Learning about Lung Cancer
- TV host Jonnie Irwin, 49, recently shared that he’s battling lung cancer that has spread to his brain. His first warning sign of the disease came in 2020 when his vision went blurry while driving.
- Now, he’s telling people that he doesn’t want any “mollycoddling.” He wants people to treat him the same way they would prior to his diagnosis.
- Lung cancer is the second most common type of cancer and it can develop in both smokers and non-smokers, but 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.
- There has been lots of progress within the world of lung cancer treatment – specifically when it comes to immunotherapy. One of our experts says “it’s really changed the face of lung cancer, just like targeted therapies.”
Irwin, host of BBC‘s “Escape to the Country,” has received a lot of support since sharing that his lung cancer has spread, or metastasized, to his brain. But in a recent interview with BBC chat show “Morning Live,” he made a point to talk about how he wants to be treated.
Read MoreJonnie Irwin’s Lung Cancer Battle
Jonnie Irwin’s first warning sign came when his vision went blurry while driving in August 2020 during a filming trip.
“Within a week of flying back from filming, I was being given six months to live,” he said. “I had to go home and tell my wife, who was looking after our babies, that she was on her own pretty much. That was devastating. All I could do was apologize to her. I felt so responsible.”
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His wife Jessica is 40 years old, and the couple shares their 3-year-old son Rex and 2-year-old twins Rafa and Cormac. And though drugs have been prolonging his life, Irwin’s future remains uncertain. He’s trying his best to spend precious time with his family and not let his disease ruin whatever time he has with them.
“I don’t know how long I have left, but I try to stay positive and my attitude is that I’m living with cancer, not dying from it,” he said. “I set little markers – things I want to be around for. I got into the habit of saying: ‘Don’t plan ahead because I might not be well enough.’ But now I want to make plans.
“I want to make memories and capture these moments with my family because the reality is, my boys are going to grow up not knowing their dad and that breaks my heart.”
Regardless of the harrowing path ahead, Irwin is determined to put up a fight.
“One day, this is going to catch up with me,” he said. “But I’m doing everything I can to hold that day off for as long as possible. I owe that to Jess and our boys. Some people in my position have bucket lists, but I just want us to do as much as we can as a family.”
Understanding Lung Cancer
Lung cancer is the second most common type of cancer. Diagnosis and treatment of the disease can be tricky since symptoms often don’t appear until the cancer has spread.
An initial symptom, for example, could be as serious as a seizure if the lung cancer has already spread to the brain. But other symptoms can include increased coughing, chest pain, unexplained weight loss, shortness of breath, wheezing, losing your voice or persistent infections like bronchitis or pneumonia.
The two main types of lung cancer are non-small cell, which makes up 85 percent of cases, and small-cell. These types act differently and, accordingly, require different types of treatment.
Dr. Patrick Forde, a thoracic oncologist at Johns Hopkins Medicine, tells SurvivorNet about how distinguishing between the two types – and their subtypes – can be very beneficial.
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“Within that non-small cell category, there’s a subtype called non-squamous adenocarcinoma, and that’s the group of patients for whom genetic testing is very important on the tumor,” he explains. “Genetic testing is looking for mutations in the DNA, in the tumor, which are not present in your normal DNA.”
Declining smoking rates have lead to an improved outlook for lung cancer since cigarette smoking is the number one risk factor for the disease. In fact, the Centers for Disease Control & Prevention states that cigarette smoking is linked to about 80 to 90 percent of lung cancer deaths.
It’s important to remember, however, that even people who’ve never smoked before can still get lung cancer. The CDC reports that, in the United States, about 10 to 20 percent of lung cancers, or 20,000 to 40,000 lung cancers each year, happen in people who’ve never smoked.
“Some lung cancers are from unknown exposure to air pollution, radon, or asbestos,” Dr. Raja Flores, system chair of thoracic surgery at Mount Sinai previously told SurvivorNet in a previous interview. “We also see more never-smokers with lung cancer who have a family history of it.”
Advances in Treatment
Despite the fact that lung cancer is the leading cause of cancer deaths for men and women in the United States, there has been lots of progress within the world of lung cancer treatment – specifically when it comes to immunotherapy.
“Immunotherapy is here to stay,” Dr. Brendon Stiles, chief of thoracic surgery and surgical oncology at Montefiore Health System, told SurvivorNet. “And it’s really changed the face of lung cancer, just like targeted therapies.”
Getting even more specific, checkpoint inhibitors and our ability to genetically test for targeted medications have made a huge difference. Checkpoint inhibitors are a class of immunotherapy drugs that specifically target proteins found either on immune or cancer cells to prevent their binding together. In other words, these drugs don’t kill cancer cells directly, but instead stimulate the immune system to attack cancer cells while hopefully not affecting other surrounding healthy cells.
“It’s amazing to me now that you can have Stage IV lung cancer and actually not even need chemotherapy,” Dr. Stiles said. “If you have high expression of a protein that we know is targeted by immunotherapy, you may just get immunotherapy alone.”
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But how do doctors know if immune checkpoint inhibitors can be used to treat your lung cancer? Through testing.
If you were recently diagnosed with non-small cell lung cancer (NSCLC), your cancer care team should take the time to talk about PD-L1 testing with you. PD-L1 testing is a laboratory test cancerous tumor tissue is sent to a laboratory for evaluation and analysis in order to helps physicians determine if a patient will likely benefit from immune checkpoint inhibitors.
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PD-1, referred to as programmed cell death 1, is a protein that is found on the outer surface of cells in your immune system. PD-L1, referred to as programmed cell death ligand, is on the outer layer of some normal blood cells, as well as some cancer cells. When PD-1 binds to PD-L1, this puts the brakes on the immune system and can prevent immune cells from attacking and killing cells.
Normally, this acts as a braking mechanism to prevent our immune systems from becoming overactive and going somewhat haywire by attacking our normal cells. Cancer cells can take over or override this innate mechanism, preventing cancer cells from dying.
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Immune checkpoint inhibitors are drugs that are designed to blocks proteins called checkpoints that are made by some types of immune system cells. Two important such checkpoint proteins are PD-1 and PD-L1 as well as CTLA4.
“Immune checkpoint inhibitors … these are IV therapies — antibodies — that wake up the immune system,” Dr. Geoffrey Oxnard, a thoracic oncologist at Boston Medical Center, told SurvivorNet. “We are blocking this signal called PD-L1. PD-L1 is a signal that your tumor uses to tell the immune system to go away and ignore it.
“It is a Jedi mind trick, OK? It tells the immune system, ‘Move on. Bye. Ignore me.’ If we block that signal, the immune system wakes up, sees the cancer, and attacks.”
Checkpoint inhibitors for non-small cell lung cancer (NSCLC) patients include the following:
- Nivolumab (Opdivo)
- Pembrolizumab (Keytruda)
- Cemiplimab (Libtayo)
- Ipilimumab (Yervoy)
In addition, it’s important to remember that there are many targeted therapies out there for patients. And genetic testing can reveal the presence of certain genetic mutations — including KRAS, ALK, EGFR and a number of others — which can help doctors tailor treatment for each person’s specific lung cancer. Overall, it’s important that people with lung cancer advocate for themselves and ask if targeted therapies and immunotherapies may be right for them.
Contributing: Dr. Andrea Tufano-Sugarman
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