Longer Lives, Fewer Cases: Lung Cancer Prevention and Treatment Efforts at The James
As lung cancer continues to claim tens of thousands of lives each year, our researchers remain focused on treatment innovation and prevention efforts that can improve outcomes for today’s patients while reducing cases in the future.
The nation’s leading cause of cancer-related deaths in the U.S. (approximately 165,000 per year), lung cancer is the second most commonly-diagnosed form of the disease, with around 266,000 new American cases expected in 2018. Of those cases, 80 to 90 percent will be linked to smoking, according to the Centers for Disease Control.
Despite these daunting numbers, progress in lung cancer care is underway, with researchers hard at work developing new therapies while doctors promote screening and healthy habits to prevent people from becoming patients.
National studies have shown that detecting lung cancer in the early stages reduces the mortality rate by 20 percent, says Cassandra Grenade, MD, an assistant professor in the Division of Hematology at Ohio State and a member of the Molecular Carcinogenesis and Chemoprevention Program at the OSUCCC – James.
With that in mind, Grenade helps lead the Lung Cancer Screening Clinic at The James, where doctors utilize the latest technology, along with their expertise, to detect the disease at its early stages in high-risk patients (55 to 80 years old, current heavy smokers and those who quit the habit within a 15-year period).
At the clinic, patients undergo CT scans, which are followed by PET scans using radioactive tracers if cancer markers are found.
“We have them come back every year for a screening,” Grenade says, adding that patients who continue to smoke undergo the screenings until the age of 85, while others are screened for 15 years from the date they give up cigarettes.
Beating Lung Cancer in Ohio
The Beating Lung Cancer in Ohio (BLC-IO) initiative is a cutting edge program aimed at saving and extending lives in the Buckeye State through prevention and clinical trials.
“About 2,300 lung cancer patients in Ohio will be part of this program,” says Peter Shields, MD, deputy director of the OSUCCC and the lead investigator of the BLC-IO.
All the patients in BLC-IO have Stage 4 lung cancer—a status that, among the general population, comes with a median life expectancy of four to six months. That span rises to 10 to 12 months for patients enrolled in clinical trials.
“About 50 to 60 percent of these patient could have a genetic mutation that can be treated by a drug already approved by the FDA, or they could be enrolled in a clinical trial,” Shields says. “This will add two or three years to their lives, and by then, new drugs and clinical trials could extend their lives even longer.”
A smoking cessation program for the patients with Stage 4 lung cancer will also be part of BLC-IO.
“Smoking is the number-one risk factor for lung cancer,” Grenade says.
There were few active therapies for lung cancer when David Carbone began his medical career in the mid '80s, says the now-director of the James Thoracic Center. “There was some chemotherapy available, but back then it wasn’t even offered to most lung cancer patients because the survival prolongation was so short and the side effects so severe.”
Now, thanks in large part to researchers like Carbone, there are more and more chemotherapy options for lung cancer patients that target specific mutations. The next step is immunotherapy, a process that reinvigorates the body’s immune system to help it detect and kill cancer cells.
“It was found that an important immunologic checkpoint was PD-L1,” Carbone says. “It acts like a force field around the cancer cell. If you have a drug that blocks PD-L1, a checkpoint inhibitor, it allows the immune system to see and kill cancer.”
Around 25 to 30 percent of Carbone’s lung cancer patients have tumors with a high expression of PD-L1. “The response [to treatment] is 45 to 50 percent in the patients with the highest PD-L1 markers, which means shrinkage or total elimination of the tumors.”