Prof. Dr. med. Michael Thomas is an outstanding personality in the field of thoracic oncology and enjoys an excellent reputation both nationally and internationally. As Chief Physician of Internal Oncology of Thoracic Tumors at the renowned Thorax Clinic in Heidelberg, he heads one of the leading institutions in Europe for the treatment of lung and breast cancer with great expertise. The Thorax Clinic, which is part of Heidelberg University Hospital, combines over a century of tradition with state-of-the-art medical research and care. Here, patients benefit from an interdisciplinary approach that combines cutting-edge medicine, innovative therapies and patient-centered care.
Prof. Dr. Thomas has been Chief Physician at the Thorax Clinic since 2005 and has held the professorship for internal oncology of thoracic tumors at the University of Heidelberg since 2006. He also has an additional qualification in palliative medicine, which underlines his expertise in the holistic care of patients. Since 2015, he has been a member of the Board of Directors of the National Center for Tumor Diseases (NCT) in Heidelberg, where he plays a key role in shaping the interface between scientific research and clinical application. Under his leadership, state-of-the-art diagnostic procedures and therapy concepts are developed and implemented, which rely on both molecular biological findings and innovative approaches such as immunotherapies and multimodal treatment strategies.
The range of diseases treated by Prof. Dr. Thomas encompasses all tumors of the chest, including non-small cell and small cell lung carcinomas, Pancoast tumors, thymus tumors, pleural mesotheliomas and pulmonary sarcomas. His expertise ranges from classic chemotherapies to state-of-the-art immunological and molecular-biologically stratified system therapies, always accompanied by closely coordinated interdisciplinary case conferences. Patients benefit from customized therapy concepts that include innovative procedures such as stereotactic radiotherapy or intensity-modulated radiotherapy (IMRT) and aim to achieve the best possible results.
Prof. Dr. Michael Thomas combines medical excellence with a special focus on the individual needs of his patients. Under his leadership, the Thoraxklinik Heidelberg is not only a place of cutting-edge medicine, but also a role model for patient-centered and research-driven care. In an interview with Prof. Dr. Michael Thomas, the editors of the Leading Medicine Guide were able to find out more about modern treatments for lung cancer and the range of treatments offered by the Thoraxklinik in Heidelberg in particular.
Lung cancer is one of the most common and aggressive forms of cancer worldwide and poses major challenges for both patients and medicine. Due to its often late onset of symptoms, lung cancer is frequently only diagnosed at an advanced stage, which makes treatment more difficult and worsens the prognosis. In recent years, however, significant advances in diagnostics and treatment have opened up new perspectives. In particular, personalized approaches, such as molecular therapy and immunotherapy, as well as modern imaging techniques and multimodal concepts are increasingly enabling more precise and effective treatment. Understanding the biological mechanisms of this disease and developing innovative therapies are the focus of current research, with the aim of improving survival rates and increasing the quality of life of those affected.
Considerable progress has been made in the early diagnosis of lung cancer in recent years, which has the potential to significantly improve the prognosis and survival rate of patients.
Lung cancer is often only diagnosed at an advanced stage, when the chances of recovery are already severely limited. Modern technologies and optimized screening programs aim to detect tumours early, before they cause symptoms or metastasize. “Basically, you go to the doctor if you notice a change in your condition. In the case of lung cancer, the primary tumor may or may not cause symptoms. One possible symptom is a persistent cough that lasts longer than four weeks and does not change. However, smokers often suffer from chronic bronchitis, which causes recurrent coughing - a chronic inflammatory reaction in the bronchial tubes that also causes increased mucus production. In smokers, you may notice a change in the character of the cough, for example if the cough suddenly becomes persistent and does not go away or even becomes bloody. It is also possible that the disease has already metastasized, as lung cancer develops over a certain period of time. During this time, the tumor has the opportunity to change in such a way that it has a high metastatic potential. Metastases can then form in the bones, liver, brain or adrenal glands, for example. Symptoms here can be pain in the bones or back, but also fatigue and limited ability to work under pressure, or impaired concentration or headaches,” explains Prof. Dr. Thomas and explains the early diagnosis:
“There is evidence that screening can offer benefits. In large studies that ran over long periods of time, a high-risk group was screened annually using low-dose CT. One study involved 15,000 smokers, 50% of whom received the screening and the other 50% did not. The prerequisite for participation was an age between 70 and 75 years and an average 15-year consumption of one pack of cigarettes per day. These 15 “pack-years” are also achieved with a consumption of two packs over 7.5 years or half a pack a day for 30 years. It was found that mortality from lung cancer was reduced in the screening group, as the findings were detected earlier - and with smaller tumors, which could therefore be treated more effectively. A higher percentage of tumors were detected at an earlier stage, could be operated on and received appropriate follow-up treatment. However, even small tumors may have already metastasized; in the early operable tumor stages, metastases can often be detected within one to two years after their removal. It is therefore important to reduce the risk of metastasis even in the early stages through appropriate therapeutic approaches, and there are also new developments in this area."
A key development in the treatment of lung cancer is immunotherapy, which has been used in treatment since 2015
“It is important to know that the immune system is regulated in many different ways. T lymphocytes, a subgroup of white blood cells, are specialized in recognizing and fighting pathogens, infected cells and degenerated (e.g. cancerous) cells. They react to certain signals, sometimes even more strongly. To prevent an excessive reaction, the body has a back-regulation mechanism that puts the T cells back into a resting state. However, the tumor can specifically exploit this mechanism by producing the protein PD-L1 on its surface. This inhibits the lymphocytes or even causes them to die. This is precisely where medical research comes in: Scientists discovered that this mechanism can be blocked by antibodies that either act directly against the protein responsible for the feedback loop or cover the PD-L1 protein on the tumor. The Nobel Prize in Medicine was awarded in 2018 for this groundbreaking discovery. We refer to this method as immunotherapy,” explains Prof. Dr. Thomas and adds:
“The use of this form of immunotherapy shows that around one fifth of patients treated for metastatic tumors survive in the long term, twice as many as with chemotherapy alone - an important advance that encourages further development and improvement of this therapeutic approach. Immunotherapy is now also used for locally advanced tumors. This involves either surgery or modern radiotherapy with few side effects, usually combined with chemotherapy. If the tumor has a PD-L1 expression of at least 1%, the above-mentioned form of immunotherapy is indicated and enables a significant increase in the 5-year survival rate in the order of 15% - and here, too, further improvement is being pursued in studies. The greatest challenge lies in combating micrometastases. Until a few years ago, chemotherapy was the only treatment after surgery for this reason. Today, a combination of immunotherapy and chemotherapy is used before the operation. After the operation, an individual decision is then made as to which form of therapy makes the most sense - whether a continuation of immunotherapy or an alternative concept. This is currently being investigated and further optimized in numerous clinical studies. The aim is to strengthen the immune system in a targeted manner by using various antibodies or coupled substances. Our clinic is intensively involved in this area, conducting its own studies and working in our oncology study center to further develop and improve existing concepts."
Genetic and molecular changes in tumor tissue have a significant influence on the choice of therapy for lung cancer. In recent years, research has gained deeper insights into the molecular structure of lung cancer, leading to the development of increasingly personalized treatment approaches that target the specific characteristics of an individual patient's tumour.
“It is important to obtain sufficient tissue from the tumor, for example through bronchoscopy. This works very safely and well at our center - we perform around 5,000 bronchoscopies and around 1,000 CT-guided punctures every year. At the same time, we have a highly specialized pathology and molecular pathology department. Molecular pathology examines genetic and molecular changes in cells in order to specifically characterize and treat diseases such as cancer. Through DNA and RNA analyses, it enables personalized therapies and contributes to more precise medicine. This also includes the immunohistochemical determination of PD-L1. This is followed by molecular analysis, which uses complex procedures to examine genetic changes and provide information about specific mutations. The most common genetic alterations that occur in lung cancer include mutations in the Epidermal Growth Factor Receptor (EGFR) gene, the Kirsten Rat Sarcoma Virus (KRAS) gene, the BRAF gene, the Anaplastic Lymphoma Kinase (ALK) gene, the RET gene and the ROS1 gene, as well as other defined genetic alterations. These genetic alterations promote the uncontrolled growth of cancer cells and offer specific targets for targeted therapies, such as tyrosine kinase inhibitors in tablet form. These drugs inhibit the signaling pathways that are activated by the genetic alterations. By precisely analyzing the molecular characteristics of a tumor, doctors can select more individualized and effective therapies that are targeted to the specific mutation and tumor behavior,” explains Prof. Dr. Thomas.
Personalized therapy for lung cancer is made possible by rapid advances in molecular diagnostics. Personalized medicine is based not only on the detection of tumor mutations, but also on the tumor microenvironment, the patient's immune status and other factors, which together enable a tailored therapy. A key advantage of personalized therapy is that it can help to reduce side effects, as the treatment is targeted at the tumour cells and healthy cells are largely spared.
Modern forms of therapy have a significant impact on the recurrence rate and survival prognosis of lung cancer, both in the early and advanced stages. In particular, the introduction of immunotherapies, targeted therapies and new chemotherapeutic approaches has revolutionized treatment options and led to significant progress in oncology.
“Drug therapy can of course have side effects. Patients may suffer from diarrhea, skin reactions, muscle pain or elevated liver or pancreas values. In such cases, the dose of the tablets must be adjusted or a break in therapy must be taken. Immunotherapy can also cause similar side effects and others that are a reaction of the body to the interference with the immune system. It is therefore important that the patient is also well informed about this and observes themselves closely in order to take timely countermeasures in the event of side effects,” states Prof. Dr. Thomas.
Despite this progress, however, there are challenges, particularly with regard to the development of resistance. Many patients who initially respond to immunotherapies or targeted therapies develop therapeutic resistance after a certain period of time. This means that the tumor develops mechanisms to evade the therapy and continue to grow. In the case of immunotherapy, one of the main causes of this resistance is the alteration of the tumour cells, which enables them to no longer be recognized by the T cells of the immune system. The tumor microenvironment can also change and prevent immune cells from functioning properly. A not uncommon problem with targeted therapies is the development of secondary mutations in the target gene. The tumor tissue develops new genetic changes that block the effect of the drugs. To counteract this resistance, researchers are working on new combination therapies that address several mechanisms of action simultaneously and thus reduce the risk of resistance developing.
“Ultimately, therapy is becoming increasingly effective thanks to all the different new procedures. Systemic therapy in particular, in the form of immunotherapeutic approaches with specific antibody constructs, antibodies that are directly coupled with chemotherapeutic substances, or new molecule developments to improve oral tablet therapy, is making steady progress. In the locoregional, non-metastatic tumor stages, the aim is to effectively combine modern concepts of radiotherapy and thoracic surgery with the best possible systemic therapy in a multimodal therapy approach. Here it is important to have the best possible expertise in each specialist area. Fortunately, as the largest lung cancer center in Germany, we in Heidelberg have a very high level of expertise in all areas. Every year, we have 1000 new diagnoses of lung cancer, develop multimodal therapy concepts, set up studies for marginalized groups and are active as a sought-after partner in the development of national and international guidelines as well as in the development of studies,” Prof. Dr. Thomas emphasizes the high level of expertise that is bundled in the Lung Cancer Center in Heidelberg.
Basic appeal for prophylaxis and assistance from Heidelberg
“Please stop smoking if you smoke. It's never too late! The risk of cancer decreases after about 12 to 15 years and reaches the level of a non-smoker. You will quickly become fitter, have a lower risk of infection, stop the breakdown of lung tissue and improve your circulatory system. Every smoker can get good information on how best to quit. We also offer a stop smoking program here in Heidelberg. You can also consult your family doctor, who can arrange for further referral if necessary. The important thing is to keep at it! If the family doctor detects signs of possible lung cancer, it is crucial to be referred to a specialist center in order to benefit from the necessary expertise from various disciplines. If you are diagnosed with lung cancer, you need a good strategy for dealing with the uncertainty and existential stress that can arise. These issues can also be discussed with the family doctor or the attending physician at the hospital,” appeals Prof. Dr. Thomas and concludes our discussion by presenting a concept from the Heidelberg Lung Cancer Center that supports patients during the course of their illness:
“We have developed the HeiMeKOM concept (Heidelberg Milestone Communication Concept) for this purpose. In this concept, interprofessional tandems consisting of a doctor and a nurse conduct structured discussions with lung cancer patients and their relatives at fixed points in the course of the disease. The concept is aimed at preference-sensitive and forward-looking joint decision-making, as well as improving the patient's quality of life. In all cases, the aim is to empower patients and their relatives so that they can cope with the disease in everyday life. We always have our patients 100% in mind”.
Thank you very much, Prof. Dr. Thomas, for this important information, which gives hope and encouragement!
