Pulmonary nodule future or investigational therapies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]
Overview
There are several ongoing studies on future therapies for the management of pulmonary nodules such as real-time tumor imaging, drugs targeting cancer cell growth and spread, and immune therapy drugs to help the immune system fight cancer cells.
Future or Investigational Therapies
Surgery
Video-assisted thoracic surgery (VATS) has been used by surgeons to treat small lung tumors. This lets surgeons remove parts of the lung through tiny incisions, which can lead to shorter hospital stays and less pain for patients involved. Surgeons are now studying if VATS can be used for large tumors. A newer approach to this is the surgeon sits at a control panel in the operating room to maneuver surgical instruments using robotic arms. This approach; robotic-assisted surgery is currently being used in some larger cancer centers. It is currently not clear if this type of procedure is better than the current traditional surgery for lung cancer.[1]
Real-time tumor imaging
Four-dimensional computed tomography (4DCT) is being looked into by researchers as a new imaging technique to help improve treatment. The CT machine scans the chest continuously for approximately 30 seconds in this technique, showing where the tumor is in relation to other anatomical structures as the patient breathes, compared to giving a ‘snapshot’ of the chest at a point in time, as a standard CT does. 4DCT can be used to determine precisely where the tumor is during each phase of the breathing cycle, to help the doctor deliver radiation precisely to the tumor. It might also be used to help show if a tumor is attached to or invading important anatomical structures in the chest, helping doctors determine patients' eligibility for surgery.[2]
Targeted therapy drugs
AZD3759 is a new drug being tested in early clinical trials which shows promising results in patients with Non-small-cell lung carcinoma (NSCLC) with EGFR positive gene change and metastasis to the brain. The drug can cross the blood-brain barrier. Epitinib, a kinase inhibitor, is another investigational oral drug that has shown some promising results in treating brain metastases in NSCLC patients with the EGFR positive gene change.[3]
Immune treatments
PD-L1, a surface protein on cancer cells that helps them evade the immune system and its corresponding PD-1 protein on T cells are now a target of new drugs that can help the immune system recognize cancer cells and attack them. Some drugs in this class are now approved for use in advanced NSCLC. Studies are currently evaluating the benefits of an immunotherapy drug alongside radiation therapy in people who can't undergo surgery if it can boost the shrinkage of cancer cells and help patients live longer.[4]