Over the past twenty years, the way thoracic cancers, and particularly lung cancer, are diagnosed and treated has undergone a profound transformation. Once considered a severe disease with a very limited prognosis, lung cancer can now be better controlled, and in some cases even cured, thanks to advances in medical research. These improvements are based on a deeper understanding of how tumors function and on increasingly personalized treatment approaches.
To mark its 20th anniversary, the Journal of Thoracic Oncology (JTO) published an international review highlighting these major advances. The article was co-authored by leading experts from around the world, including Professor Paul Hofman, Director of IHU RespirERA. It illustrates the shift from a “one-size-fits-all” approach, where all patients received similar treatments, to precision medicine, which tailors care to the specific characteristics of each individual cancer.
Earlier Screening for Better Treatment
Lung cancer screening is one of the most effective ways to improve patient survival. It is now based on low-dose chest CT scans, also known as LDCT (Low Dose Computed Tomography). This imaging technique makes it possible to detect lung abnormalities at a very early stage while minimizing exposure to X-rays.
Large international studies have shown that this type of screening significantly reduces deaths related to lung cancer. By identifying the disease before symptoms appear, it becomes possible to offer lighter and more effective treatments. To guide this practice, healthcare professionals now rely on tools such as Lung-RADS, a classification system that helps interpret CT scan images and determine the most appropriate follow-up. The goal is to avoid both delayed diagnoses and unnecessary examinations.
When cancer is detected early, localized treatments can be offered. Surgery can be used to remove the tumor, while stereotactic body radiotherapy (SBRT) delivers highly precise radiation beams to destroy cancer cells without damaging surrounding healthy tissue.
Understanding the Tumor to Target It More Effectively
Research has shown that lung cancer is not a single disease. In reality, each tumor has its own unique “biological identity.” Certain genetic abnormalities, known as mutations, act as true drivers of tumor growth.
Identifying these mutations has led to the development of targeted therapies. Unlike conventional chemotherapy, which affects all rapidly dividing cells in the body, these treatments specifically target cancer cells carrying a particular abnormality. They are often better tolerated and can be taken in tablet form.
Another major breakthrough is immunotherapy. Rather than acting directly on the tumor, this approach focuses on the patient’s immune system. Under normal circumstances, our natural defenses are able to recognize and eliminate abnormal cells. Cancer cells, however, manage to block this response. Immunotherapy drugs remove this “brake,” allowing the immune system to attack the tumor. These treatments have dramatically changed therapeutic strategies and have improved both quality of life and survival rates for many patients.
Progress for Rarer Thoracic Cancers as Well
Scientific advances are also benefiting rarer thoracic cancers, such as mesothelioma, a cancer of the pleura often linked to asbestos exposure. Researchers have identified the role of the BAP1 gene, certain mutations of which are associated with familial forms of the disease. These forms tend to progress more slowly and are linked to a significantly longer life expectancy, allowing for more tailored management.
Tumors of the thymus, an organ located in the center of the chest and involved in immune function, are also the focus of active research. Although these cancers remain rare, a better understanding of their biology is paving the way for more targeted treatments in the future.
Liquid Biopsy: A Simple Blood Test to Monitor the Disease
Among the most promising innovations is liquid biopsy. This technique involves analyzing circulating tumor DNA, tiny fragments of genetic material released by the tumor into the bloodstream, using a simple blood sample. It provides valuable information without the need for invasive procedures, which can be uncomfortable for patients.
Liquid biopsy is also a highly sensitive monitoring tool. It can detect extremely small traces of cancer after treatment, known as minimal residual disease, long before they become visible on medical imaging. This early detection makes it possible to intervene more quickly and prevent relapses.
Turning Major Advances into Benefits for All
In twenty years, thoracic oncology has entered a new era characterized by more precise, personalized, and effective medicine. The current challenge is to ensure that these innovations are accessible to all patients, regardless of where they receive care or their personal circumstances.
At the heart of this progress, IHU RespirERA is committed to bridging the gap between cutting-edge research and real-world patient care. At a time when advanced technologies such as genomic sequencing and artificial intelligence are becoming essential, this commitment is crucial to continue advancing the fight against respiratory diseases.
Full article: Advances in the Basic Sciences in Thoracic Oncology in the Last 20 Years and Their Translational Impact
