Lung cancer is the most commonly-diagnosed cancer in Canada. The Canadian Cancer Society estimates there will be 29,300 new cases this year, and 21,000 lung cancer deaths — more than the number of deaths from breast, prostate, and colon cancers combined.
Lung cancer can be categorized into two types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC accounts for 80%–85% of cases. However, SCLC, representing 15%–20% of cases, grows more rapidly and can quickly spread to other parts of the body, making it especially challenging to treat.
Despite lung cancer being so widespread, with the prevalence in Canada only increasing, it doesn’t receive the same level of investment as other cancers. “There is historic underfunding of research dollars for lung cancer compared to other cancers, and while there has been some change, there is still unfortunately a social stigma around lung cancer,” says Dr. Paul Wheatley-Price, President of Lung Cancer Canada and an oncologist at The Ottawa Hospital Cancer Centre. “Many people associate lung cancer with smoking, but not every smoker will get lung cancer and there are many people who have never smoked who will get the disease. It deserves more attention because it’s the most common cancer with traditionally poor survival outcomes.”
Complex cancers demand complex solutions
Finding successful treatment for people with SCLC has been difficult because of the complexity of the disease and also because it’s often detected in the later stages, when it has already spread. Dr. Wheatley-Price says that the genetic fingerprint of SCLC is complex, as there aren’t just one or two gene mutations, but thousands. There has been very little progress for SCLC patients until recently, where trials showing the positive effect of immunotherapy are inspiring hope among patients and doctors.
“There has been an explosion of new treatments in the last decade,” says Dr. Wheatley-Price. “Immunotherapy, in particular, has revolutionized cancer treatment in the last five years. Cancer cells are good at hiding from our immune system, but instead of targeting the tumour directly, these new intravenous drugs unmask the cancer cells, making it easier for our immune system to find and destroy the cancer.”
Dr. Wheatley-Price adds that while chemotherapy has traditionally been the go-to treatment for SCLC, having new treatment options will lead to better outcomes.* There are many types of cancer where immunotherapy has proved remarkably successful, and according to Dr. Wheatley-Price this is the case with many lung cancers. “Where it does work, we are seeing great benefits with fewer side effects than chemotherapy,” he says. “And it can work for years. This is something we never saw before. People who would die of the disease are now living. What would have been months is now years.”
[Lung cancer] deserves more attention because it’s the most common cancer with traditionally poor survival outcomes.
Dr. Paul Wheatley-Price, Oncologist & President of Lung Cancer Canada
Playing an active role
The goal is to find a cure for everyone — but if that’s not possible, Dr. Wheatley-Price’s hope is that lung cancer will turn into a chronic disease that can be managed safely and effectively. He believes that with immunotherapy, this could be possible for many people. But every Canadian has a part to play to make this treatment accessible to everyone. Once a treatment is approved by Health Canada, it’s important for people to play an active role in advocating for these treatments to their health care team and government representatives, as not all treatments are available across the country through provincial drug plans.
More than anything, Dr. Wheatley-Price wishes for his patients to live as well and as long as possible, so they can enjoy time with their families, travel, and work if they choose to. With new treatment advances like immunotherapy, he remains optimistic.
* For SCLC, usually a combination of two chemotherapy drugs — commonly etoposide and a platinum-containing drug such as cisplatin or carboplatin — is used. Some combination regimens may use a chemotherapy drug called irinotecan instead of etoposide. If you cannot tolerate combination treatment, you will be treated with only etoposide. New evidence suggests that combining chemotherapy with platinum and etoposide with a PD-L1 inhibitor, may be beneficial in the first line treatment of extensive stage small cell. Speak to your physician to see if this triplet therapy is appropriate for you. Recurrent cancer is also treated with etoposide, topotecan, or with a combination of three chemotherapy drugs — cyclophosphamide, doxorubicin, and vincristine.
This article was made possible with support from Roche Canada.
