Adventures of a Diva Princess: LUNG CANCER

Immunotherapy drug outperforms chemo in latest trial

A recent study comparing the immunotherapy drug pembrolizumab to chemotherapy could alter more than 30 years of practice in lung cancer treatment.

The clinical trial, known as Keynote-024 (KN-024), showed pembrolizumab’s superiority in preventing cancer progression and prolonging the lives of previously untreated patients with non-small cell lung cancer (NSCLC).

“We believe that the KEYNOTE-024 results have the potential to change the therapeutic paradigm in first-line treatment of non-small cell lung cancer,” said Dr. Roger M. Perlmutter, president of MSD Research Laboratories. “We look forward to sharing these data with the medical community and with regulatory authorities around the world.”

Pembrolizumab boosts the immune system’s antitumor activity by preventing cancer cells from interacting with the immune system’s T-cells. During interaction, tumor cells produce a protein called the Programmed Death-Ligand 1 (PD-L1) which deactivates T-cells. Blocking this enables T-cells to remain capable of detecting and destroying cancer in the body.

The Philippine Food and Drug Administration (FDA) approved pembrolizumab for the treatment of advanced melanoma and PD-L1-positive lung cancer that failed previous therapies. Immuno-oncology leader MSD introduced this breakthrough anti-cancer drug in the Philippines last March.

Consistent results on safety and efficacy

KN-024 is a randomized study with 305 participants who received either pembrolizumab or chemotherapy. When it demonstrated the new drug’s efficacy in halting the progress of cancer and increasing survival rates, an independent Data Monitoring Committee (DMC) recommended an end to the trial. The DMC further recommended that patients on chemotherapy be given the opportunity to receive pembrolizumab.

The results also showed that the drug was consistent in terms of safety and tolerability, with side effects commonly immune-mediated, or due to the response of the immune system. Only less than five percent of participants experienced these adverse effects during the study.

In case of a severe reaction to the drug, doctors advise stopping treatment temporarily and taking steroids to alleviate the side effects. Treatment may resume once the patient’s condition improves.

A game-changer in cancer treatment

According to Globocan 2012, lung cancer is the top cause of cancer mortality worldwide, accounting for 1.5 million deaths annually. In the Philippines, doctors report over 12,000 new cases of lung cancer each year and more 10,000 deaths due to the disease.

With immunotherapy possibly becoming the new standard of lung cancer treatment, millions of patients can now hope for better chances of survival while being spared from the harsh effects of existing treatment options.

MSD will present the results of the KN-024 trial in an upcoming medical meeting.

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The Medical City offers comprehensive diagnosis, treatment modalities for colorectal, lung cancers

The World Health Organization (WHO) says the early detection of cancer greatly increases the chances for its successful treatment. Recognizing the warning signs of cancer and taking prompt consultation usually leads to early diagnosis and treatment. Providing health professionals and the public with an awareness of the early signs of cancer will have a great impact in addressing the illness. In fact, early diagnosis is relevant to specific types of cancer, namely those affecting the breast, cervix, mouth, larynx, colon and rectum, lung and skin.

The Medical City Cancer Center

Cancer Research UK, a leading global charity dedicated to beating cancer through research, says the early diagnosis of cancer means it can be easily removed or treated. The late diagnosis of cancer makes treatment difficult and lowers a person’s chances of surviving the illness. It estimates that as much as 10,000 deaths from cancer could be prevented with early diagnosis and treatment.

The Philippine Cancer Society lists lung cancer as the leading cause of deaths from cancer in the country. In 2010, a total of 11,458 cases were reported, while there were 9,184 deaths. Colorectal cancer, on the other hand, ranks no.4 in terms of cancer deaths. In the same year, 5,787 cases were recorded, while deaths due to colorectal cancer reached 3,060 cases.

The Medical City Cancer Program

The Medical City (TMC) Cancer Program, organized in 2006, adopts a unique multidisciplinary team approach to cancer prevention, early detection, diagnosis, and management. It applies innovative molecular technologies in diagnosis and treatment for a truly customized and personalized care.

With a full appreciation that no two individuals are alike, regardless of similarities between two patients diagnosed with the same type of cancer, TMC Cancer Program applies an individualized approach to cancer diagnosis and treatment based on the patient’s profile and history.

With this, a personalized treatment plan according to the profile and preferences of the patient is developed by a multidisciplinary team. The highly trained medical team includes cancer specialists, nurses and other specialized health care professionals. Family members are also an important part of this. Central to everyone, the focus of our cancer program is the patient.

Cancer Center

Colorectal Cancer

Colorectal cancer is among the top five most common cancers in the country today. Recent studies showed that the Philippines has a higher colorectal cancer mortality compared to other countries. Colorectal cancer is cancer that starts in either the colon or the rectum.

Colorectal cancer ranks fourth among cancer-related deaths in Filipinos. According to the Philippine Cancer Society, Inc., almost 75 percent of the individuals affected were aged 50 and above, while only about three percent were children 14 years old and below. It is estimated that one out of 1,800 Filipinos will develop the cancer yearly.

Dr. Ramy Roxas, head of TMC’s Colorectal Clinic, says, “With good screening and early diagnosis, 90 percent of colorectal cancers are curable."

Early screening and a multi-modality treatment such as chemotherapy, pre-operative radiotherapy and surgery are among the factors responsible for improving colorectal cancer outcomes.

TMC’s Colorectal Clinic offers cancer-screening tests, including FOBT, diagnostic and therapeutic flexible sigmoidoscopy, and colonoscopy. “Colonoscopy is one of the most unloved cancer tests, but it can save lives. It is the most accurate test for colorectal cancer,” says Dr. Roxas.

He explains a fecal occult blood test (FOBT) is recommended for everyone aged 50 and above. This test should be done every year after age 50. The other alternative is to undergo colonoscopy every five to 10 years. Those with a strong family history of colorectal cancer or those with two or more family members who had the disease should be screened earlier, ideally 10 years before the age of diagnosis of their relatives with colorectal cancer.

In fact, the WHO says research on the efficacy of FOBT for screening saw a reduction of up to 20 percent in colorectal cancer mortality from biennial screening, and a greater reduction as a result of annual screening.

TMC’s Colorectal Clinic provides expert diagnoses and multimodality treatments for colorectal cancer, including chemotherapy, radiotherapy, and surgery. The clinic promotes minimally invasive procedures for early cases, as well as radical operations for advanced and recurrent cases. Laparoscopic surgery, trans-anal endoscopic microsurgery, and robotic-assisted surgery are among the minimally invasive procedures being offered by the clinic.

Among all private hospitals in the Philippines, TMC’s Colorectal Clinic has performed the greatest number of preoperative chemo-radiotherapy for rectal cancers and minimally invasive laparoscopic colorectal cancer procedures, including robotic surgery. It also boasts the greatest number of patients in a private hospital setting with complete pathologic response following neoadjuvant chemo-radiotherapy for rectal cancer, and the highest anal sphincter.

TMC’s Colorectal Clinic also caters to patients with anorectal diseases, such as hemorrhoids, perianal infection, fistula, fissures, and fecal incontinence to name a few. It offers various treatment options for hemorrhoids, such as rubber band ligation, transanal hemorrhoidal dearterialization (THD), and stapled hemorrhoidectomy, which are proven to be less painful procedures than traditional surgery.

The Medical City’s Colorectal Clinic is managed by a nationally renowned team of board-certified experts. It is located at the second floor of the Nursing Tower. For details, call 988-1000 or 988-7000 ext. 6214.

Lung Cancer

Lung cancer is the leading cause of cancer deaths worldwide in both men and women, with more than one million deaths recorded annually. However, most cases are detected during their advanced stages when patients are already symptomatic, and their chances of survival are very low.

TMC has a Lung Cancer Program that aims to detect the disease early in high-risk individuals and to provide optimal options for management of both early and advanced stages.

Among the latest options TMC uses for screening lung cancer is the Endobronchial Ultrasound (EBUS), a state of the art minimally invasive procedure used in the diagnosis of lung cancer, infections, and other inflammatory diseases in the chest. Presently, TMC is the first and currently the only hospital in the country to offer EBUS.

“With EBUS as an additional diagnostic option for high-risk patients, we are expecting to increase detection rates of early stage lung cancer, which may be salvageable by surgery and has good prognosis. In addition, EBUS can aid in the diagnosis of benign diseases that need specific pathologic confirmation,” says Dr. Christine Chavez, interventional pulmonologist and head of the Lung Unit of TMC Center for Cancer Care and Research.

EBUS assists patients and doctors by shortening the time from diagnosis to treatment. EBUS is a procedure that incorporates ultrasound technology in bronchoscopy. By means of a small video device, it allows bronchoscopists to view lung abnormalities through and beyond the surface of the airways for real-time image guidance during procedures; hence, higher degree of diagnostic accuracy and safety is possible.

With real-time imaging and ultrasound guidance, doctors can map, evaluate, and safely biopsy tumors and lymph nodes. This procedure is called EBUS-transbronchial needle aspiration, or EBUS-TBNA, which results in accurate diagnosis and staging of the lung cancer and detection of other causes of pulmonary mass such as tuberculosis, sarcoidosis and lymphoma.

The Medical City Cancer Center are headed by medical professionals namely: