Lung cancer, which ranks first in cancer mortality both domestically and globally, often lacks distinct early symptoms, making early detection difficult. By the time it is diagnosed, the cancer is often significantly advanced.

Lung cancer is a malignant tumor that occurs in the lungs. It arises when abnormal cells proliferate uncontrollably in the epithelial cells covering the bronchi, bronchioles, or alveoli of the lungs.

Recently, the development of lung cancer treatments has been active, bringing changes to clinical settings. Professor Jinseok Ahn of the Department of Hematology and Oncology at Samsung Medical Center was interviewed to discuss trends in lung cancer treatment and the latest therapies.

―Is it possible to detect lung cancer early through health check-ups?

“The diagnosis of lung cancer patients in Korea shows a polarized pattern. In the past, many cases were discovered at stage 4, but with health check-ups and CT scans, early detection cases are increasing. In Korea, there are relatively many stage 1 and stage 4 patients, while stage 2 and 3 patients are fewer.”

―The development of new lung cancer treatments is active recently. What changes are seen in clinical settings?

“Currently, more than 10 drugs are used in lung cancer treatment. For patients, having more options is positive, but for researchers, there is the burden of understanding the effects and side effects of each drug. Drugs like lazertinib, which are used frequently, are familiar, but drugs used for rare mutation patients, who may only appear once or twice a year, may need to be rechecked. The most important thing is to accurately identify the target mutation suitable for the patient. If a mutation is not discovered, even if a specific drug could be applicable, the treatment opportunity is missed. For this reason, the importance of precise diagnosis through next-generation sequencing is growing.”

―There must be differences in treatment methods depending on the stage....

“The most important criterion in lung cancer treatment is the stage. About 80-85% of all lung cancer patients have non-small cell lung cancer (NSCLC), and the remaining 15% have small cell lung cancer. Generally, when referring to lung cancer, it means NSCLC. For NSCLC, surgery is the basic treatment from stage 1 to early stage 3, and for some stage 3 patients who cannot undergo surgery, chemotherapy and radiation therapy are combined. From stage 4, systemic treatment is implemented. Recently, as immunotherapy shows effectiveness as a neoadjuvant therapy in stage 2-3 patients, cases of pre-surgery chemo-immunotherapy are increasing. In stage 4, targeted therapy remains crucial. Especially since January last year, with the reimbursement of lazertinib and osimertinib targeted therapies, monotherapy with third-generation tyrosine kinase inhibitors (TKIs) has begun in earnest. In June, combination therapy also received partial reimbursement, expanding treatment options. For patients who cannot use targeted therapies, immunotherapy alone or in combination with chemotherapy has become the standard. Clinical trials for new combination therapies are also continuously underway.”

―What changes have occurred in clinical settings with the reimbursement of third-generation TKIs as first-line therapy?

“About 90% of patients with epidermal growth factor receptor (EGFR) mutations start treatment with third-generation drugs. Initially, osimertinib was mainly used, but since the introduction of lazertinib, both drugs are now used at almost similar rates. As clinical data on lazertinib combination therapy has been released, there is a partial preference for lazertinib in the field. Lazertinib is the first anticancer new drug approved and reimbursed based on data accumulated jointly by domestic pharmaceutical companies and academia, which endears it to domestic researchers. Yuhan Corporation operated a free support program (EAP) for six months before reimbursement, expanding treatment opportunities for patients. Lazertinib combination therapy has been confirmed to extend overall survival by more than a year compared to osimertinib. However, cost burden and increased side effects remain challenges. Another challenge is the follow-up option after failure of third-generation TKI use as first-line treatment. Currently, chemotherapy is the standard, but various attempts, such as combining targeted drugs for patients with MET amplification, are underway. Although still in clinical stages, it will be an important research topic in the future.”

―What is the effect of the lazertinib-amivantamab combination therapy? How is it used in actual clinical practice with partial reimbursement?

“In terms of effectiveness, combination therapy is superior to monotherapy. Both progression-free survival (PFS) and overall survival (OS) have been proven to improve. However, side effects also increase, which can be burdensome for elderly patients. Therefore, it is relatively recommended for younger patients. If the patient cannot bear the economic burden, only lazertinib, which is reimbursed, is used as monotherapy. Some patients choose combination therapy despite the cost, but the proportion is not large.”

―As the president of the Korean Cancer Study Group, could you introduce the group?

“Since March, I have been serving as the president of the Korean Cancer Study Group (KCSG). Most full members of the group are oncologists. The group's main goal is to improve cancer patient survival rates through clinical research. Additionally, it is responsible for cancer-related public promotion and education for researchers and oncology medical staff. Most of the clinical trials led by the group are investigator-initiated trials. Unlike trials directly designed and conducted by pharmaceutical companies, these are proposed by researchers and conducted with drug or research funding support from pharmaceutical companies. It focuses on areas with relatively less interest from pharmaceutical companies rather than commercially profitable fields. For example, it centers on comparative studies of existing drugs, rare disease research, or topics that are medically significant but commercially less profitable. Furthermore, international cooperation is actively pursued through joint research with overseas research institutions.”

―Could you discuss the group's goals and future plans?

“In the past, researchers' opinions were actively reflected in clinical trial design. However, recently, with the increase in pharmaceutical company-led research, the role of researchers has relatively diminished. Consequently, it is regrettable that investigator-initiated trials are shrinking in areas lacking pharmaceutical interest. Another difficulty is the global clinical research environment. The Korean Ministry of Food and Drug Safety tends to review conservatively. As a result, some studies cannot be conducted domestically, or certain patient groups are excluded. Consequently, the opportunity for Korean participation in global clinical trials is decreasing. Korea has made significant contributions to global clinical research, but recently, in more experimental clinical trials, domestic approval processes have imposed restrictions. After the medical conflict incident, the shortage of essential medical personnel is also severe. Hematology and oncology are representative of avoided specialties within internal medicine, and although not immediately apparent, a significant gap may occur within 10-20 years. At the group level, there are plans to demand institutional support to maintain essential medical specialties stably and to expand clinical research for public purposes.”

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