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History of the evolution of lung cancer treatment

  The word “cancer” is generally believed to have been created by Hippocrates more than 2,000 years ago. The Latin word for cancer means crab, and the tumor that people saw at that time was a kind of savage growth in the human body like a crab, which was difficult to remove. Something that cannot be cured.
  The concept of cancer was born in the West, but some diseases described in ancient Chinese medical writings should be what we call cancer today. For example, the description of “lung accumulation” in various traditional Chinese medicine books is very close to lung cancer.
Main classifications of lung cancer

  Lung cancer is mainly divided into non-small cell lung cancer and small cell lung cancer, of which non-small cell lung cancer is more common, accounting for about 85%, and non-small cell lung cancer includes adenocarcinoma, squamous cell carcinoma and large cell carcinoma. After the diagnosis of lung cancer, the staging of lung cancer is of great significance to determine the progression of the disease and guide the treatment. Currently, lung cancer is divided into stage I, stage II, stage III and stage IV, of which stage I-II is early stage, stage III is locally advanced stage, and stage IV is advanced stage.

Lung cancer treatment

  The treatment methods of lung cancer include surgery, radiotherapy and drugs. The drugs are mainly chemotherapy, molecular targeted drug therapy and immunotherapy. These treatments need to be used in a planned and rational manner to maximize the benefits of patients.
  Various treatment methods run through the entire process of lung cancer treatment and play different roles. The main treatment methods for patients with early stage lung cancer are surgery, which can be combined with radiotherapy and chemotherapy. The treatment methods for patients with advanced lung cancer mainly include radiotherapy, chemotherapy, targeted drug therapy, and immunotherapy.
Operation
1912 Pioneers of Lung Cancer Surgery

  Doctors in London, England have completed the world’s first anatomical lung cancer resection, greatly improving the safety of the operation.
1933 Lung cancer surgery matures

  Surgeon Graham performed the world’s first left pneumonectomy for lung cancer. But in fact, not all lung cancers require whole lung resection. In 1948, a comparison between “pneumonectomy” and “lobectomy” found that for lung cancer with limited lesions, only one lung lobe was cut.
In the 1950s and 1960s, the standard of surgical treatment of lung cancer was formally established

  The standard surgical treatment of lung cancer has basically been established, that is, “lobectomy + mediastinal lymph node dissection”, and it has been used until now. Nowadays, patients can choose minimally invasive thoracoscopic lung cancer surgery. After the invention of the surgical robot, the robot can assist doctors to carry out thoracoscopic lung cancer surgery.
radiotherapy
early radiotherapy techniques

  In 1899, some people began to use X-rays to treat skin cancer, and radiation therapy for malignant tumors became a craze.
  In 1950, the application of high-energy radiation 60-cobalt treatment machine and linear accelerator increased the radiation dose of tumors and established the status of modern radiation oncology. Combined with surgery, it improved the survival rate of most tumor patients.
  In the late 1960s, the application of electronic computer technology made radiotherapy more accurate, and the radiation target area could obtain the largest tumor lethal dose, while the radiation damage to the surrounding vital organs was minimal.
The era of precision radiotherapy

  With the continuous progress of modern medicine, radiotherapy for cancer has entered the era of precise treatment, “emphasis on radiotherapy”, “Gamma Knife”, “Cyber ​​Knife”, “TOMO Knife” and other radiotherapy methods have entered everyone’s attention, and more It kills tumor cells well while protecting normal tissues.
  Radiation therapy continues to escalate toward greater precision. The “radioactive particles” mentioned in interventional therapy are also a kind of radiotherapy, also known as “inter-tissue radiotherapy”. risk of pain, bleeding, and damage to surrounding organs. Proton and heavy ion therapy are more advanced technologies in current radiotherapy, which are more powerful in killing malignant tumors, and at the same time, they can avoid surrounding normal tissues and organs as much as possible.
Chemotherapy
concurrent chemoradiotherapy

  In the early 1990s, concurrent chemoradiotherapy emerged and became the standard regimen for the treatment of stage III unresectable NSCLC. A large number of patients cannot tolerate and cannot perform concurrent chemoradiotherapy, and sequential chemoradiotherapy has become an important alternative.
immunoconsolidation therapy

  Until the emergence of immunoconsolidation therapy in 2017, a new treatment model for locally advanced unresectable NSCLC was created, and immunoconsolidation therapy after concurrent chemoradiotherapy became the standard treatment mode.
The emergence of immune preparations

  In 2022, the emergence of another immune preparation, sugalimumab, brought survival benefits to patients with concurrent and sequential chemoradiotherapy, and became the standard treatment for patients with stage III unresectable NSCLC after concurrent or sequential chemoradiotherapy.
driver gene-positive targeted therapy
EGFR-targeted drugs

  EGFR-related targeted drugs are the first targeted drugs to be developed. The first EGFR-targeted drug was approved in 2009, and since the advent of second- and third-generation EGFR TKIs, the survival time of lung cancer patients has been prolonged. So far, there are three generations of EGFR-targeted drugs on the market in China, and they have been widely used in the first-line standard treatment of NSCLC patients with EGFR-sensitive mutations.
ALK targeted drugs

  In 2011, the first ALK TKI, crizotinib, was approved by the FDA for the treatment of ALK-positive advanced non-small cell lung cancer, ushering in the era of targeted precision therapy for ALK-positive non-small cell lung cancer.
  Subsequently, the second-generation ALK TKIs came out one after another, which greatly enriched the clinical drug options. The first third-generation ALK TKI, lorlatinib, will be approved in China in 2022. Compared with first- and second-generation ALK TKIs, lorlatinib can greatly prolong the progression-free survival of patients. At the same time, its unique small-molecule macrocyclic amide structure It has stronger antitumor activity, broader anti-ALK resistance mutation spectrum and stronger intracranial efficacy.
More targeted drugs for rare targets

  With the widespread application of next-generation sequencing technology, more and more driver genes with lower mutation frequencies have been discovered. Typical rare targets include ROS1, BRAF, NTRK, MET, RET, KRAS, etc.
  In 2016, crizotinib was approved as the first-generation ROS1 inhibitor, and the median overall survival time of first-line treatment was 51.4 months. Since then, rare target drugs have been continuously launched to promote the process of chronic lung cancer.

Driver gene-negative immunotherapy

  In 2015, the clinical trial of the first immunotherapy single drug started, which opened the era of immunotherapy exploration.

  In 2017, the results of immunocombination chemotherapy in the treatment of non-small cell lung cancer were announced, showing that it can prolong the survival time of patients with advanced non-small cell lung cancer. Since then, the era of immunotherapy has begun, and a variety of PD-1 and PD-L1 inhibitors have emerged.

  The exploration of immunotherapy has not stopped, and emerging immunotherapies such as new immune targets, bispecific antibodies, antibody-conjugated drugs and vaccines have jointly promoted the survival of lung cancer patients.

  We believe that with the continuous advancement of science and technology and the continuous advancement of new drug research and development work, there will be more treatment methods in the future, and the birth of more good drugs and new drugs will bring longer survival for lung cancer patients and truly realize slow Disease management.