed cell death).
How do you control, or more precisely, prevent the development of immunity to tumor biologicals?
Every three months I perform a CT scan, and if there is a lack of positive dynamics, if there is no improvement, a biopsy is performed and when it detects mutations, I begin to treat the tumor resistance to biological drugs immediately.
Basically, is CT the primary method of evaluating the success of treatment?
Yes, absolutely. I would like to continue the theme of personalized medicine. We engage lab mice in the research for the individual therapeutic program. It is as follows: implanted tissue tumor afflicted with lung cancer are implanted in several rodents.
After some time, 5-6 diseased mice are selected, each of which is assigned a certain line of treatment. Ultimately, the program, which had a very strong therapeutic effect on the mouse is used to treat lung cancer patient from whom tissue fragment was transplanted. By the way, my aunt is now in a state of a long-term remission thanks to this model.
You spend a large amount of time on clinical research. Can patients who are not Israeli citizens, participate in them?
Yes, I run many studies and invite foreign patients to take part in them. Patient from all over the world will have to be diagnosed and in accordance with the results, will be invited to participate in the program of clinical research, which corresponds to a gene mutation.
Is it possible to diagnose lung cancer at an early stage of its development, before the first symptoms?
Sure. At "Herzliya Medical Center," a program of early diagnosis has been devised, which includes a clinical examination, spirometry, CT scans and detailed analyzes of blood (special markers) - CEA, CA125, Oncimmune, CYPHRA21, NSE, PROGRP.
In case of suspicious growths found during CT, a bronchoscopy is performed and research on the malignant nature of the tumor is being conducted. A biopsy is performed under the control of computer tomography (CT). This survey takes 2-3 days. Results are ready on the third day of the diagnostic program for the early detection of lung cancer.
What caused the availability of computed tomography and an early diagnosis program? Justification for the exposure that a patient receives?
First, we perform a CT scan at a low dose of radiation, which is equivalent to a dose of x-ray, so no harm is inflicted, and believe me, it is much safer to pass a CT scan on time and to begin treatment than to learn that you have an aggressive lung cancer at a later stage. After all, most of the patients come to the doctor in the later stages of the disease and are forced to undergo a lot of unpleasant procedures and anguish. It is much better to make a decision and pass the diagnostic tests on time.
What population segment do you recommend to make a decision?
First of all, my suggestion applies to those who are at the major risk factor for lung cancer, long-term nicotine addicted smokers and tobacco, which is one of the most abused substances in the world. The next group of people - people who live in regions of high air pollution, as well as employees in reactors or in the production of asbestoses. Certainly, former lung cancer patients, and former heavy smokers are required to undergo inspection as well.
"Abusing tobacco." What are the criteria for such a determination?
According to the International Association of Lung Cancer, this corresponds to an annual 30 packs for the entire period of smoking. The result is calculated by the following formula - the number of packs smoked per day multiplied by the number of years of smoking. For example, if a person smokes two packs of cigarettes a day for 17 years, then the multiplication of these data, we obtain a figure of 34 packs for the years of abuse, which is a high risk factor for malignant lung diseases.
What does the program offer at "Herzliya Medical Center" to patients who are diagnosed with "lung cancer"?
For these patients, "Herzliya Medical Center" has developed a special program of diagnosis, including computed tomography to determine the extent of metastasis. If a patient is diagnosed at the first stage of the disease, then a brain CT is conducted. If necessary, bronchoscopy is performed for a more accurate staging of the disease, as well as invasive procedures, such as the placement of stents in the airways, in order to reduce local airway pressure, or surgery.
Personalized medicine for patients with inoperable lung cancer, what is the approach taken?
We have developed an individual treatment program, which includes: advanced methods of genetic and molecular studies of the tumor to determine sensitivity to anticancer drugs; biological treatments are applied, taking into account the characteristics of the disease; and developing an optimal treatment strategy using modern chemotherapy drugs and radiotherapy.
For patients with inoperable lung cancer, we create a specific combination of chemotherapy and radiotherapy in order to achieve the maximum effect of treatment and to reduce the size of the tumor to allow a surgical procedure.
Do all patients receive personalized medicine treatment with lung cancer?
Prof. Peled: At this stage, we have found several mutations that cover about 30% of patients who develop lung cancer. At this stage, only those patients are amenable to biological treatment, in whom we can detect the known mutations of the tumor, and thus assign targeted therapies. In the remaining patients, we are unable to detect the mutation and thus for them there is no targeted therapy drug yet.
In 2006, you’ve participated in the development of an "electronic nose" that recognizes lung cancer by smell. The concept of the “electronic nose” was developed by sniffing dogs. Tell me more about it
It has long been observed that dogs can detect cancer or other diseases by the scent. Cancerous cells have a different metabolism from normal cells, and therefore emit a different pattern of chemicals, a different odor.
Thus, the researchers concluded that cancer is a "smell." However, it should be noted that the identification of odors in the conventional sense does not occur, but rather the identification of molecules produced by tumors that are released into the bloodstream, and then into the lungs and are present in the exhaled air. Embodiment of the concept into reality was made possible by nanotechnology.
The "Electronic nose" works as follows: miniature size sensors in billionths of a meter (100 thousandth of the diameter of a hair) create a very large surface, which leads to a high adsorption of molecules (absorption and an increase in concentration of a substance). Readable information is transformed into a graph showing the concentration of molecules of the disease up to 90%.
How does it work in practice?
The "Electronic nose" looks like a mobile phone, the patient brings it to his mouth, then breathes in a special bag. The material is then transferred to a laboratory for analysis of the Technion, and within a few days, we obtain a response.
When can people get an early diagnosis of this kind?
I hope that in the near future. We are going through the final stages of inspections and permits. I do hope that this portable device, which is a non-invasive diagnostic device will be at the disposal of each doctor.
From the author:
In anticipation of the meeting with Prof. Peled, I spent about a quarter of an hour in the company of one of his patients, Dorothy W. Three and a half years ago, Dorothy W. was hospitalized in a serious condition, and required resuscitation and a surgical intervention. Dorothy W., as the majority of patients had been suspected of developing the disease.
Everything happened "suddenly"; sudden convulsions and loss of consciousness. Fortunately, the patient's spouse, when Dorothy suffered a seizure, was nearby and called an ambulance. The reason for the attack was that metastases had spread to the brain. Dorothy at that time was 43 years old. "I have to thank Professor Peled for each day of my new life” says Dorothy.
“If not for his concept of personalized medicine, I would no longer be here”, I don’t have enough words to express my gratitude, what a treasure of a MAN. Professor Peled is in touch with me constantly, gives me good energies and directs my thoughts to positive thinking. I am familiar with all of his patients, we meet at seminars, and each of them sees him as an angel - a savior. "
Professor Nir Peled is a leading lecturer in seminars for patients with cancer of the lungs, and their relatives. His workshops train and support patients and their families in this difficult period of treatment. His loyal audience meets every six months to hear about new methods of therapy, patients’ progress, achievements and clinical studies. Through such seminars a group for mutual support was established, numbering about 1,000 patients, which allows all participants to express complaints and to share emotional experiences and express hope for recovery.