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Dr Daniel Tan, Senior Consultant, Division of Medical Oncology, National Cancer Centre Singapore (NCCS), a member of the Singhealth group shares on the treatment for lung cancer.

In Singapore, lung cancer has the highest cancer mortality rate among males and second highest among females.

Lung cancer is a disease that begins in the cells of the lungs and can be divided into two main types:

  • Non-small cell lung cancer (NSCLC): The most common type of lung cancer. It can be further divided into subtypes, including adenocarcinoma, squamous or large cell lung cancer. Adenocarcinoma itself has various molecular subtypes.
  • Small cell lung cancer (SCLC): Makes up less than 10 per cent of all lung cancer cases.

Smoking remains the leading cause of lung cancer, although non-smokers exposed to second-hand smoke are also susceptible to the disease. Apart from smoking, long exposure to harmful industrial chemicals such as asbestos and radon, and previous lung cancer diagnosis can greatly increase the risk.

During the early stages of lung cancer, symptoms are often vague or non-existent. Common symptoms include persistent cough with blood in the phlegm, shortness of breath and recurrent lung infections.

As lung cancer tends to be diagnosed in later stages, depending on where the cancer spreads and which organs are affected, patients may experience other symptoms such as headaches, weakness, bone pain, weight loss and loss of appetite.

New type of chemotherapy drug for lung cancer treatment

Depending on the type and stage of the cancer, lung cancer treatment usually involves a combination of surgery, radiation therapy and chemotherapy. Due to the cumulative toxicity of platinum agents (current standard of care), doctors previously had to adopt a wait-and-see approach after administering chemotherapy.

Since October 2012, Health Sciences Authority (HSA) of Singapore has approved the use of a new drug called Alimta (pemetrexed), which limits cell division by blocking certain DNA making processes. The drug is administered intravenously, once every three weeks. The infusion takes about 10 minutes.

“When using pemetrexed to treat NSCLC – unlike conventional chemotherapy drugs where cumulative toxicity can be a problem – patients can now go beyond four to six cycles of lung cancer treatment, thus maintaining control of the disease,” says Dr Tan.

Is this treatment suitable for all lung cancer patients?

Maintenance chemotherapy is only suitable for patients who showed response to their first-line therapy. It is available at all government and private hospitals throughout Singapore. Medisave and Medishield can be used to pay for this treatment.

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