Medical Advances Offering New Hope to Lung Cancer Patients
The most common signs and symptoms of lung cancer are non-specific — losing weight or having a cough. By the time more serious symptoms are displayed — headaches, bone pain, weakness of an arm or leg — the cancer has already spread elsewhere in the body, meaning it has become metastatic.
“It’s generally not curable at that stage,” said Dr. David Carbone, director of the Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Institute.
That’s why Carbone stresses the importance of CT screenings that can detect lung cancer in its infancy stages for people who have no symptoms but are considered high risk because they are a heavy smoker – or have been in the past.
According to the Centers for Disease Control and Prevention, the U.S. Preventive Services Task Force recommends yearly screening for people who:
- Have a history of heavy smoking, and
- Smoke now or have quit within the past 15 years, and
- Are between 55 and 80 years old.
While most lung cancers can be linked to smoking, about 20 percent of patients have never smoked. Non-smoking lung cancer can be attributed to a variety of causes, including environmental hazards like radon exposure or secondhand smoke as well as family history and gene mutations.
“Oftentimes, non-smoking lung cancer is diagnosed by accident because patients see their doctors for ailments they think are unrelated,” Carbone said.
In addition to early detection and quitting smoking, recent breakthroughs in treatments and therapies for lung cancer in all stages are exponentially increasing quality of life and survival rates. In the past, when a patient was diagnosed with lung cancer, his or her life expectancy might have been as little as a few months. Today, survival rates can be upward of several years, Carbone said.
There are multiple therapeutic options for lung cancer, but there are three main approaches: chemotherapy, targeted therapy and immunotherapy. Lung-cancer experts at The James are continually making breakthroughs in each of these areas.
Chemotherapy broadly treats the cancer, damaging noncancerous cells as well cancerous cells. “But it’s not evil, and some patients seem to tolerate it quite well,” Carbone said.
Targeted cancer therapies, or drugs in the form of a pill, are used when a gene analysis of a tumor shows it has specific characteristics that could benefit from a certain drug. These drug therapies block the spreading of tumors by inhibiting or blocking their growth.
One of the challenges is that patients don’t often undergo the appropriate genetic testing to see whether they could be a candidate for these targeted therapies, Carbone said. “Targeted therapies are highly effective — about 95 percent of the time — in turning off a gene that’s been turned on. That results in slowing cancer’s growth or stopping it entirely.”
Targeted therapy drugs used to treat some lung cancers include gefitinib (Iressa), crizotinib (Xalkori) and erlotinib (Tarceva). These drugs target specific enzymes that help regulate cell growth.
When it comes to immunotherapy, Carbone said patients, especially ones who have non-smoking lung cancer, are responding extremely well. With immunotherapy, antibodies — instead of chemicals — are used to target the cancer.
Immunotherapy uses a patient’s own immune system to fight off the cancer cells. When cancer invades the body, the immune system takes over to fight it. But in the process, the cancer creates proteins, which prevent the immune system from doing its job.
Immunotherapy turns off the immune “force field,” said Carbone, adding that The James is studying the effectiveness of pairing immunotherapy and surgery. New research presented at the European Society for Medical Oncology meeting in October 2016 showed that the immunotherapy drug pembrolizumab beat platinum-based chemotherapy as an initial therapy for non-small cell lung cancer.
In addition, experts at The James are researching resistance mechanisms to understand why patients stop responding to targeted therapies. This information will help scientists modify existing targeted therapies – and develop new ones – aimed at better cancer control for longer periods of time. “These second mutations are harder to treat, but drugs can be effective.”
Other ongoing research at The James includes genetic testing for family members of cancer patients to see whether they have inherited factors that predispose them to cancer. If patients are genetically predisposed to lung cancer, they can obtain a baseline lung cancer CT screening to look for early signs of cancer.
“There is just a small percentage of people who fit this scenario, but they are often non-smokers so a lung cancer diagnosis is completely unexpected. We want to catch these cancers while they are still treatable,” adds Carbone.
To learn more about the lung cancer team at The James, call 1-800-293-5066. Lung cancer screenings are offered every week at the Martha Morehouse Medical Plaza Tower Building and at University Hospital East.