Within the Division of Thoracic Oncology, a dedicated staff of Medical Oncologists is specialized in the comprehensive care and treatment of patients with thoracic malignancies, particularly lung cancer but also neuroendocrine tumors of the lung and pleural mesothelioma. The mission of the Division is to provide personalized, evidence-based treatments to improve clinical outcomes and maximize the quality of life for patients affected by these diseases. The role of Medical Oncologists is pivotal in the multidisciplinary team, where they collaborate closely with other specialists such as thoracic surgeons, radiation oncologists and pulmonologists to develop tailored treatment plans for patients.
TREATMENT OF PATIENTS WITH LUNG CANCER
Within the Lung Program, approximately 120 patients are discussed at the multidisciplinary meeting each month and a significant percentage of them, accounting for almost 600 patients annually, is evaluated by Thoracic Oncologists afterwards.
The treatment landscape for non-small cell lung cancer (NSCLC) is constantly evolving and, with the growing understanding of NSCLC heterogeneity, in the past decade intriguing advancements in precision medicine, immunotherapy and multimodal approaches have been reached. Overall, these innovative approaches are aimed at maximizing the therapeutic efficacy to improve survival outcomes, alongside minimizing treatment-related toxicities.
Only a small proportion of NSCLC cases are diagnosed at an early stage, where patients may be eligible for surgery, potentially followed by adjuvant treatments to reduce the risk of disease recurrence. Alternatively, some cases are identified at a locally advanced non-resectable stage, requiring a treatment regimen that involves chemotherapy and radiotherapy, with the possibility of receiving immunotherapy upon completion.
In the advanced setting, molecular testing plays a crucial role as it provides valuable information about the genetic landscape of the tumor. Indeed, molecular testing helps to identify genetic mutations or alterations in the tumor that can be targeted by precision therapies, such as tyrosine kinase inhibitors or other targeted agents, leading to better responses to treatment and improved clinical outcomes. Targetable alterations in NSCLC include the EGFR, ALK, ROS1, BRAF, RET, HER2, NTRK, MET, KRAS genes, among others. Moreover, molecular testing provides prognostic information, such as life expectation and response to therapies prediction, that can guide the treatment strategy. Finally, molecular testing enables the monitoring of treatment response and the detection of acquired resistance mutations that may develop over time to targeted therapies, to optimize the treatment strategy and delay disease progression.
Similarly, programmed death-ligand 1 (PD-L1) expression is a complementary biomarker that helps to predict which patients are more likely to benefit from immunotherapy agents known as immune checkpoint inhibitors. PD-L1 is a protein expressed on the surface of cancer cells and interacts with its receptor PD-1 on immune cells to suppress the immune response, allowing cancer cells to evade detection and destruction by the immune system. Generally, patients with higher levels of PD-L1 expression are more likely to respond to immunotherapy and may derive greater clinical benefit from this type of treatment.
However, clinical factors, patients’ preferences and comorbidities are also taken into account when deciding the most appropriate treatment approach for each patient.
CLINICAL ACTIVITY
The clinical activity of the Division of Thoracic Oncology is delivered in an out-patient and an in-patient setting. In the outpatient clinic various services are provided:
- Oncological consultations for patients with a suspected or confirmed diagnosis of thoracic malignancy;
- Administration of anticancer therapies that do not necessitate hospitalization;
- Follow-up visits for patients who do not require active treatments or who have already completed their treatment plan;
- Day Hospital for clinical visits and rooms in which beds and therapy-chairs are placed for the administration of intravenous therapies (both anticancer and supportive therapies…)
The Oncology Ward is dedicated to the hospitalization of patients who require more continuous assistance to manage complications related to the disease or the oncological treatments and to deliver specific services that cannot be provided on an outpatient basis.