Doctors Turning Lung Cancer Research into Results at The James

David Carbone  OSUCCC James

There are more lung-cancer diagnoses and deaths than most people realize.

“It’s not universally recognized how much of a problem lung cancer is,” says David Carbone, MD, PhD, at the beginning of his recent Hope for Lung Cancer Patients presentation sponsored by JamesCare for Life.

“If you were to ask people what cancer is the number-one killer of women, I think 90 percent would say breast cancer,” says Dr. Carbone, director of the Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James).

However, 25 percent of all cancer deaths among women are from lung cancer, followed by breast cancer (14 percent) and colon cancer (8 percent), Dr. Carbone says, citing statistics from the American Cancer Society. For men, lung cancer accounts for 27 percent of all cancer-related deaths, followed by colon cancer (9 percent) and prostate cancer (8).

There will be an estimated 223,000 lung-cancer diagnoses in the United States in 2017 and about 156,000 deaths, according to the National Cancer Institute.

However, as the title of Dr. Carbone’s talk suggests, the tide is turning and he is very optimistic.

“What I hope to convey to you is how much progress is being made in treating lung cancer,” Dr. Carbone says. “The pace is incredible, but we still have a long way to go.”

Improvements in screenings that lead to earlier diagnoses make up the foundation of all the progress in the fight against lung cancer, as early diagnoses can greatly improve the outcomes for patients. Other research breakthroughs include: New and improved, third-generation chemotherapy drugs; the genetic testing of tumors that leads to targeted—or precision medicine—treatments designed to fight a specific cancer-causing mutation; recent advances in immunotherapy that help the body’s immune system detect and attack cancer cells that have learned how to put up force fields.

There are currently several clinical trials in which third-generation drugs are showing tremendous promise, Dr. Carbone says. “These third-generation drugs are working even better and can prevent brain metastasis and are less toxic and have fewer side effects.”

Brain metastasis (in which the cancer cells travel from the lungs to the brain) “is a big problem with lung cancer,” Dr. Carbone says. “And these new third-generation drugs can actually shrink the brain metastasis.”

While statistics are important to help understand the scope of lung cancer, Dr. Carbone eloquently described how all the lines on the graphs he showed “are real people, real patients,” and each patient and their families are important parts of the team at the OSUCCC – James.

Dr. Carbone described a patient with Stage 4 lung cancer whose lungs were filled with tumors She was on a ventilator and “was weeks away from dying” when genetic testing of her tumors helped Dr. Carbone and his team identify the specific markers of her cancer, leading them to enroll her in a clinical trial.

“A few months later, all her tumors were gone,” Dr. Carbone says, adding that these types of success stories keep him motivated.

Immunotherapy shows great promise in treating a wide range of solid-tumor and blood cancers.

The body’s immune system is designed to detect and attack bacteria, viruses and other foreign bodies, such as cancer cells. T-cells are the immune system’s primary weapon in fighting cancer and, when working properly, these immune system cells detect and kill cancer cells before they can form tumors and spread throughout the body. However, cancer is tricky and can adapt and fool the immune system.

“If a patient has cancer, it’s clear the immune system isn’t working,” Dr. Carbone says. “The cancer cells have avoided it.”

One way these cancerous cells can avoid T-cell detection is by “expressing PD-L1, a protein that acts like a force field around the tumor and prevents the T-cells from recognizing and attacking them,” Dr. Carbone says.

These proteins are called inhibitors. Immunotherapy drugs create what are known as checkpoint inhibitors that eliminate the force field around cancer cells and allow the body’s immune system to seek and destroy them.

The average survival rate for patients newly diagnosed with Stage 4 lung cancer was about six months. “Now, with immunotherapy, it is four to five or even more times longer than historical numbers and that’s a huge improvement,” Dr. Carbone says.

There are several immunotherapy drugs currently in clinical trials that show great promise.

“We’re seeing amazing results with these new immunotherapy drugs,” Dr. Carbone says. “The hope is these drugs are the beginning of a whole new series of immune therapies that target several different mechanisms that tumors have learned in order to escape the immune system.”

Among the keys to continued success, he says, are even more research and the enrollment of more and more lung cancer patients in clinical trials because these trials “give patients access to tomorrow’s treatments today.”

The majority of lung cancer patients are never cured because “their tumors eventually become resistant to the treatment,” Dr. Carbone says. “But we’re making so much progress and we can offer our patients real hope. In the last year or two, we’ve had six or seven new treatments approved for lung cancer, which is more than we had in the last 20 years. Now, we’re keeping patients alive longer with the hope that next month, or next year, an even better treatment will be here.”