The Changing Face of Lung Cancer: Why Should You Care? | July 23 2022

July 23, 2022

First, A Little Report

“You are doing remarkably well.” So starts the pulmonologist’s note after our check-in this past week. I had to do a pulmonary function test (ick) plus 6-minute walk. Results: breathing tests are normal. I can move 110% the amount of air predicted, and get it out 107% of predicted. My lung capacity is 97% of predicted, and my ability to transfer air from lungs to blood vessels is 90% of predicted.

When he asked how far I’ve been able to ride, I said “30 miles,” and he cheered. When I described falling over on a hill on that ride, he countered with a story of his foot sliding off a pedal before he’d clipped in.  His calf ugliness from refusing to get stitches was impressive. I love this guy.

Was everything perfect? Of course not. If the cancer were to progress, my history of pneumonitis might make some of the more current treatments risky or even inadvisable. <shrug> We will cross that bridge etc.

Which brings us to the second remarkable thing: developments in lung cancer treatment.

Remarkable Advances In Lung Cancer!

The Lungevity Foundation’s third annual International Lung Cancer Survivorship Conference (ILCSC 2022) took place online on July 15 and 16. (All sessions were recorded and are available to view for 90 days from July 21 to October 19, 2022. Simply register, for free.) The discussions on developments in immunotherapy and targeted therapies were great, as were sessions with physician-researchers about specific biomarkers.

What stuck me most was how far lung cancer has come in a very short time.Two of the speakers offered remarkable perspectives of how the field has changed, and why the speed of these changes holds so much hope for physician-researchers and their patients.

The first, the keynote speaker, Dr. David P. Carbone, is a medical oncologist who also earned a PhD in genetics. (Brains, much?!) He combines the two to develop novel treatments for lung cancer patients. He’s a Professor in the Division of Medical Oncology, The Ohio State University; the Barbara J. Bonner Chair in Lung Cancer Research; and Director of the James Thoracic Oncology Center. He’s also a lymphoma survivor and deeply sympathetic to the lung cancer patient community.

The next, Dr. Benjamin Levy, is associate professor at the Johns Hopkins School of Medicine and clinical director of The Sidney Kimmel Cancer Center, Johns Hopkins Medicine at Sibley Hospital in Washington, DC. He looks like he’s about 26 (with early hair loss.).

Here are some of the basics that make me feel 1.) like a miracle; and 2.) lucky to be sick in this time. (OK, I know– the PollyAnna stuff is making you queasy…me too.)

How Have Things in Lung Cancer Changed?

“Lung cancer is a horrible, horrible diagnosis,” said Dr. Carbone. (Truth; refreshing to hear.) But the situation was even worse when he started.

Dr. Carbone said the time from diagnosis to death was 4-6 months and the treatments were so awful, plus the data so grim about the outcomes (palliative care only vs. treatment), it was genuinely unclear whether treating patients was worth it for them.

Here’s what’s happened with treatment options after a little lot of research in the field.

Knowledge is a wonderful thing! Once you know more about the molecular subtypes of the lung cancer you have (above) treatment options open up (below).

Dr. Levy is a super-fan of targeted therapies.

Good News All Around

Levy and Carbone– all the speakers at the conference, in fact– bubbled over with enthusiasm about the progress that’s been made and the hope they want that to inspire in lung cancer patients. Dr. Carbone showed the power of the new treatments in one slide, below.

A woman came to him with serious late-stage cancer (left image, below). Despite being on oxygen, she struggled to breathe. She’d been told she did not have long to live. Carbone started her on a therapy known to counteract the cancer-producing mutation she had. Within 5 months, her diseased lungs were clear of cancer (right image on slide below.)

The very serious question we should consider, he cautioned, is whether we should be using really expensive drugs when the body eventually develops resistance to them and the cancer returns. (Why would he say something that appears to argue against targeted therapy? Keep in mind, his new research is based on a theory that the cancer disappears because the mutation-based growth factors are curtailed, but returns because there are still cancer stem cells just hanging out, napping. His question is part of a powerful  argument to persuade colleagues, patients, and funders, that his study on cancer stem cells is not only viable, it’s necessary. Me, I buy it completely. I’d sign up for the study in a heartbeat, but I’m excluded because I’m currently on the TKI he’s including in his study.)

There are so many developments in the field, the specialists almost can’t keep up with them. It’s great! There are scads of clinical trials open to patients, which means they get tomorrow’s care today. (The kinds of studies with a control group getting a placebo pretty much don’t exist any more.) That’s amazing!

What’s the Current Landscape?

Hope is never a bad thing! But let’s not forget the current landscape in the world of cancer research and outcomes. In the slide Dr. Levy uses, below, lung cancer is green, breast cancer is pink, colon cancer is blue. (Sorry for the lousy quality; screenshots are hard to clean up. I think the picture is pretty clear even without words.)

(For more about the current landscape in lung cancer, scroll down. )

Now let’s take a closer look at the first two goals Dr. Levy presents for 2030, 8 years from now.

Decrease deaths from late stage diagnosis of lung cancer.

Increase 5 year survivorship to 50%.

Dr. Carbone differs from these stats a bit– he says the goal for all lung cancer patients should be 5 year survivorship.

My conclusion: If you were thinking of buying me dinner, it might not be a bad idea to do it sooner rather than later. Of course, given Covid’s increased transmissibility of late (as of 7/2022), we’d have to eat outside….

Look, a big part of having lung cancer has been wrapping my mind around what tends to happen. Now I have the mental wherewithal to decide how to live my life and live it.

For example, if there were progression of my disease– and we’ll find out with next week’s scans– I’d still go on vacation to Cape Cod. I’d get an appointment for a second opinion, possibly with an EGFR expert at Mass General (mostly because I could walk there from the ferry I’d take from Provincetown.) I’d probably look for a clinical trial. Meanwhile, there are other actions to be taken, and you bet I would.

Just because there are crappy things that are true about lung cancer doesn’t mean you stop living the best life you can each day.

Why Should You Be Aware of Lung Cancer?

65% of all lung cancers are diagnosed in never-smokers. (That “only smokers get cancer” thing? MYTH.)

Lung cancer is the leading cancer killer in both men and women in the U.S. In 1987, it surpassed breast cancer to become the leading cause of cancer deaths in women.

The only requirement for getting lung cancer? Having lungs.

From the LUNGevity 2022 “Facts about Lung Cancer”

So…?

If you meet the criteria for annual screening for lung cancer, GET SCREENED.

Early detection gives you a better shot to live longer.

If you or someone you love get a cough that doesn’t go away, even if there are no other symptoms, go get a low-dose CT scan. If your primary care doc poo-poos you, get to a pulmonologist and ask for one. Early detection means everything. Other things to pay attention to and seek care for (according to the Mayo Clinic, among others):

• A new cough that doesn’t go away
• Coughing up blood, even a small amount
• Shortness of breath
• Chest pain
• Hoarseness
• Losing weight without trying
• Bone pain
• Headache

By the way, have you checked your house for radon yet?

Thanks for reading. I hope your scorecard today shows lots of gold stars.