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Mueller: EDITORIAL

The last few years have witnessed dramatic changes in the diagnosis and therapy of lung cancer. Today, the universal concept of any therapeutic measure is a wider interpretation of the term ‘targeted therapy’. Previously, the armamentarium of systemic therapy comprised only a few chemotherapeutic agents. Today, the identification of specific mutations, and the development of specific drugs directed against these mutations, as well as of angiokinase inhibitors and immunotherapy, have dramatically improved survival rates and stimulated oncologists, scientists and industry.

Similarly, the routine practices of diagnosis have undergone significant changes. Specific mutations are no longer investigated; instead, a broad panel of clinically relevant targets are studied using next-generation sequencing. Liquid biopsy of peripheral blood taken from patients with histologically verified tumours is another diagnostic tool and enables epidermal growth factor (EGFR) mutations to be investigated without biomarker analysis, and EGFR tyrosine kinase inhibitor therapy to be monitored so that the development of drug resistance can be detected at an early stage. Furthermore, traditional thoracic surgical techniques have been replaced by both minimally invasive procedures as well as more radical procedures. Together with modern options for radiotherapy, the concept underlying treatment of lung tumours may be described as multimodal targeted therapy.

Multimodal targeted therapy necessitates the integration of all disciplines involved in the diagnosis and therapy of these malignant diseases. The benchmark of this approach is that not a single patient suffering from lung cancer should undergo any therapy without it having been discussed by an interdisciplinary panel of experts. Although the term ‘targeted therapy’ derives from the fact that therapy is aimed at the manipulation of specific molecular targets, it may also be applied to therapeutic interventions that optimize effectiveness and selectivity while reducing invasiveness. In fact, these concepts apply not only to systemic therapy, but also to radiotherapy, which nowadays is more specifically targeted at tumour and with the aim or reducing damage to surrounding normal tissue.

The same principle applies to radical surgical treatment of lung cancer. Nowadays, thoracic surgery is two-faced – maximal radicality meets minimal invasiveness. Today, as a result of improvements in technology and surgical technique, radical and oncologically correct surgical therapy of lung cancer allows for complete resection of locally advanced tumours in specialized centres. On the other hand, a high percentage of radical anatomical procedures for lung cancer can be performed using minimally invasive techniques. The oncological radicality of these procedures can be further improved by bilateral mediastinal lymphadenectomy through cervical access (video-assisted mediastinal lymphadenectomy – VAMLA).

Despite all these advances, targeted therapy remains most effective in early stages of lung cancer. Implementation of rational and cost-effective screening programmes based on low-dose computed tomography combined with novel methods, such as exhaled breath analysis, has the potential to extraordinarily improve early detection and raise the cure rate of lung cancer in populations at risk of developing this disease.




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