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Uncertain realities faced by lung cancer patients

In 2020, Maria and ~ 478,000 others across Europe, were diagnosed with lung cancer.[1] Maria was diagnosed with non-small cell lung cancer (NSCLC) with distant metastasis. She faces a terrifying 5-year survival rate of 6%.[2] Devastatingly, Maria’s precious time left is tainted by the physical and emotional burden of her illness.[3]

The patient described is fictional and has been used for illustrative purposes only.

Lung cancer can be classified as either non-small cell lung cancer (NSCLC) or small-cell lung cancer (SCLC)[4]

SCLC is sometimes called oat cell cancer, and accounts for approximately 10–15% of lung cancer cases.[4]


NSCLC accounts for ~80–85% of lung cancers.[4] Depending on the type of cells that are cancerous, NSCLC can be categorised into adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.[4] Most lung cancer deaths are due to advanced-stage adenocarcinoma and squamous cell carcinoma.[5]

Heavy smokers have a 20-fold higher risk of lung cancer[6]

Risk factors for lung cancer include:

Smoking

Smoking is a leading risk factor for lung cancer.[7] However, 20% of lung cancer deaths are unrelated to smoking[7][8]

Environmental factors

Exposure to radon gas, asbestos, air pollution, and other agents such as coal smoke and diesel fumes can cause lung cancer[7][8]

Lung diseases

Conditions such as chronic obstructive pulmonary disease (COPD) can pose an increased risk for lung cancer, and a number of studies suggest this is independent of smoking[8]

Chronic infections

Patients with pulmonary tuberculosis have been found to be at increased risk of lung cancer[8]

Family history of lung cancer, or genetic factors

Several registry-based studies have found that family history is a risk factor for early-onset lung cancer.[8] What’s more, chromosome 6q23–25 has been shown to be genetically linked to lung cancer[8]

Lung cancer is the leading cause of cancer death worldwide[1]

In 2020, there were 2.21 million new diagnoses and 1.79 million deaths caused by lung cancer worldwide.[1]

ASCO GU - Lung cancer

Adapted from International Agency for Research/World Health Organization, 2020.[1]

Number of lung cancer cases in Europe in 2020[9]

country map

Adapted from International Agency for Research on Cancer/World Health Organization, 2020.[9]

The median age of lung cancer diagnosis is 71, and most people are diagnosed above the age of 65.[10]

In Western Europe, lung cancer is nearly twice as common in men than in women,[1] although this gap has been closing over the past few decades.[4]

Worldwide, twice as many men die from lung cancer than women.[11][12]

Most lung cancers do not cause any symptoms until they have spread, but some patients experience the following:[13]

Cough


Shortness of breath (dyspnoea)


Blood in sputum (haemoptysis)


Infections


Fatigue


Weight loss


Lung cancer is often diagnosed at a late stage.[14] Various techniques are used for diagnosis including:

Assessment of medical history[15]

To assess symptoms and possible risk factors

Physical exam[15]

To determine signs of lung cancer as well as other health problems

Blood test[15]

To identify biomarkers and obtain a genomic profile of the cancer[16]

Computed tomography (CT) of the chest and upper abdomen[15]

A CT scan uses X-rays to make detailed cross-sectional images of the body. This technique helps to identify the shape, size, and position, of tumours.

Biopsy[14]

Needles are often used to extract samples from suspected tumours. Techniques used include: transtracheal or transbronchial fine needle aspiration (FNA) or core biopsy involving a larger needle.

The European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) clinical guidelines recommend the use of molecular testing at the initial diagnosis of lung cancer to detect the presence of molecular biomarkers.[17][18]

Lung cancer stages are classified using the TNM system[19][20]

The fundamental structure of stage classification is the TNM system: T for characteristics of the primary tumour, N for nodal involvement, and M for (distant) metastasis.[19][20] NSCLC stages range from 0 through to IV, the earliest stage is 0 (also called carcinoma in situ or CIS).[19]

If lung cancer spreads to other parts of the body, it may cause bone pain or nervous system changes (such as headache, weakness or numbness of an arm or leg, dizziness, balance problems, or seizures), from cancer spread to the brain. It can also cause yellowing of the skin and eyes (jaundice), from cancer spread to the liver, or swelling of lymph nodes.[13]

The poor prognosis of lung cancer means receiving a diagnosis can be overwhelming and incredibly frightening[2]

Lung cancer has an overall 5-year survival rate of 20.5%.[10] Survival rates differ depending on the type and disease state at diagnosis:[2]

  • Localised NSCLC has a 5-year survival rate of 61%
  • Metastatic NSCLC has a 5-year survival rate of 6%
  • Localised SCLC has a 5-year survival rate of 27%
  • Metastatic SCLC has a 5-year survival rate of 3%

Lung cancer is associated with not only a decreased chance of survival,[2] but can also reduce quality of life for patients.[3] This is as a result of the amount and severity of symptoms experienced having an impact on patients’ mental health, cognitive functioning, and physical abilities.[3] It is therefore important that management of the disease incorporates maximising patients’ quality of life as well as overall survival.[3]

At Janssen Oncology, we are precisely focused on mastering the areas where we can make the most meaningful difference

We know that the words “you have cancer”, are terrifying for patients to hear and distressing for healthcare professionals to say. We also know that the precious time that cancer patients have left is often tainted by the physical and emotional burden of their illness. At Janssen Oncology, we are working tirelessly to transform outcomes and ensure healthcare professionals can help patients maximise the time they have left.

Lung cancer brings fear and uncertainty. Patients, their families, and the entire oncology community deserve transformed outcomes.

At Janssen Oncology, our purpose is to make cancer a manageable and, ultimately, curable condition. It provides us with a constant source in which to channel our efforts, making us feel a part of something far bigger, outside ourselves.

Treatment of lung cancer is stage specific.[21] Options include:

Surgery

Surgery, where possible, to remove the lung tumour.[21]

Chemotherapy

Chemotherapy agents for the treatment of locally-advanced and metastatic lung cancer.[21]

radiation therapy

Radiation therapy, which can be used alongside chemotherapy to destroy the cancer cells, or instead of surgery in localised disease.[21]

Immunotherapy

Immunotherapy, which can be used to help boost the patient’s immune response against the cancer.[4]

targeted therapies

Targeted therapies, which are designed to target a specific molecular feature of the cancer.[4][21]

Despite available treatments, patients with lung cancer face a frightening reality:

Chemotherapy can demonstrate low response rates for some patients[22]
Resistance to targeted therapies can develop in some cases[23]

There is a need for new targeted therapies in NSCLC.[23]

Janssen Oncology & The Lung Cancer Initiative: striving to address challenges across the lung cancer patient pathway

At Janssen Oncology, we know that change can only come through collaboration, so we invest our time and resources to partner with experts, unlocking the potential around us. All in pursuit of better outcomes for patients and their families. As a part of the Johnson & Johnson Lung Cancer Initiative, we are striving to address challenges across the entire patient pathway and ultimately transform outcomes for patients suffering from lung cancer.[24][25]

Together, we have a deep and differentiated pipeline, including precision medicines,[26][27] medical technologies improving lung cancer screening,[25] and consumer health products encouraging smoking cessation.[25]

Janssen Oncology and the Lung Cancer Initiative are transforming the science of lung cancer, taking it from where it is to where it has never been before, through targeted transformation.[24][25]

ASR, age-standardised rate. COPD, chronic obstructive pulmonary disorder. CT, computed tomography. NSCLC, non-small cell lung cancer. SCLC, small-cell lung cancer. TNM, tumour-node-metastasis.

Date of Preparation: June 2021  |  CP-230384

References

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