This is the lung cancer that Mila Ximénez suffered from: very serious and difficult to diagnose

The popular Save Me collaborator had been fighting the “most feared” of tumors for a year, a type of cancer with a complicated prognosis that took her away from television after long chemotherapy sessions.

Lung cancer: this is the serious tumor that Mila Ximénez suffered

The sad death of Mila Ximénez puts one of the most feared diseases, lung cancer, back in the public eye. Is about one of the most common tumors but also the most difficult to diagnose and treat. Fortunately, doctors and researchers are managing to unravel the opacity of this cancer and in recent years it has been better understood, which is allowing the development of new therapies aimed at the many fronts that this tumor opens up in the body.

What has been known for a long time is that tobacco is the main cause of 80% of lung cancers that are diagnosed, about 29,500 each year, of which 8,000 are women. This last figure has been growing in recent decades, precisely due to the greater number of women smokers in the last half century.

Being the fourth most diagnosed cancer (after colorectal, prostate or breast cancer), it is the one that generates the highest number of deaths: it is responsible for one in five cancer deaths in our country, according to the report ‘Las Cancer figures in Spain’, from the Spanish Society of Medical Oncology (SEOM). In women, however, it is the third with 12.3% of deathsafter colorectal and breast cancer.

Five-year survival (after which the risk of relapse is assumed to be minimal) is 12.7% in men and 17.6% in women. The good news is that these percentages have been increasing little by little in recent decades. Just 10 years ago, it was 16% in women.

Even so, it is a very low survival compared to other frequent cancers, such as breast cancer. This is mainly due to the fact that most cases are diagnosed in advanced stages of the diseaseas happened with Mila Ximénez: when the tumor was detected in June 2020, it had already spread to the liver and other areas of the body, which made surgical intervention unfeasible.

Early diagnosis is the main challenge of this pathology. Only in 21% of cases are they detected in early stages. The problem is that currently Reaching the diagnosis requires several tests, starting with blood tests and continuing with X-rays, cytology or CT scans. Population screening strategies, such as mammograms in the case of breast cancer, have so far been dismissed due to their complexity and lack of reliability.

Advances in the treatment of lung cancer

Where more progress has been made is in treatment. In recent years, various mutations that play a key role in the disease have been identified, and drugs directed against them have been developed. Tumor sequencing (because each one has specific mutations) is important to determine the order of treatment for each patient. And it is that, as they comment from the SEOM, “lung cancer is the best example of precision medicine”.

Thus, treatments have been developed for mutations in the EGRF (gefitinib, erlotinib, afatinib), ALK (crizotinib, ceritinib, alectinib, brigatinib) or ROS-1 (crizotinib) genes. There are genes, such as BRAF or HER2, that affect other cancers such as melanoma or breast cancer, and some more, such as MET, RET or NRTK for which various drugs are being tested, although the European Medicines Agency has not yet authorized in several of them the indication in lung cancer.

Such diversity explains the difficulty of fighting lung cancer. There are numerous and varied mutations that accumulate over time until the tumor appears, as if the cancer cells had to sneak past numerous checkpoints until they could grow uncontrollably. The above therapies are known as monoclonal antibodies and have been developed in recent decades, they are usually offered in various combinations and also together with platinum-based chemotherapies. It is these combinations that have been shown to further prolong the survival of these patients.

With everything, there is a good part of these cancers that do not have a key mutation identified. In these cases, chemotherapy is the mainstay of treatment, although it is also combined with some monoclonal antibodies, such as bevacizumab, whose function is to prevent the development of blood capillaries that feed tumors.

In recent years, a new weapon has emerged with the ability to change the course of the disease in its worst states. This is immunotherapy, which consists of treatments that ‘discover’ cancer cells to the body’s immune system and are attacked by it.

Pembrolizumab is the therapy that leads this revolution and, together with nivolumab, is being used in metastatic lung cancer and is starting to be used in earlier stages. They are most effective when PD-L1 protein expression levels are highalthough various trials have shown its benefits when used together with chemotherapy in tumors that do not have clearly identified genetics or do not express PD-L1 sufficiently.

The battle against lung cancer is one of the most difficult in oncology and, in fact, for many years doctors seemed unable to change its prognosis. Step by step they have been achieving various achievements and, although many of its variants are still far from curbing the disease, the expectation of the future glimpses a positive panorama that until recently seemed impossible to imagine.

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