A bright future for lung cancer care

On this World Lung Cancer Day, I am reflecting on the great leaps we have made in changing the course of this disease, while recognising the important work remaining to provide optimal prevention and care to all people living with lung cancer.

When I began my career as a medical oncologist many years ago, there was only one chemotherapy regimen available for patients with advanced disease, and most patients did not receive it. I am in awe of the progress we have made and grateful to be a part of this amazing story. 

Over the past few decades, we have witnessed unprecedented advances in the screening, early detection, and treatment of lung cancer. Notable advances include the discovery of several druggable genetic alterations [Editor's note: specific mutations or changes in genes that can be targeted with therapeutic drugs], which have forever changed how we approach lung cancer as we celebrate 20 years since the discovery of EGFR mutations.

Importantly, we've seen an impressive mobilisation of patients to advocate for progress. On the heels of molecular targeted therapy came surprising data that immune-based therapies were not only effective but could cure a fraction of patients – even those with advanced disease.

In addition to new therapies across all stages of lung cancer, a long-awaited screening test for lung cancer, low-dose chest tomography (CT), emerged. I must also recognise pivotal advances in pathology, surgery, radiation oncology, technology, and science that have played a role in this journey. 

Despite this positive news, lung cancer remains the leading cause of cancer-related deaths worldwide. Each year, more than 2.4 million people worldwide receive a diagnosis, and nearly 2 million people succumb to the disease. In addition, lung cancer is no longer a disease of those who smoke but also of those who do not.  Lung cancer in never smokers ranks as the 5th leading cause of global cancer deaths. When you consider that the mortality rate of lung cancer is nearly double that of the second-highest cancer, colorectal cancer, it's clear that there is more work to be done to implement these advances worldwide. 

Armed with these advances and many more to come, the International Association for the Study of Lung Cancer (IASLC) is more confident than ever that we can conquer lung cancer in the 21st century.

Our multidisciplinary, global members, the heart and soul of the IASLC, are dedicated to achieving this goal by fostering collaborative approaches to raising awareness, education, research, and partnerships. We are privileged to have such a diverse and expansive membership ranging from epidemiologists, basic scientists, translational and clinical scientists, radiologists, pulmonologists, pathologists, thoracic surgeons, radiation oncologists, medical oncologists, nurses, allied health professionals, patients, caregivers, and industry partners from across the world. A multipronged approach, which includes tobacco control, screening, early detection, and biomarker testing, is needed to achieve a dramatic decline in lung cancer mortality. 

Ideally, detecting lung cancer in its earliest and most curable form is the penultimate goal. Low-dose CT screening is recommended for current and former smokers. While these recommendations are a step in the right direction, they are not universally implemented and omit never smokers, who can constitute the majority of patients in areas such as East Asia. Even in areas with screening programmes, participation rates remain disappointingly low. In the US, fewer than 5% of eligible patients have undergone screening, highlighting a significant opportunity for improvement. The IASLC is eager to partner with others to expand global CT screening efforts. 

In parallel, the IASLC has a focus on improving global rates of comprehensive biomarker testing. There are ten distinct, independent drivers of lung cancer, each with their own treatment. Comprehensive biomarker testing is required to enable providers and patients to select the most effective targeted therapies, thus improving a patient’s chance of survival while ensuring patients do not receive alternative agents that could be harmful.

The IASLC has just completed a global survey to identify barriers to biomarker testing and has plans to develop a toolkit to assist healthcare systems overcome these barriers. However, testing is step one. Access, availability, and affordability of these highly effective therapies must also be tackled. I am personally heartbroken that all patients across the world may not see these lifesaving treatments. We must do better, and I know we will with all our bright minds working together. 

As the IASLC celebrates its 50th year, we remain committed to conquering lung cancer by bringing together healthcare providers, patients, caregivers, advocacy groups, and industry partners. I have no doubt that the next 50 years will see continued progress on lung cancer prevention, detection, and treatment that will benefit patients around the world.