How Lung Cancer Treatment Advances Offer Patients Hope
- A Michigan woman, 62, who spent decades smoking cigarettes, was diagnosed with lung cancer. She underwent treatment that included surgery and targeted immunotherapy to make her “cancer-free” and stave off recurrence.
- Lung cancer treatment has evolved dramatically based on its genetic and molecular makeup, which can, in some cases, help inform the treatment plan.
- Testing can search for hundreds of different genetic mutations, including those common in lung cancer, for which new, highly effective, and much less toxic treatments are available.
- Many of these genetic changes that influence your cancer can be targeted with medications, such as targeted therapy.
- Lung cancer screening is painless and lasts only a few minutes. It involves using a low-dose computed tomography (LDCT). While lying on a table, an X-ray will scan your lungs for anything unusual, such as a shadow over the lungs.
- Treatment options for lung cancer depend on its type, its location, and its staging. In general, treatment methods include surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of any of these treatments.
Denise Lee, 62, knows the stranglehold cancer can have on a family because her father died of prostate cancer. However, cancer wasn’t a mere thought when she first picked up a cigarette at just 14 years old in an attempt to lose weight. Whether she actually lost weight at the time took a backseat to the nicotine she eventually became addicted to.
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Lung cancer screening is painless and lasts only a few minutes. It involves using a low-dose computed tomography (LDCT). While lying on a table, an X-ray will scan your lungs for anything unusual, the Centers for Disease Control and Prevention (CDC) explains.
RELATED: What Is Comprehensive Biomarker Testing for Lung Cancer And Who Needs It?
“I was afraid of what they would find,” Lee explained while reflecting on the impact her late father’s cancer had on her mother.
Lee’s screening revealed that she had a tumor, which caused her great panic. She soon prepared for treatment, which involved lung cancer surgery to remove the tumor from her lung. Afterward, she underwent targeted therapy and immunotherapy, which reengineered her immune system to fight off cancer cells as if it were a virus. After treatment, her doctors found no evidence of disease, and she has been declared “cancer-free” since 2018.
“I’m just so grateful that my diagnosis was early because then I had options. I could have surgery, I could have chemotherapy, I could be part of a clinical trial,” Lee added.
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Biomarkers Changing Treatment Approaches for Advanced Lung Cancer
In the past, chemotherapy was considered the treatment standard for advanced lung cancer, but biomarker testing is helping doctors find more targeted, less toxic treatments.
If you have lung cancer, you should talk to your oncologist about genetic testing to better understand the molecular characteristics of your tumor. Testing can search for hundreds of genetic mutations, including those common in lung cancer, for which new, highly effective, and much less toxic treatments are available.
“The way to find the best treatment for you when you’re diagnosed with Stage 4 lung cancer is to get your tumor characterized,” thoracic oncologist Dr. Geoff Oxnard of Boston Medical Center previously told SurvivorNet.
WATCH: How Genetic Testing Determines Treatment in Lung Cancer
Doctors can perform tests on tumors that involve genetic sequencing to learn more about how your cancer develops and spreads.
“Next-generation sequencing is testing that we do in order to find special mutations or alterations within a patient’s tumor,” Dr. Katherine Scilla, a thoracic medical oncologist at the University of Maryland Medical System, told SurvivorNet.
“We can do this on tumor tissue itself, which is our gold-standard approach. Or there are newer technologies looking at what we call liquid biopsy or circulating tumor DNA, which are little bits of DNA that are being shed out into the bloodstream that we can collect on a peripheral blood draw and do a lot of similar testing, looking for changes within a patient’s tumor,” Dr. Scilla further explained.
Many of these genetic changes that influence your cancer can be targeted with medications, such as targeted therapy. Essentially, the more targeted the therapy, the lower the risk for side effects and any type of collateral damage, such as hair loss.
Common mutations that have approved drugs include:
- EGFR gene mutation
- Available EGFR inhibitors include Erlotinib (Tarceva), Afatinib (Gilotrif), Gefitinib (Iressa), Osimertinib (Tagrisso), and Dacomitinib (Vizimpro).
- ALK rearrangement
- ALK gene mutations cause five percent of non-small cell lung cancer (NSCLC) patients. Some of these drugs include Crizotinib (Xalkori), Ceritinib (Zykadia), Alectinib (Alecensa), Brigatinib (Alunbrig), and Lorlatinib (Lorbrena).
- ROS1 rearrangement
- The drugs that inhibit ROS1 are Crizotinib (Xalkori), Ceritinib (Zykadia), Lorlatinib (Lorbrena), and Entrectinib (Rozlytrek).
- KRAS gene mutation
Targeted therapy works by identifying specific markers on tumor cells. These markers allow doctors to target specific cancers with drugs or other treatments designed to attack them. This treatment method reduces side effects while increasing efficacy and improving survival rates. If you’re receiving targeted therapy for your lung cancer, this means that your doctor has found targets on the surface of cancer cells or in your tumor.
Generally, targeted and immunotherapies can include one of the following forms:
- Small molecules: These can enter cells effortlessly, so they are utilized for intracellular targeting.
- Monoclonal antibodies: are proteins synthesized in the lab using varying techniques. Some are made to mark cancer cells to be recognized by the immune system and destroyed; others can stop cancer cells from growing or cause them to self-destruct, and then some are loaded with toxic drugs to project them directly into cancer cells. This last form is called an antibody-drug conjugate, and there have been many new and exciting advancements in this type of therapy.
Dr. Oxnard told SurvivorNet that his lung cancer patients using target therapies are living vibrant lives.
“Patients of mine who are taking a (target therapy) pill once a day and their cancers melted away,” Dr. Oxnard said.
He notes that he only has to see them for follow-up appointments “every few months” and that they are “living fully.”
However, Dr. Oxnard cautions that targeted therapy drugs for lung cancer patients may not last forever.
“They can develop resistance,” he said.
One way to stay ahead of the curve of your tumor is to do regular testing of the tumor to ensure your treatment options remain effective.
What Types of Immunotherapy Are Approved for Lung Cancer
Ipilimumab is a type of immunotherapy that the FDA approved in 2011. It works by blocking a protein called CTLA-4 on immune cells and preventing them from turning off T cells that attack tumors. It’s currently used as an additional treatment in combination with chemotherapy for patients whose tumors have not responded to other drugs.
Another immunotherapy for lung cancer is nivolumab (Opdivo), which blocks PD-1 receptors on immune cells and prevents them from stopping T cells from attacking tumors. It was approved by the FDA in 2014 and has since been shown to improve survival rates when used with chemotherapy in patients with advanced lung cancer who had previously been treated with chemotherapy or radiation therapy.
WATCH: Immunotherapy Has Changed The Game For Lung Cancer
Additionally, there’s pembrolizumab (Keytruda), which binds to PD-1 receptors on immune cells and stops cancer. Keytruda cancer treatment is one of the most widely used forms of immunotherapy for lung cancer and has been approved by the FDA since 2016. It targets a protein called PD-1 on tumor cells so your immune system can destroy them. In addition to its treatment effectiveness for lung cancer, Keytruda has shown promise in fighting other forms of cancer.
What Kind of Side Effects Do Targeted and Immunotherapy Bring to Patients?
Like most treatments, targeted immunotherapy has side effects that often impact patients. The severity of the side effects can vary depending on the dosage, the overall health of the patient, and the type of targeted drug or immunotherapy.
Known side effects may include:
- Fatigue or tiredness
- Low immune cell count (white blood cells)
- Breathing difficulties
- Coughing
- Diarrhea
- Constipation
- Change in taste
- Loss of appetite
- Flu-like symptoms
- Nausea
- Weight gain
- Skin reactions (ex., rashes or itching)
- Eye problems (ex., light sensitivity, dryness, redness, or impaired vision)
Smoking and Lung Cancer Risk
Lung cancer is the leading cause of cancer deaths for men and women in the United States. Nonsmokers still get lung cancer, but cigarette smoking is the number one risk factor for the disease. Tobacco smoke contains a mixture of more than 7,000 different chemicals, at least 70 of which are known to cause cancer, the CDC says.
The Centers for Disease Control and Prevention (CDC) says cigarette smoking is linked to about 80 to 90 percent of lung cancer deaths, and people who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who don’t smoke. Additionally, second-hand smoke can cause lung cancer.
Smoking is, of course, the primary cause of lung cancer, but nonsmokers can and do develop this disease. Researchers have made progress in understanding the differences between lung cancer in smokers versus nonsmokers, says Dr. Ronald Natale, a medical oncologist at Cedars-Sinai Medical Center, and they’re developing targeted treatments that will be able to address the genetic drivers of lung cancer in nonsmokers.
“Among patients who are nonsmokers, or former very light smokers, we identify a mutation that we can target with pills in about 60% to 70% of them. That leaves 30% or so, 40%, in whom we either have a target for which we do not have successful treatment,” Dr. Ronald Natale, a medical oncologist at Cedars-Sinai Medical Center, tells SurvivorNet.
“Among patients who are smokers, who have more complex cancers that have hundreds, sometimes thousands of mutations, don’t have a driver mutation that we can give a pill for, which is only a tiny percentage of lifelong smokers. Chemotherapy is the primary treatment in most patients,” Dr. Natale explains further.
Guidelines for Lung Cancer Screening
Guidelines set by the American Cancer Society (ACS) recommend yearly lung cancer screening for people who “smoke or formerly smoked and have a 20-year or greater pack-year history,” an ACS press release says.
“This updated guideline continues a trend of expanding eligibility for lung cancer screening, which will result in many more deaths prevented by expanding the eligibility criteria for screening to detect lung cancer early,” said Dr. Robert Smith, senior vice president of early cancer detection science at the American Cancer Society and lead author of the lung cancer screening guideline report.
Understanding Lung Cancer
Lung cancer forms when cancer cells develop in the tissues of the lung. It is the second most common form of cancer and the leading cause of cancer deaths in both men and women in the U.S., SurvivorNet experts say. The reason is that it’s “completely asymptomatic,” says the thoracic surgeon-in-chief at Temple University Health System, Dr. Joseph Friedberg.
“It causes no issues until it has spread somewhere. So, if it spreads to the bones, it may cause pain. If it spreads to the brain, it may cause something not subtle, like a seizure,” Dr. Friedberg adds.
WATCH: Detecting lung cancer in the absence of symptoms.
Scans such as X-rays can help doctors determine if a shadow appears, which can prompt further testing for lung cancer.
Lung cancer often doesn’t cause symptoms until it has already spread outside the lungs, according to SurvivorNet’s experts.
There are two main types of lung cancer, which doctors group together based on how they act and how they’re treated:
- Non-small cell lung cancer (NSCLC) is the most common type and makes up about 85% of cases.
- Small cell lung cancer (SCLC) is less common, but it tends to grow faster than NSCLC and is treated very differently.
If you quit smoking, you can significantly reduce your risk of developing the disease and dying from it.
Treatment options for lung cancer depend on its type, its location, and its staging. In general, treatment methods include surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of any of these treatments.
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