Towards treatment individualization in lung cancer
Towards treatment individualization in lung cancer
Despite scientific progress within pulmonary oncology, including the introduction of targeted therapy, immunotherapy, and increasing research into potential biomarkers, most patients ultimately develop tumor progression. Further optimization of treatment strategies is essential. This thesis of Benthe Muntinghe aimed to improve the identification of lung cancer and the selection of patients, and to further individualize treatment, through several biomarker-driven studies.
Part 1 (diagnostic) investigated biomarkers measured prior to the start of treatment. Using exhaled breath analysis via an electronic nose (eNose), people with and without lung cancer could be well discriminated. ENose measurements could also reasonably predict whether immunotherapy would be effective. In addition, the degree of T-cell activation appeared to possibly distinguish between patients who did and did not respond to immunotherapy. DNA levels of torque teno virus in blood did not appear to be a suitable biomarker for predicting treatment response to immunotherapy.
Part 2 (monitoring of disease)investigated biomarkers measured during treatment. The study protocol of an ongoing trial on therapeutic drug monitoring with alectinib was described. Circulating tumor DNA in patients with EGFRexon20+ lung cancer correlated with tissue in 65% of cases, and several potential resistance mechanisms to osimertinib were identified. In addition, a treatment combination of (double) immunotherapy with radiotherapy to the primary tumor was safe and feasible in patients with advanced lung cancer who had previously received chemotherapy.
In summary, the results presented in this thesis contribute to the search for biomarkers to detect lung cancer and predict treatment response, with the ultimate goal of better individualizing treatment.