• Health: Genetics confirms that it is never too late to quit smoking
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If talking about lung tumor (the leading cause of cancer death worldwide) are already "big words", when it comes to a specific type of this disease, small cell lung cancer (CPM), we are undoubtedly before what could be considered the most extreme version of this pathology, which for many years has brought specialists down the path of impotence, mainly due to the therapeutic aridity they have had to face.

And it is as explained by Pilar López Criado, head of the Section of Lung Tumors, Head and Neck and Melanoma of MD Anderson Cancer Center Madrid, "not all lung cancers are the same. In fact, it can be said that it is not treated of a single disease but of more than 20 different subtypes or diseases.This evidence has allowed us to know the different manifestations and better define each tumor, which in turn has opened the way to provide the best treatment in each case. From the point of view of patients, knowing that their tumor has a 'last name' helps them demystify the disease. We are at a time when the general approach to lung cancer is no longer valid, we have to go one step further. "

This diversity of presentation referred to by López Criado is grouped around two main types of lung cancer: the most frequent (it represents 85% of all cases), which is non-small cell lung cancer (NSCLC) or large cell, and microcytic (CPM), also called small cell tumor, which, despite its low frequency (about 15% of cases) is not only a challenge but also an unmet medical need , due its biological peculiarities and the way in which the disease occurs.

This tumor causes around 3,000 deaths a year in Spain, 40,000 in Europe and 150,000 in the United States . It is a type of cancer of neuroendocrine origin, whose main characteristic is the great speed with which it progresses and evolves. "Biologically it is an aggressive tumor, since it accumulates a large number of genetic alterations, with a greater tumor burden and an adverse prognosis. It is diagnosed in advanced stages in two thirds of patients," explains Dolores Isla, head of the Oncology service. Physician at the Hospital Clinico Universitario Lozano Blesa, Zaragoza.

Specifically, at the time of diagnosis, 30% of patients are in what is called a limited stage (the tumor is located on one side of the thorax, affecting a region of the lung and adjacent lymph nodes), and 70 Remaining% have an extended stage (the disease has spread throughout the lung and spread to regions of the chest or other areas of the body).

Tobacco and stigma

According to Pilar López Criado, the main risk factor involved in the development of this tumor is tobacco. In fact, 98% of patients are smokers and, as in the rest of lung cancers, a clear increase in cases is being observed among the female population, which for Dr. López Criado is proportional to the higher female consumption of this substance, "a circumstance to which, beyond the social component that this habit has, other factors join. One of them is the weight loss associated with tobacco use , since many women confess that they smoke to avoid eating more. (a factor that, on the other hand, makes it difficult to stop using it.) In addition, tobacco reduces the taste of food, a 'side effect' that is also used as a strategy to reduce intake, "says López Criado. "On the other hand, tobacco produces alterations in the DNA that the body is trained to repair; however, it has been seen that the correction mechanisms of these alterations, in the case of women, are less effective than in men" , Add.

In relation to this close link between tobacco and lung cancer in general and CPM in particular, Ivana Sullivan, an oncologist at the Hospital de la Santa Creu i Sant Pau, in Barcelona, ​​stresses that early detection goes through precisely Addressing an unquestionable reality: that despite the fact that everyone knows the relationship between smoking and this tumor and the initiatives launched in this regard, the figures show how little success they have had . "The best policy to implement in this regard is primary prevention, fundamentally preventing adolescents from starting smoking, and for this, it is necessary to intervene directly and actively in educational centers. Likewise, it is necessary to promote the cessation of smoking in smokers through awareness programs , as well as providing them with the necessary tools to achieve it, something that is not easy in most cases. "

But smoking is also behind one of the main consequences that this disease has on a mental level, stigma, as is clear from the conclusions of the report "The emotional and social sphere of lung cancer", prepared by the More Foundation What Ideas and the Spanish Association of Lung Cancer Affected. According to this research, a considerable proportion of these patients experience stigma-related feelings. Specifically, 34.2% admitted feeling guilty; 21.6% considered that they were judged by others; and 19.4% affirmed having felt ashamed for suffering from lung cancer.

Regarding this issue, Ivana Sullivan explains that "the stigma is still very marked, and can have an impact on the diagnosis, since many of these patients have feelings of guilt for having been (or continuing to be) smokers . This makes them want many times hide the disease or minimize the symptoms. At other times, it is the fear that invades them that makes them not consult the specialist or do it too late ".

"Integral" impact on quality of life

The report also reflects that for more than 52% of respondents, the time of receiving the diagnosis is the most difficult and emotionally complex , followed by the period between diagnosis and the start of treatment (43.5%). "Uncertainty is the psychological reaction that we observe most frequently in lung cancer patients, mainly at the time of diagnosis. And fear is also present in most of them, especially pain, suffering, sadness and death. All this limits and reduces the quality of life, "says López Criado.

These reactions are even more intense in the case of CPM, since both medical decisions and the assimilation of the situation by the patient have to be made against the clock, so the impact on quality of life tends to be greater. Fortunately, these types of aspects are becoming increasingly important in evaluating the physical and psychological effects of the approach to this disease, "and, in fact, they are taken into account in the work being carried out to find strategies that , in addition to the therapeutic effect, reduce or control the physical and psychological repercussions of this pathology, "says Dolores Isla.

As for the diagnostic delay of the small cell tumor, it is common to all types of lung cancer (an organ in which detection is not easy) that it is normal to go to the specialist only when the symptoms give the face (coughing up blood or expectoration, chest pain, dyspnea, difficulty swallowing, change in tone of voice ...). In the case of CPM, the symptoms are the same, although they can appear more abruptly and urgently and generally with greater intensity.

To this aggressiveness and rapid evolution and late diagnosis are added the few therapeutic options that have been available so far for this tumor. Chemotherapy has been the standard option for more than two decades, with the effects that Pilar López Criado comments: "As it is a very aggressive tumor, the response is good in most cases, producing an improvement in symptoms, which which in turn helps minimize the side effects of treatment, but new therapies are needed that improve survival and reduce toxicity . "

In this sense, all eyes have been focused for some time on the other type of cancer, NSCLC, in which, in contrast to "immobility" in the field of small cell tumor, great strides have been made in what today for today it is the line towards which these treatments are directed: precision medicine . "This approach has meant an important change in the approach, since with this strategy we can currently achieve that an increasing percentage of patients can benefit from receiving personalized treatments, that is, directed at certain molecular or genomic alterations , to face them These treatments, some of which are not available outside of the clinical trials setting, have a higher specificity and, therefore, a greater efficacy is expected, which usually translates into an increase in survival compared to other more options. conventional, like chemotherapy, "explains Ivana Sullivan.

And in that, immunotherapy came

"However," continues Sullivan, "in CPM, unlike non-small cell lung cancer, we have not yet detected any molecular or genomic alteration that allows us to use targeted therapy, beyond chemotherapy, since for the last 30 years No drug has been approved with a clearly beneficial effect on this type of tumor . "

In the case of NSCLC, the combination of chemotherapy with immunotherapy is giving excellent results, with notable increases in survival rates and without increasing toxicity, being today the standard treatment in many of these patients (those with the tumor in advanced stage, without molecular or genomic alterations and that do not present contraindications to receiving immunotherapy), according to Sullivan.

And fortunately, there is recent evidence that these benefits are extensible to patients with advanced or metastatic CPM, thanks to the combination of immunotherapy and chemotherapy .

But they also insist that much remains to be done, especially with regard to better knowledge of the biology of small cell lung cancer as a basis for the search for biomarkers that allow predicting the efficacy of new therapies in a personalized way in each one. of patients with this tumor.

According to the criteria of The Trust Project

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