Identifying a driver gene mutation in lung cancer means that patients have the opportunity to receive targeted therapy. However, many patients subsequently have many questions: should targeted therapy be the preferred choice if there is a driver gene mutation? Is there still a chance for immunotherapy? After long-term use of targeted drugs, drug resistance may occur. Is there a clinical method to delay the occurrence of drug resistance?
In this issue, we have invited Professor Yang Nong, a specially-appointed expert from Hainan Cancer Hospital/Affiliated Cancer Hospital of Hainan Medical University, to provide a professional interpretation of issues commonly concerned by lung cancer patients and help everyone gain a scientific understanding of targeted therapy.
Qustions & Answers
Qustions & Answers
Q: For lung cancer with driver mutations, which treatment option should be preferred?
For lung cancer patients with driver gene mutations, targeted therapy is generally prioritized in clinical practice. If drug resistance occurs after targeted therapy and the tumor mutation spectrum becomes complex, chemotherapy combined with immunotherapy or other regimens should be reevaluated and selected. Some patients may benefit from these regimens, which can help prolong their survival.
Qustions & Answers
Q: Is it possible to delay drug resistance by appropriately discontinuing targeted therapy drugs?
Most targeted drugs will develop resistance after continuous use. It's like holding a handful of sand in your hand. When you hold it lightly, it won't fall out. But as soon as you apply pressure, the sand will seep out through the gaps.
It can also be understood in this way: tumor cells will gradually adapt and undergo changes under continuous drug pressure, which is what we commonly refer to as drug resistance.
We are also exploring a line of thought: continuous drug administration is equivalent to continuously exerting pressure on the tumor; then under appropriate conditions, will moderately relieving drug pressure change the adaptation process of the tumor?
In the EGFR mutation population, this intermittent treatment model has been explored in relevant studies. In our team's clinical cases, there are also carefully selected patients with advanced-stage disease who have undergone a regimen of intermittent discontinuation of targeted drugs under standardized evaluation and rigorous monitoring.
It is particularly important to emphasize that this regimen has strict applicable prerequisites and is not suitable for all patients. It is strictly prohibited to discontinue medication on one's own:
1. The initial systemic treatment has achieved ideal results, with targeted or other systemic regimens effectively controlling the tumor;
2. Residual lesions have been treated according to standards: Some patients have primary lesions, brain metastases, and other lesions. Local treatment methods are used to intervene and consolidate the residual lesions;
After a period of consolidation therapy, under a standardized imaging and molecular marker monitoring system, and after comprehensive evaluation by a doctor, consideration can be given to suspending targeted therapy and formulating a rigorous follow-up plan. For some eligible patients, the follow-up interval can be extended to 3 months, with a maximum of 6 months.
In the past, patients with advanced lung cancer usually required continuous medication, and the discontinuation of medication was rarely considered. It is precisely with the deepening understanding of the patterns of tumor diseases, and under the premise of strictly controlling indications and monitoring throughout the process, that clinicians carefully select such individualized treatment plans.
Expert Introduction
Yang Nong
Chief Physician, Doctoral Supervisor
Hainan Cancer Hospital/Affiliated Cancer Hospital of Hainan Medical University
Long-term employed expert of Hainan Chengmei Hospital
He currently serves as Vice President of the Second People's Hospital of Hunan Province, head of the oncology department, and director of the "Yang Nong Famous Doctor Clinic" / "Yang Nong Famous Doctor Expert Team Clinic". He is also a chief expert of the National Major Scientific and Technological Special 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 Respiratory Oncology Clinical Medical Research Center.
He has dedicated nearly 30 years to precision targeted therapy for lung cancer and gastrointestinal tumors, as well as clinical practice, research, and teaching in the management of complex recurrent and drug-resistant cases.
He has been honored with titles such as the "Outstanding Paragon of National Famous Doctors" at the 6th session, the "Annual Excellent Doctor" for eight consecutive years, and the "First Brain Doctor·Famous Doctor". He has authored national guidelines and has long been engaged in popularizing cancer health knowledge.
Specialization
Precision treatment of lung cancer, diagnosis and treatment of difficult, recurrent, and drug-resistant cases, as well as brain metastasis; individualized and precision-based treatment for brain metastases of lung cancer; early diagnosis of pulmonary nodules and lung cancer; personalized and comprehensive diagnosis and treatment for pan-solid tumors; clinical trials of the latest immunotherapy/targeted therapy drugs.
With nearly 30 years of experience in precision immunotherapy for lung cancer, he has led nearly 400 phase I-III clinical trials of new anticancer drugs (including national Class 1 new drugs).
We have been engaged in comprehensive diagnosis and treatment of multiple cancer types, individualized, and interdisciplinary for a long time.
Visit information
Clinic Hours
November 8th, 14:00-17:00
Visit location
Sixth Consultation Area of Hainan Cancer Hospital
appointment registration
Follow the official account of Hainan Cancer Hospital for "appointment registration"
Warm Reminder
To facilitate the experts in understanding your condition as soon as possible, please bring along:
●ID card, medical insurance card, mobile phone
●Accompany immediate family members (with decision-making authority)
● Arrange the relevant examinations you have ever done in chronological order
● Paper medical records of previous visits
●Surgical case biopsy: wax block or 20-30 white slides
● Pathological diagnosis report
● Inpatient medical records and notes
● Recent relevant examinations
● The patient's current treatment plan
●The most urgent questions to consult
(This article is a popular science piece on tumor health, and the content is for knowledge reference only, not constituting individualized diagnosis and treatment advice. Targeted therapy and intermittent drug withdrawal are individualized exploratory treatment strategies with strict applicable conditions and risks. Patients must not stop or adjust medication on their own. All treatment plans should be implemented after comprehensive evaluation by the attending physician.)