There’s Big News in the Fight Against Small-Cell Lung Cancer

Even though the number of new lung cancer cases across the U.S. is decreasing — partly because more people are quitting or not starting smoking — lung cancer is by far the leading cause of cancer death in the U.S. In fact, lung cancer accounts for about one in five of all cancer deaths.

Most people diagnosed with lung cancer are 65 or older. Individuals considered to be high risk are adults between the ages of 50 and 80 who have significant smoking history, such as smoking the equivalent of one pack per day for 20 years or more.

Compared to many other cancers, what’s especially dangerous about lung cancer is that it can go completely undetected, especially in the early stages.

“Many times, early lung cancer does not present with any symptoms. Early symptoms include a persistent cough or change in cough pattern. Some patients with chronic cough may noticed that their cough is becoming more productive or more frequent,” said M. Jameel Kyasa, MD, Board-certified medical oncologist and hematologist, AdventHealth Cancer Institute.

Not All Lung Cancers Are the Same

There are two types of lung cancer — small cell (SCLC) and non-small cell (NSCLC). Each type is distinguished by the appearance of its cells under a microscope, influencing its growth, spread and treatment. Between the two types, SCLC is far less common — but far more aggressive.

“Small cell lung cancer follows a rapid progression pattern that usually presents as a more advanced disease where surgery is not a treatment option. It also has tendency to spread fast to other organs, including the brain,” said Dr. Kyasa.

Early detection through screening can significantly improve outcomes for most cancer patients. For example, the five-year survival rate for stage 1 breast cancer is greater than 99 percent.

“However, early lung cancer does not usually get detected on a regular blood test. And while there are several promising screening tests that could allow for early detection of lung cancer and other malignancies, such tools are still investigational,” said Dr. Kyasa.

Once someone is diagnosed with lung cancer, treatment usually begins with surgery to remove the cancer. If the cancer is very large or has spread to other parts of the body — which is often the case with SCLC — surgery may not be possible.

The primary, non-surgical type of treatment for SCLC is chemotherapy, sometimes combined with radiation therapy.

But what happens if the cancer gets worse during treatment or returns after treatment is finished?

BiTE Therapy Emerges as a Second-Line Treatment for SCLC

Our immune systems are equipped to recognize and destroy cancer cells — if they can find them. It’s sort of like a game of hide and seek, with cancer cells too often having the advantage.

Fortunately, there’s now a way to show immune T-cells where the cancer cells are. T-cells are a type of white blood cell that helps our immune system fight germs and protect us from disease.

That’s the idea behind bispecific T-cell engagers, or BiTEs, for short.

“BiTE therapy uses biotechnology to develop drugs that can simultaneously bind to two different targets, typically a cancer cell and an immune T-cell. This dual binding brings the T-cell into close proximity to cancer cells — promoting the activation of the T-cell and leading to the destruction of the cancer cells,” said Dr. Kyasa.

The molecules released from immune T-cells serve multiple purposes:

• some poke holes in the cancer cell, forcing the cancer cell to self-destruct
• others activate cell death pathways within the cancer cell
• some prompt surrounding cancer cells to display the target protein on their surfaces, so they, too, can be targeted by the BiTE.

By bridging cancer cells and immune T-cells, BiTEs are giving immune T-cells a fighting chance by tapping into the incredible potential of the immune system.

“This novel way of specifically attacking cancer cells using the patient’s own immune cells has led to multiple drug approvals in different malignant diseases. It is literally changing the landscape of anticancer therapy,” said Dr. Kyasa.

The AdventHealth Cancer Institute is opening new doors to the future of cancer care. This state-of-the-art facility is completely dedicated to cancer care — from prevention, to diagnosis, to treatment and follow up appointments.