Alternatives to cigarettes like vaping are dangerous

Lung cancer is among the most frequent in the Spanish population and is also the one with the highest mortality. It is estimated that each year about 30,000 people die in the country from this pathology, which is usually detected in advanced stages. For this reason, advances in research are essential.

In the Nadim study, developed at the national level, the combination of immunotherapy with chemotherapy as a treatment prior to surgery has demonstrated an effectiveness that represents a paradigmatic change in the treatment of the disease. The doctor Mariano Provencio Pullahead of the Medical Oncology Service at the Puerta de Hierro University Hospital in Madrid and president of the Spanish Lung Cancer Group, has been at the forefront of the investigation, together with Dr. Charo García Campelo, head of the Oncology Service at the A Corua University Hospital Complex (CHUAC), who has led a key team for the monitoring and development of the study. The experts presented the results of the Nadim study in a keynote talk given last Wednesday, May 15, at the Royal Academy of Medicine and Surgery of Galicia, located in A Corua. In conversation with The Voice of Healththey explained what the future of this cancer will look like.

—How would you describe the current panorama of lung cancer in Spain?

—Charo García Campelo: The therapeutic strategy and approach to lung cancer, which is the pathology that causes the most cancer deaths worldwide, has changed radically in the last fifteen years thanks to two fundamental milestones, which are precision medicine. and immunotherapy. We are trying to transfer the knowledge that we have been acquiring in the treatment of more advanced stages of the disease to earlier stages.

—What mortality figures do we have for this type of tumors in our environment?

—Mariano Provencio: Lung cancer is one of the most frequent and is the tumor that causes the most deaths in Spain, more than breast, colon, pancreas and prostate cancer combined. There are 28,000 deaths per year nationwide.

—What is the reason for this high mortality rate?

—CG C: One of the most important factors is that it is diagnosed in advanced stages and this is a great handicap because the chances of cure are lower. Therefore, the biological complexity, from the molecular point of view and genetic alterations, is high.

—Will the pilot screening that has been promoted in A Corua allow progress towards an earlier diagnosis?

—MP: Galicia globally is a community that is very well positioned in terms of health strategy. From the point of view of someone who lives in Madrid, the precision and screening strategy seems enviable to me. A thoughtful and well-designed pilot program has been started here. Starting with this type of strategies has a lot of merit and I think you are on a good path, ahead of the rest of Spain. Screening requires an adaptation of the system to a flow of patients to which it is not accustomed, one must adapt and give a quick response.

—CGC: The pilot program that began a few days ago in A Corua is an enormous step when it comes to seeing what the barriers are to the implementation of screening at the general population level. It is an important program in terms of the consumption of resources it involves and the number of patients. This experience will help us understand the difficulties and how to correct them in the future. That is why it is good news not only for Galicia.

—What were the objectives of the NADIM study and its results?

—MP: We have done a neoadjuvant chemotherapy program with immunotherapy, in locally advanced stages, which are those in which there is difficulty for surgery, because it is rarely complete and, in any case, survival is poor, out of twelve and fifteen months. In the Spanish Lung Cancer Group, we thought that the combination of these treatments could contribute something, we did a first study and obtained very good survival results at two and three years, and a very high rate of possibility of complete surgery, as well as as well as complete pathological responses and disappearance of the tumor when it is removed surgically. Then, we proposed this study that is comparative with the traditional chemotherapy that we use in this situation, where the results that we had previously obtained were confirmed, both in overall survival, relapse-free survival, surgery rate and complete pathological response rate. This is the core. To this have been added international studies that have reproduced our data.

—How does this treatment improve results over surgery alone?

—MP: We knew the prognosis with surgery alone was very bad, a few months, despite it being a localized tumor. During the last 30 years we added chemotherapy prior to surgery, trying to improve that prognosis and now, along those lines, we try to improve the prognosis by incorporating immunotherapy.

—What measures can you recommend to the general population to prevent this cancer?

—MP: Quit smoking or not get into the habit. It is very striking that in Spain women continue to take up smoking more quickly and enthusiastically in the younger generations than men. In fact, an ascending curve is seen in incidence and mortality in females compared to males. 85% of lung cancers are related to tobacco. There is a lot of permissiveness and a lot of lobbying.

—Is vaping as dangerous as smoking?

—MP: The issue is that alternative formulas are always sought to soften consumption and that, in young people who have a lower capacity to evaluate risk and a training development that is not yet complete, is dangerous. It is important to intensify training and dissuasive actions in them, because it is more difficult to wean them off later. That young population of fifteen-year-olds would have to be the primary objective. Younger people don’t have as much information as adults.

—Growing up in a home where smoking increases the risk of cancer?

—CGC: Yes, on the one hand, passive exposure to tobacco is a risk associated with lung cancer. Then, social normalization means that if you have lived with tobacco since you can remember, it is more difficult for you to change that normalized view of tobacco.

—MP: If your parents, who are your models, smoke, you have introduced a psychological connection with smoking, you think that this can be done and that it is not so bad. It is important for parents to limit that exposure. Social perception has changed compared to 20 years ago. It is more widely rejected, but it is not complete and there are no campaigns maintained by the administration to reinforce it.

—An increase in lung cancer cases has been seen in young, non-smoking women. What is it due to?

—CGC: Lung cancer in non-smokers is a completely different biological entity than lung cancer associated with tobacco. It is a group of patients, usually female, of middle age, who have never been exposed to smoking, and we are still not clear what the triggering factors of the disease are in them. There are hormonal factors, there is exposure to radon, which we know is a risk in communities like ours, and they are biologically different patients who accumulate genetic alterations that we can treat in a specific way and who have a more benevolent behavior. There are multiple causes behind these tumors and we are trying to elucidate them.

—In oncology there is increasing talk of chronification of metastatic or advanced patients. Is this possible in lung cancer?

—MP: Yes. Targeted therapy with immunotherapy has led to the emergence of long-term survivors who have a life expectancy of years, instead of months. But the greatest challenge is to cure cancer, so that all these therapeutic advances in advanced disease are transferred to early disease and can be cured. And in lung cancer, the problem is that, even if you discover it very early, there is a very high percentage of relapses.

—What challenges is oncology facing in lung cancer?

—MP: Currently, except for those patients who have specific mutations, for which we have a target and a drug, we treat all the rest and some respond but others do not. We have to identify those who are not going to respond and try to avoid unnecessary treatments, as well as identify those who respond very well so as not to overtreat them. With chemo and immunotherapy, we are seeing patients who enter a complete pathological response, that is, complete disappearance of the tumor. The value there is in being more economical in the aggressiveness of the treatments, avoiding surgeries. This identification of patients allows us to know how far to go with the treatments, when to escalate the intensity. That is the future of research that awaits us.