Vera Hirsh, MD Department of Oncology, McGill University Health Center, Montreal, Canada
The demands in lung cancer care are changing as we proceed in our efforts to improve outcomes. Besides investigating the optimal succession of agents to prolong survival in the best possible way, we need to learn to manage toxicity, and strategies must be found to limit treatment costs to a range that can be afforded by healthcare systems in the long run. Trial data presented at the 19th World Conference on Lung Cancer that was held in Toronto, Canada, from 23rd to 26th September, 2018, demonstrated huge steps forward, such as the survival-prolonging effect of atezolizumab as an add-on to chemotherapy in patients with extensive-stage small-cell lung cancer. This is the first study in more than 20 years to show a clinically meaningful survival improvement over the current first-line standard of care in this setting. A singular survival benefit has also been obtained with durvalumab in unresectable, stage III non–small-cell lung cancer. Patients with ALK-positive disease were shown to benefit from the next-generation, CNS-active ALK inhibitor brigatinib when administered in the first line. Various oncogene driver mutations represent targets for potent agents; taken together, these enable us to treat a considerable percentage of patients with advanced disease today. Finally, new and exciting data were reported on the screening of lung cancer that has been under debate due to a lack of convincing evidence. Volume CT screening gave rise to substantial reductions in lung cancer mortality in both men and women.
However, we have to keep in mind that in the setting of advanced lung cancer, only 2 % of patients will achieve cure, which renders therapy essentially palliative in this large patient group. Quality of life and all aspects tied to it therefore merit great attention and should not be neglected in daily routine care. It is up to us to ensure that patients do not only live longer but also experience better quality of life than they would without treatment. Here, the patient perspective matters more than any laboratory or imaging findings, although of course these represent necessary information. Instruments have been developed to assess quality of life and patient-reported outcomes in a fast and very effective manner, and these data tell us a lot about patient needs, but also provide amazingly accurate information on the individual prognosis. The comprehensive use of the available means in each case will contribute to giving patients hope and providing them with quality time in the face of a serious disease.