Lung cancer is a multistep process of transformation from normal bronchial epithelium to overt lung cancer. Various molecular events are resulting in a gain or loss of function and dysregulation of vital genetic pathways. These pathways are involved in cellular proliferation, differentiation, apoptosis, migration, and invasion. There are many genes involved in the cancer of both small cell lung cancer and non-small cell lung cancer. The fact of the matter is that they both have unique genetic aberrations associated with each tumor type. These novel genetic “biomarkers” are evaluated in each patient, and a personalized treatment program is formulated.

Tobacco use is the most important environmental factor associated with the development of lung cancer. Approximately 85% of lung cancers occur in current or former smokers. Cigarette smoke contains more than 60 known carcinogens, 20 of which have been shown to cause lung tumors in laboratory animals or humans. Recurring mutations in DNA repair genes are increasingly becoming recognized in lung cancer. These include BRCA 1 and BRCA2 proteins that are both involved in the repair process when there are breaks in our double-stranded DNA. Carcinogens and genetic drivers are evaluated through new molecular testing.

New molecular testing can now help identify individuals at high risk of developing lung cancer. We can now measure several genes involved with lung cancer prior to its appearance on an MRI or CAT scan. Early detection is essential.

This is the application of molecular analysis to each unique case of lung cancer. Targeted therapies are unique to each patient and their set of genes. The use of low-dose chemotherapy based on chemosensitivity testing is utilized. Low-dose chemotherapy resulted in minimal toxicities and greater adherence. Low-dose chemotherapy does not produce chemotherapy resistance and does not suppress the patient’s immune function as does traditional maximum tolerated dose chemo. Natural therapies are always synergistic.

There are new autologous tumor vaccines, dendritic cell vaccines, and supportive oligonucleotide therapies (SOT), which can now be used in a synergistic matter combining them with low-dose targeted chemotherapy as well as natural substances and checkpoint inhibitors. A combination of synergistic multimodal programs works best. Your immune status is extremely important, and is optimized in each patient.