When you hear the word “gene”, you can think of those you inherit from your parents. But when gene and lung cancer There is a tie, very little known genes can transfer a high chance of lung cancer from parent to child.

“We don’t see those people [people] Very often, because most [people] Lung cancer is not a hereditary cause, ”says Kerry Kingham, lead Cancer Genetic Counselor at Stanford Health Care.

There are some exceptions, she says. Where many members of a family have lung cancer, with no apparent external cause (eg. Smoking), You may want to see a genetic counselor.

“But in them too [people], We often do not find the reason for this. “

Only 1% of these cases show inherited mutations.

“And when we find hereditary mutations and we’re able to test other family members, there’s really no good guideline that tells us what exactly to do for them outside of more careful screening,” Kingham. it is said.

She says cancer cells are being tested after diagnosis.

More common tie

Small bits of genetic material (which your doctor may call “protein”) were previously healthy The lung Tissue cells can form, or “mutate” cancer cells. As cells divide, they continue to pass these changes, or “mutations”, into new cells, which form tumors.

Doctors do not know what causes these mutations. But you do not inherit them from your parents and you cannot give them to your children. If you get them nor is it your fault. These mutations “just happen,” Kingham says. They are not due to something you did or did not do.

“This is nobody’s fault. This is not what you ate. It’s not because you saw the moon wrong or lived an unhealthy lifestyle, for most people “she says.

“It sometimes happens, cells make mistakes when they divide.”

When Jean Testing Matters Most

Some lung cancer gene mutations can help doctors detect a treatment plan. The doctor calls these mutations a “biomarker”.

It is important to understand and treat some lung cancer biomarkers differently, says Heather Wakeley, MD, a medical scientist at the Department of Medical Oncology at Stanford University Medical Center.

EGFR (epidermal growth factor receptor) is probably the most common. About 10% –15% of non-small-cell lung cancers are EGFR-positive, meaning they have a cancer mutation of the EGFR gene.

This is what doctors call “driver mutations”, which means that this is why there is cancer. This mutation occurs in some people with lung cancer, such as:

  • Nonmokers
  • Women
  • People of Asian or East Asian heritage
  • Who have lungs Adenocarcinoma (A type of lung cancer)
  • Young adults with lung cancer (half of these cases are EGFR positive.)

But everyone with a non-small-cell lung cancer (NSCLC) diagnosis should receive an EGFR test, not just these high-risk groups, says Wakeley.

“It is really important that every non-small-cell lung cancer tumor is tested for EGFR, regardless of stage,” she says.

And not just for EGFR. There are at least seven more gene biomarkers that your doctor should test if they diagnose your lung cancer.

they include:

  • ALK
  • ROS1
  • To get wet
  • Had a meeting
  • BRF
  • NTRK
  • Her2

Each accounts for up to 5% of NSCLC cases.

These tests are so important for people with NSCLC that scientists have designed Targeted cancer therapy For tumors with these particular gene mutations.

“If we get a tumor mutation, we can treat it better Medicine – Besides being more effective is often a better tolerant drug. “This is now true for eight different genes, and therefore it is really important that the tumor be tested before treatment begins, whenever possible.”

In simple terms, these drugs target a protein, which remains in the “on” state and “turns off” it.

You can take most of the targeted drugs in pill form at home instead Chemotherapy By IV at the hospital. Not only are they more effective, says Wakeley, they are generally much easier on your system than other cancer treatments.

When there is a viable gene to target, these treatments shrink tumors more than chemotherapy or Immune therapy, And treatment often works over a long period of time.

For people with early stage NSCLC who have undergone surgery, an EGFR drug called osimertinib (Tagrisso) Can delay the return of cancer and reduces the likelihood that the cancer will spread Brain.

People with stage IV EGFR-positive NSCLC can also receive Tagrisso as it is more likely to shrink the tumor and work longer than any other form of treatment.

There is no approved targeted treatment of small-cell lung cancer yet. clinical trials Continue to explore the possibility.

importance of patience

With your panel of genetic tests (sometimes called “molecular tests”), your doctor should test for another biomarker called PD-L1. Levels of this protein indicate whether or not you are likely to react to treatment Immune therapy Drugs.

Wakeley says this can make things more complicated, as PD-L1 results generally come before mutation results.

High PD-L1 often means Immune therapy Can be successful.

“And so it’s tempting to act on it,” Wakeley says. But this is not always the best route. If you have some mutations, such as EGFR, then immunotherapy may cause more harm than good. And this may make targeted therapy more toxic to your system in the future.

This is why, says Wakely, it is important to wait until you return All Of the results before making any decision.

And this is just one example of potential complications. In some cases, there are a lot of complex tumor factors that affect your Healthcare The team will convene with a group called the Molecular Tumor Board:

  • Specialist doctor
  • Medical oncologist
  • Surgeons
  • Radiation The doctor
  • Researchers
  • Genetics
  • Pathologist

“Just diagnosed for someone Stage IV lung cancer“Waiting can be very stressful,” says Vekli. “Most people want to start treatment immediately. But to understand this most important option it is really important to wait to get the full story about the tumor. “

It’s not just smokers

An ugly stigma may be that if you have lung cancer, you may have been caused by smoking. This is unfortunate, says Yasir y Alamein, MD, a thoracic Medical oncologist And assistant professor of thoracic medical oncology at the University of Texas MD Anderson Cancer Center.

He says that this is also wrong.

Although smoking is still the biggest risk factor for the disease (outside of age), up to 1 in 5 people die of lung cancer each year. It tops the list of deadliest cancers in the United States, with lung cancer among those who have never smoked.

“I don’t think anyone deserves to have lung cancer, whether a smoker or autocratic. But I think we have to understand that lung cancer is not a particularly smoking-related disease.

This is particularly true for lung cancers that respond to targeted therapy.

“For the most part, they are not associated with smoking.” Says alumin. “I think it’s a very painful reminder that lung cancer is not just related to smoking. So hopefully, it will help us remove the stigma surrounding that.”

Future of targeted therapy

Targeted treatments can improve the quality of life with fewer side effects and better results. But these treatments are frustrating. One of them is that people build a resistance for them.

“This is one of the sad realities of targeted therapy,” Elamin says.

This may take 2 or 3 years, but eventually, almost all people who take targeted therapy build resistance, especially those who begin treatment in later stages of the disease. A lot of new research concentrates to overcome this issue.

“We’re focused on how and why resistance develops,” Elamin says.

Hopefully, to come up with ways to delay or overcome resistance, or better yet, stop it.

Overall, however, Elamin expects a lot. He used the drug alectinib (Alexna), A targeted therapy for ALK biomarkers. Research found that more than 60% of people with late-onset NSCLC, who underwent treatment, survived for at least 5 more years.

“Imagine the difference,” he says. “When I was doing my training, the 5-year survival for the same group was 5 to 6%. this is incredible.”

Of course, 60% is not the goal, but alumin is encouraged.

“We are expected to be 90 or 100% a day. But I think we have made the advance and in this case, the numbers talk about themselves.”

Sources

Source:

Heather Wakeley, MD, thoracic oncologist, professor of medicine, Stanford University Medical Center.

Yasir Y. Alamin, MD, Vascular Medical Oncologist, Assistant Professor of Vascular Medical Oncology, MD Anderson Cancer Center.

Carey Kingham, principal cancer genetic counselor, Stanford Health Care.

American Cancer Society: “Lung Cancer Risks for Smokers,” “Tests for Lung Cancer.”

CDC: “Lung cancer is among those who have never smoked.”

Lung Cancer Foundation of America: “What is EGFR-positive lung cancer and how is it treated?”

Memorial Sloan Catering Cancer Center: “Lung Cancer Genomic Testing (EGFR, KRAS, ALK).”

UC San Diego Health: “Molecular Tumor Board, Center for Individual Cancer Therapy.”


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