Department of Internal Medicine Deputy Director Der-Chun Xia,
Division of Chest Medicine Director Zhi-Yen Tu

According to the statistics of top ten causes of mortality released by the Ministry of Health and Welfare, lung cancers have topped the 1st place for 10 years in a row and the highest rate of mortality. In Taiwan, about 14,000 patients of lung cancer are diagnosed each year and due to the ambiguous symptoms in the early stage, nearly 60% of patients diagnosed with lung cancer as last stage of cancer.

CMUH –Department of Internal Medicine, Division of Chest Medicine Director Zhi-Yen Tu stated that lung cancer can be divided into non-small cell lung cancer and small cell lung cancer, with 85% of the patients belonging to non-small cell lung cancer. Lung adenocarcinoma is the most common cancer among non-small cell lung cancer. The known disease genes of lung adenocarcinoma-EGFR, account for 50-60% of genetic mutation and are most commonly seen. Nonetheless, ALK, ROS 1 and BRAF account for ratio less than 5%, but the mutations of these diseases, including EGFR, ALK, ROS 1, and BRAF, all have corresponding medicines which patients can take. Due to the previous limitation with testing technology, it was difficult to patients with these existing genes. Currently the global genetic testing technology has substantially improved to provide clinical doctors with more precise diagnosis tools, designing individual precision therapy for patients to substantially improve the effective cure rate.

CMUH and Taiwan Association of Cancer Patients collaborate to improve the public understanding on rare lung cancer by holding the health education campaign of “Stop worrying about rare lung cancer. Precision therapy is easy.” CMUH Department of Internal Medicine Deputy Director Der-Chun Xia, Division of Chest Medicine Director Zhi-Yen Tu, and Taiwan Association of Cancer Patients Director Wei-Jie Lin jointly unveil the prelude to health education for “Stop worrying about rare lung cancer. Precision therapy is easy.” The public is encouraged to participate.

▎Current Status of Lung Cancer in Taiwan

Q：Therapy of Lung Cancer (surgery, chemotherapy, target…etc.), how to diagnose the different genetic types for patients with last-stage lung cancer?

About 14,000 new patients of lung cancer are diagnosed in Taiwan each year. Lung cancer can be divided into non-small cell lung cancer and small cell lung cancer, with 85% of the patients belonging to non-small cell lung cancer. The common non-small cell lung cancers include lung adenocarcinoma, squamous-cell carcinoma, large-cell lung cancer, and neuroendocrine tumor. In particular, lung adenocarcinoma is the most common type. Patients with last-stage lung cancer confirmed as non-small cell lung cancer by the pathology report, particularly lung adenocarcinoma, are currently tested for several specific and important genetic types, such as EGFR, ALK, ROS1, and BRAF. The patient may also choose to take NGS next generation sequencing to find out the likely driver mutation of the patient at once and thereby conducting therapy plans, if the financial situation of the patient allows.

Q：What are rare lung cancers?

Lung cancers can be divided into various types and genetic mutations. The most common types of cancers found in Taiwanese are “non-small cell lung cancer,” including lung adenocarcinoma, squamous-cell carcinoma and large-cell lung cancer. There are some important genetic mutations in lung adenocarcinoma and the most common type is EGFR genetic mutation, accounting for over half or the ration in Taiwan. The other types of genetic mutation include ALK, ROS1, MET, and BRAF, and the aforementioned gene incidence rates are generally under 5. These rare lung cancers all have corresponding therapy options in target medicine.

Q：What are the corresponding testing and therapies for rare lung disease?

Currently there are many genetic testing methods, which technologies have substantially improved, including immunostaining, polymerase chain reaction test, and genetic sequencing, and the latest generation genetic sequencing with high precision. Doctors will be provided with more precise diagnosis reference to conduct precision therapy on different types to enhance the therapy performance.  The therapy for late-stage lung cancer mostly comprises of chemotherapy, radioactive therapy, immuno-therapy, and target therapy. Currently there are more and more corresponding target therapies for lung cancer that attack the lung cancer of specific genetic types.

Q：The importance of genetic testing or pathological diagnosis on patients with rare lung cancers.

Cancer genetic testing can find out which genetic mutation of cancer is carried by the tumors of patients so the doctors can develop suitable treatment strategies for patients carrying specific genetic. Doctors will develop suitable therapy strategies for patients with specific genetic mutation, thereby accomplishing better therapy effect and controlling the golden therapy period.  Such reference on the genetic characteristics of each patient leads to a therapy new trend for precision chose medicine, known as “Precision Healthcare” or also known “Individualized Healthcare.”