Lung cancer treatment has changed forever: How immunotherapy is giving patients new hope

The mood in my OPD is cheerful. The patient is beaming; his wife is grinning. I am smiling. We are all thrilled with the recent PET scan. The mood is considerably different from what it was a few months ago when the patient was diagnosed. His response to the immunotherapy has been impressive and we are all so relieved with the result. Now we can discuss surgery.

Lung cancer remains one of the world's biggest cancer killers. But science is slowly rewriting its story. Patients who, just a decade ago, might have survived only months are now living for years. Many continue to work, travel, plan weddings and watch grandchildren grow up.

The transformation is nothing short of extraordinary.

For decades, treatment relied largely on surgery, chemotherapy and radiation. While these therapies saved lives, advanced lung cancer was rarely controllable for long. Then came a revolution that changed oncology forever. 

We discovered that lung cancers are not all the same tumor but many different tumors with distinct calling cards hiding under the same name. Some tumours are driven by specific genetic alterations such as EGFR, ALK, ROS1, RET or KRAS.

Identifying these mutations through molecular testing allows patients to receive precision medicines that specifically target the cancer cells while causing fewer side effects than conventional chemotherapy. For many patients, these tablets have turned an aggressive cancer into a disease that can be controlled for years.

The second revolution has been even more remarkable—immunotherapy.

Instead of attacking the cancer directly, these medicines remove the 'invisibility cloak' that cancer uses to hide from the immune system. Once exposed, the body's own immune cells begin recognising and attacking the tumour.

For some patients, the results have been dramatic. Long-term survival, once considered exceptional, is now an achievable reality for a growing number of people with advanced lung cancer.

The good news does not stop there.

Patients with early-stage lung cancer now benefit from minimally invasive VATS or robotic-assisted surgery and highly precise radiation therapy to reduce the chances of recurrence. Every year, new clinical trials continue to improve survival and quality of life. Researchers are already studying next-generation immunotherapies, personalised vaccines and innovative cellular therapies that promise even better outcomes in the future.

I have seen patients return to their professions after treatment. I recently had a patient who attended his grandson’s graduation. Something he didn’t think possible two years ago.

Yet it is important to note that some cancers develop resistance, and many people still cannot access molecular testing or newer medicines because of cost or availability. Lung cancer is still a serious disease that demands early diagnosis and multidisciplinary care.

Equally important is prevention. The increase in vaping and smoking amongst the young is not a comforting statistic. Quitting smoking remains the single most effective way to reduce the risk of lung cancer. Reducing exposure to tobacco smoke and air pollution has to be the main focus of our preventive strategies. Increasing awareness and screening people at high risk with low-dose CT scans can detect cancers when they are still curable.

Medicine has moved faster in lung cancer than almost any other field of oncology. The most important message is that every newly diagnosed patient deserves comprehensive molecular testing and a discussion about targeted therapy, immunotherapy and clinical trials. The treatment that was impossible yesterday may well be the standard of care today.

A diagnosis of lung cancer is still life-changing. But it is no longer the dreaded full stop. We hope that, in the future, with the advent of AI in screening, we will be able to achieve better results. Sanjay Dutt, who was diagnosed with advanced Lung cancer in 2020, has been a beacon of hope for many. So, in the words of Munnabhai… immunotherapy has been the proverbial Jadoo ki Jhappi!

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.