Treating Rare Small-Cell Lung Cancer
- Rolling Stones guitarist Ronnie Wood, 79, was diagnosed with small‑cell lung cancer, which is a rare, fast‑growing disease with a five‑year survival rate of only 5–10% according to the National Cancer Institute. Nearly a decade after treatment, he’s marking the milestone with a new album and concert tour.
- Without treatment, average survival for small‑cell lung cancer is just 2–4 months; even with therapy, only about 10% of patients remain disease‑free two years after starting treatment.
- The ADRIATIC trial has established a new standard of care by adding immunotherapy for early‑stage small‑cell lung cancer patients being treated with curative intent, according to Dr. Lauren Byers of MD Anderson Cancer Center.
- Immunotherapy has expanded treatment options for both early‑ and late‑stage lung cancer, and in some cases may reduce the need for chemotherapy, according to Dr. Brendon Stiles of Montefiore Health System.
- Wood previously said he smoked heavily for more than five decades; experts note quitting smoking lowers lung‑cancer risk, though it never returns to that of a lifelong non‑smoker.
- “[Quitting smoking] decreases your chance of getting lung cancer. You never return down all the way to the person who never smoked, as far as your risk of lung cancer, but it goes down,” says thoracic surgeon-in-chief at Temple University Health System Dr. Joseph Friedberg.
The legendary rock band “The Rolling Stones” is celebrating a major milestone with the release of its 25th studio album, and the momentum doesn’t stop there. Guitarist Ronnie Wood, 79, a two‑time cancer survivor, is also gearing up for his own European tour nearly a decade after undergoing lung cancer surgery.
“I cannot wait to start my FEARLESS tour in Europe this summer!” Wood shared on social media.
When Wood was diagnosed with lung cancer, he had a much rarer subtype. Small-cell lung cancer, a rare and aggressive disease with a five-year survival rate of just 5 to 10 percent, according to the National Cancer Institute.
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
Lung cancer experts tell SurvivorNet that treatment varies depending on which type and stage of cancer you have. If the cancer is local — meaning just in the lungs — surgery may be an option. But if it has spread to the lymph nodes, a combination of radiation with chemotherapy, followed by immunotherapy, may be the best option.
Dr. Brendon Stiles, chief of thoracic surgery and surgical oncology at Montefiore Health System (previously a thoracic surgeon at Weill Cornell Medical Center), tells SurvivorNet that immunotherapy has shown great promise for patients.
WATCH: Immunotherapy Has Changed The Game For Lung Cancer
He says using immunotherapy in both early-and late-stage lung cancer has given patients more treatment options. “It’s amazing to me now that you can have Stage IV lung cancer and actually not even need chemotherapy. If you have high expression of a protein that we know is targeted by immunotherapy, you may just get immunotherapy alone,” Dr. Stiles said.
Dr. Stiles adds that immunotherapy for later-stage lung cancer has been the gold standard for some years since its Food and Drug Administration (FDA) approval.
Wood’s Previous Smoking Habit May Have Contributed to His Diagnosis
Wood previously told The Daily Mail, “I smoked for England for 54 years. 25 to 30 [cigarettes] a day, at least, for 50 odd years.”
WATCH: Lung Cancer in Smokers vs. Non-Smokers
Dr. Friedberg urges people concerned about their lung cancer risk to quit.
“There’s no gray zone. Smoking causes lung cancer. That’s it. If you’re smoking, stop,” says thoracic surgeon-in-chief at Temple University Health System Dr. Joseph Friedberg.
“[Quitting smoking] decreases your chance of getting lung cancer. You never return down all the way to the person who never smoked, as far as your risk of lung cancer, but it goes down,” Dr. Friedberg continued.
A seven-year study published in the Annals of Internal Medicine observed the benefits of lung cancer patients who stopped smoking.
“We found quitting smoking after diagnosis to be an important predictor of overall and progression-free survival in patients with early-stage NSCLC. Compared with patients who continued smoking in the follow-up period, those who quit smoking had 33% decreased risk for overall mortality and 25% decreased risk for cancer-specific mortality,” notes lead author Dr. Madhi Sheikh, a member of the Genetic Epidemiology Group at IARC.
“Furthermore, the median survival time was 21.6 months longer among those who quit smoking than among those who continued smoking.”
All Lung Cancer Patients
- Median Survival Time: 5.2 years
- Probability of Survival at Five Years: 50.9%
Lung Cancer Patients Who Continued Smoking
- Median Survival Time: 4.8 years
- Median Progression-Free Survival: 3.9 years
- Median Time to Lung-Cancer Specific Mortality: 6.0 years
- Probability of Survival at Three Years: 66.2%
- Probability of Survival at Five Years: 48.6%
Lung Cancer Patients Who Quit Smoking After Diagnosis
- Median Survival Time: 6.6 years
- Median Progression-Free Survival: 5.7 years
- Median Time to Lung-Cancer Specific Mortality: 7.9 years
- Probability of Survival at Three Years: 74.5%
- Probability of Survival at Five Years: 60.6%
These numbers show that patients who quit smoking had longer median survival time (6.6 years v. 4.8 years), longer median progression-free survival (5.7 years v. 3.9 years), and longer median time to death from lung cancer (7.9 years vs. 6 years).
Wood’s Cancer Journey
Wood’s first cancer battle followed a routine checkup with his doctor. A “cancerous legion” was found, CNN reported. He had emphysema in the upper lobe of one of his lungs. This condition is characterized by “abnormal permanent enlargement of lung air spaces,” according to the National Institutes of Health.
In 2017, he underwent a five-hour operation to remove part of his lung to remove the cancer.
“Luckily, all mine was contained within the left lung, and I was fortunate enough to get shot of it, bang. There was none in the rest of my body, so I didn’t require chemo,” he told the U.K.-based news outlet, The Times.
He admitted he was a heavy smoker for 50 years. He went through 25 cigarettes a day before quitting the habit in 2016. The birth of his two youngest children helped prompt his lifestyle change.
After beating his first bout with cancer in 2018, Wood was diagnosed again with small-cell carcinoma in 2020.
“Sure enough, when I had recovered from the lung cancer, I was invaded by the worst kind of cancer. It’s called small-cell,” Wood said on an episode of Ireland’s “The Late Late Show.”
“I had to have really heavy chemo and radiation, and they said they’d given me a year’s worth of medication in three weeks, and my body just jumped to defense,” Wood said.
During his cancer treatment, Wood took to painting to help him cope.
“Art therapy was self-imposed in a way, especially in the [coronavirus] lockdown. The art has got me through it to express and get lost. I’d be painting (the twins) all the time if I could, but it’s amazing to be with them and just observe, soak it in that way,” he shared with The U.S. Sun.
He credits positive thinking, his art, music, and the support of loved ones to help him through his cancer journey, and that’s an approach our experts love to see!
After completing his small-cell carcinoma treatments, he said his doctor gave him the “all clear.”
Throughout his cancer journey, Wood never stopped making music.
Expert Resources for Lung Cancer Patients
- A New Wave Of Treatments Is Providing Hope For Small Cell Lung Cancer Patients
- Advanced Small Cell Lung Cancers Can Benefit from the Promising Immunotherapy Drug Keytruda Now, Too
- Certain Non-Small Cell Lung Cancer Patients Who Get Immunotherapy Alongside Chemo Live Longer Without Cancer Returning Or Worsening, Promising Trial Shows
- Could Timing Give Your Cancer Treatment A Boost? New Study On The Best Time To Receive Immunotherapy & Chemo For Non-Small Cell Lung Cancer
Smoking and Cancer Risk
Wood’s years as a smoker likely contributed to her lung cancer diagnosis.
Although nonsmokers can get lung cancer, 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 Centers for Disease Control and Prevention (CDC) says.
The 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, secondhand 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 a 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.
WATCH: Does smoking marijuana pose health risks?
“[Eliminating] tobacco use alone could prevent 1 in 4 cancer deaths or approximately 2.6 million cancer deaths annually,” said Dr. Ahmedin Jemal, senior vice president of surveillance & health equity science at the American Cancer Society and senior author of the study.
Tobacco, more specifically smoking cigarettes, is a significant risk factor for lung cancer, which is “the most commonly diagnosed cancer and leading cause of cancer death overall and in men worldwide,” the American Cancer Society says.
Understanding Lung Cancer and Why It’s Hard to Catch Early
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. It’s “completely asymptomatic,” Dr. Joseph Friedberg adds.
“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.
Some people with lung cancer may experience symptoms such as:
- A cough that doesn’t go away, that gets worse, or that brings up bloody phlegm
- Shortness of breath
- Fatigue
- Chest pain
- Hoarse voice
- Appetite loss
- Weight loss
If you are experiencing these kinds of symptoms consistently, contact your doctor for further tests.
How Molecular Testing Helps Lung Cancer Patients
Lung cancer treatment has seen notable progress, partly because of molecular testing and profiling. This type of testing helps better understand specific genetic alterations and mutations that drive the growth, development, and progression of cancer cells. Some of these molecular characteristics can be targeted using precise and effective new therapies to improve patient outcomes. Ultimately, understanding the molecular profile of each person’s cancer allows oncologists to use customized and personalized treatments.
RELATED Next-Generation Sequencing in Lung Cancer
There are several next-generation sequencing (NGS) tests you may encounter, depending on where you are getting treatment and what you are getting treatment for. Here are some of the common ones currently on the market:
- FoundationOne®CDx looks at 324 genes in solid tumors and says results can take up to 12 days. Test results include microsatellite instability (MSI) and tumor mutational burden (TMB) to help inform immunotherapy decisions.
- OmniSeq Insight provides comprehensive genomic and immune profiling for all solid tumors. It looks for 523 different genes. Test results include microsatellite instability (MSI) and tumor mutational burden (TMB), as well as PD-L1 by immunohistochemistry (IHC).
- Cobas EGFR Mutation Test v2 identifies 42 mutations in exons 18, 19, 20, and 21 of the epidermal growth factor receptor (EGFR) gene. It is designed to test tissue and plasma specimens with a single kit, allowing labs to run tissue and plasma simultaneously on the same plate.
Advancements In Lung Cancer Treatment
Lung cancer treatment is still evolving, offering the promise of hope for people living with this type of cancer. Research presented at the 2024 American Society of Clinical Oncology (ASCO) showed that (generic name: durvalumab) (brand name: Imfinzi), a type of immunotherapy drug, could reduce the risk of death for patients with limited-stage small cell lung cancer (LS-SCLC) by 27 percent.
The study demonstrated that the use of Imfinzi improved overall survival and progression-free survival (the time a patient lives without their disease getting worse) in patients.
“SCLC is one of the most aggressive types of lung cancer. The ADRIATIC trial is a landmark study and provides a new standard of care with the addition of immunotherapy for patients with early-stage SCLC who are being treated with the goal of curing their cancer,” said Dr. Lauren Byers, thoracic section chief in the Department of Thoracic-Head & Neck Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston.
Dr. Byers pointed out that Imfinzi helped patients live for years compared to many other treatment approaches, where the benefits were measured in months.
Another treatment option that has shown great promise is the drug Rybrevant, which is approved by the U.S. Food and Drug Administration for non-small lung cancer (NSCLC) and has a specific genetic mutation your doctor can identify through testing.
“When a patient comes in, we immediately sequence the tumor. We are doing panels that might include three, four, or 500 genes, the ones that are most likely. Some sort of next-generation approach is the best standard of care these days – it has to be done,” Dr. Roy S. Herbst, the chief of medical oncology at the Yale Cancer Center, Yale School of Medicine, explains.
The active ingredient in Rybrevant is amivantamab-vmjw. It belongs to a class of drugs known as biologics, which are made from living cells.
The drug works like a guided missile, finding and sticking to the bad cancer cells. It targets and attaches to two specific proteins in cancer cells, disrupting their growth signals and activating the immune system to fight the cancer.
Once it finds its target, it blocks the signals the cells need to grow and spread. This stops the cancer from worsening and helps patients feel better for longer.
Rybrevant is different from older cancer treatments because it is a targeted drug therapy. It doesn’t just attack all rapidly dividing cells as traditional chemotherapy does. Instead, it goes after the cancer cells with the mutation it was designed to treat while avoiding the healthy surrounding cells. This means it can be more effective and might have fewer side effects than other treatments.
WATCH: Imfinzi offering hope to patients.
Lorlatinib and crizotinib are other lung cancer treatments known as tyrosine kinase inhibitors. These drugs target ALK, a signaling protein inappropriately present in the tumors of about five percent of patients with NCSLC.
“It is encouraging that the upfront benefits of lorlatinib over crizotinib continue for several years in more than half the patients. It is also encouraging that patients receiving lorlatinib had much fewer incidences of brain metastasis, which can be devastating,” Dr. Leslie Busby, an oncologist at Rocky Mountain Cancer Centers, told SurvivorNet.
Five-year PFS, or the percentage of patients who lived five years without any evidence of cancer growth or death, was 60% among patients who received lorlatinib compared to only 8% among patients who received crizotinib—an absolute difference greater than 50%.
Questions for Your Doctor
If you find yourself diagnosed with lung cancer and are concerned about the long-term impacts, here are some questions you can ask your doctor.
- Has my cancer spread to other parts of the body?
- Based on my cancer stage, what are my treatment options?
- What are the side effects of my recommended treatment?
- Are there ways to help minimize the effects of treatment?
- How long will I be unable to work or carry out my daily activities?
- What financial resources are available to get the treatments I need?
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