Lung cancer is a type of malignant tumor that originates from the mucosa or glands of the trachea and bronchi. As one of the most common solid tumors worldwide, it is also currently the malignant tumor with the highest incidence and mortality rate, posing a serious threat to human health.
However, with the advancement of medical technology, many innovative techniques and treatment plans have emerged in the field of lung cancer treatment, bringing more hope for survival to patients.
After being diagnosed with lung cancer, patients and their families often fall into confusion and anxiety - is there still a chance for surgery in advanced lung cancer? What should be done after the targeted drugs become resistant?
We have specially invited Professor Yang Nong, a distinguished expert from Hainan Cancer Hospital, to provide professional interpretations on common issues faced by lung cancer patients.
Questions & Answers
Q: Is there still a chance for surgery for advanced lung cancer?
Professor Yang Nong: Based on the long-standing clinical practice and various guidelines and consensus over the years, it was generally believed that there was no opportunity for surgery for advanced lung cancer. However, in recent years, with the application of targeted therapy, immunotherapy, and anti-angiogenic therapy, many patients have seen their tumors significantly shrink and their conditions controlled after effective drug treatment.
For instance, if the metastatic lesions are well controlled and only the primary lesion remains, the tumor can be removed through surgery, stereotactic radiotherapy or ablation. Sometimes, although the primary lesion in the lung is well controlled, there are still one or more residual metastatic lesions. In such cases, attempts are made to remove these metastatic lesions all at once or one by one.
Such patients not only gain the opportunity for surgery but may even achieve clinical cure. However, the prerequisite for all this is that advanced-stage patients must first receive effective anti-tumor treatment to control the disease to the greatest extent possible. On this basis, surgery is then performed to remove the residual lesions. After the surgery, some patients need to continue maintenance treatment, while for others, the timing of drug withdrawal can be determined through close monitoring.
Questions & Answers
Q: Since targeted drugs will eventually lead to drug resistance, what other methods can be used to control the disease?
Professor Yang Nong: The vast majority of patients with advanced-stage diseases will face drug resistance when taking targeted drugs, its just a matter of time. But theres no need to panic. We still have ways to deal with it. Targeted drugs are difficult to be effective permanently. When the therapeutic effect reaches its maximum, we should actively deal with the remaining primary and metastatic lesions, and flexibly apply surgical operations, radiotherapy, ablation and other methods to control the tumor at the current stage.
Therefore, such patients are expected to stop anti-tumor treatment and enter a "drug holiday" - this is a situation where the condition is extremely well controlled. Additionally, some patients with a low tumor burden can also consider stopping medication under the monitoring of tumor micro-residuals, allowing the tumor to enter a stable "rest period".
Qustions & Answers
What should be done after developing resistance to targeted drugs?
Professor Yang Nong: Resistance to targeted drugs can occur in several situations.
01 Extensive drug resistance throughout the body:
If both the primary lesion and the metastatic lesion show progression, it indicates that the targeted drug has failed. At this point, the drug must be discontinued, and retesting should be conducted as soon as possible to identify the cause of drug resistance and adjust the treatment plan in a timely manner. This situation is considered as comprehensive drug resistance, and usually requires the combined application of drugs such as chemotherapy, anti-angiogenic targeted drugs, and immunotherapy.
02 Partially drug-resistant / Slowly drug-resistant:
The manifestation of partial resistance or slow resistance is that when the overall lesions are under stable control, isolated new lesions suddenly appear or a previously existing lesion slowly enlarges - it may occur in the brain, liver, adrenal glands, or other parts of the lungs or bones. In such cases, if the number of lesions is not large and their volume is not significant, they can be removed through local treatment methods such as surgery, radiotherapy, or ablation. With a slight adjustment in the treatment plan, the original targeted drug is retained and other drugs are added for continued treatment. This is the approach to dealing with partial resistance.
Expert Introduction / Clinic Information
[Expert Introduction]
Yang Nong
Chief Physician, Doctoral Supervisor
Long-term contracted experts of Hainan Cancer Hospital and Hainan Chengmei Hospital
Currently, he serves as the vice president of the Second Peoples Hospital of Hunan Province, the leading figure of the oncology department, and the director of "Yang Nong Famous Doctor Clinic" / "Yang Nong Famous Doctor Expert Team Clinic". He is also the chief expert of the National Major Science and Technology Project, a member of the Lung Cancer Special Committee of the National Cancer Quality Control Center, the director of the Hunan Provincial Key Laboratory of Precision Diagnosis and Treatment of Lung Cancer, and the director of the Hunan Provincial Clinical Medical Research Center for Respiratory Tumors. He has been dedicated to the precise targeted treatment of lung and gastrointestinal tumors, as well as the clinical, research and teaching of difficult, recurrent and drug-resistant cases for nearly 30 years.
He was honored with the title of "Outstanding Style" at the 6th "National Famous Doctor" award, and has been consecutively selected as the "Annual Good Doctor" by patients for 8 years. He was also named as one of the "Top Brain Doctors". He has authored national guidelines and won the third prize of Hunan Province Science and Technology Award. He has over 500,000 followers on all social media platforms, and his anti-cancer science popularization videos have been viewed over 120 million times.
Medical expertise
Main focus: Precision treatment of lung cancer, breakthroughs in difficult, recurrent, drug-resistant and brain metastasis cases; individualized and precise treatment of lung cancer brain metastases; early diagnosis of pulmonary nodules and lung cancer; personalized comprehensive diagnosis and treatment of various solid tumors; clinical trials of the latest immunotherapy and targeted therapy drugs.
With nearly 30 years of experience in precise immunotherapy and targeted therapy for lung cancer, he has led nearly 400 phase I-III clinical trials of new anti-cancer drugs (including national first-class new drugs), and is particularly skilled in treating complex cases such as difficult-to-treat, recurrent and drug-resistant cases, as well as brain metastases.
Early diagnosis and treatment of pulmonary nodules and lung cancer, with over 2,000 cases diagnosed annually (cumulative over 10,000 cases from 2019 to 2024), and a detection rate of approximately over 90% (retrospective study in 2023).
At the same time, he/she is proficient in the comprehensive diagnosis and treatment of multiple types of solid tumors (such as stomach, intestine, brain, etc.), personalized and interdisciplinary.
Professor Yang Nong has treated over 14,000 patients annually (data from 2023).
Manage the "Lung Cancer Immunotherapy Targeted Treatment Patient Group", conduct long-term follow-up management of over 4,000 long-term surviving lung cancer patients, and accumulate rich clinical experience.
[Consultation Information]
01 [Outpatient Clinic Time and Location]
August 3rd, 8:00 - 12:00
The Sixth Clinic Area of Hainan Cancer Hospital
02 [Appointment for Registration]
Follow the official WeChat account of Hainan Cancer Hospital "Appointment Registration"
03 [Health Consultation]
13876807106
04 [Warm Reminder]
To facilitate the experts prompt understanding of your condition, please bring:
1.ID card, medical insurance card, mobile phone
2. Accompanying immediate family members (with decision-making power)
3. Arrange the relevant examinations that have been done in chronological order.
4. Paper medical records of previous visits
5. Surgical case sections: Paraffin blocks or 20-30 white slides
6. Pathological Diagnosis Report
7. Inpatient medical records and notes
8. Recent Relevant Examinations
9. The current treatment plan for the patient
10.The several most urgent questions I want to consult about