When it comes to cancer treatment, the heartbreaking truth remains that we still have a lot of work to do. However, dramatic statements that suggest there has been little improvement shortchange important advancements that have been, and are still being made, such as targeted therapies and treatments that unleash the power of the immune system to attack cancer. As a medical oncologist specializing in lung cancer, I’ve seen incredible progress first-hand that has allowed many of my patients to live longer with fewer side effects. Although this isn’t true for everybody, there are currently people living years with good quality of life with a diagnosis of stage 4 lung cancer. This is a new reality.
Many people have asked me about the meaning of a recent article published in the Wall Street Journal, including a patient and his son who expressed concern and confusion about the claim that little progress has been made in cancer treatment. This particular patient was in his late 50s when he was diagnosed with widespread lung cancer that had already spread to his brain. After receiving radiation to his brain, he started chemotherapy, but unfortunately, the cancer kept growing. Previously, this scenario often left hospice as an inevitable option.
Fortunately, a new class of immunotherapy drugs had received FDA accelerated approval. This new treatment enabled his immune system to fight the cancer and control his disease for 2 years beyond what was previously considered possible. When his cancer started rapidly growing, a simple blood draw detected the presence of a cancer mutation (BRAF V600E), providing another opportunity for a recently approved new treatment, this time with targeted therapy. His cancer again responded, dramatically decreasing in size. This new “precision” treatment controlled his disease for another 14 months.
When his cancer became resistant and grew again, the only site of disease, an adrenal gland, was surgically removed. Had he been in his initial predicament only a year prior, his life expectancy would have been a few months. Thanks to advances in treatment, he has celebrated many more holidays and birthdays. During his most recent office visit, he excitedly shared pictures of his new home. There have indeed been bumps in the road, but this man has lived 4 years (and hopefully many more to come), with effective disease control made possible from significant scientific achievements. He is not alone. There are many other stories of survival that would have previously been impossible, if not for these new treatment options.
Lung oncology in particular has benefited from some of the biggest advances over the past decade. Ten years ago, a trial was published reporting a targeted therapy pill used to effectively treat lung cancer with EGFR mutations better than chemotherapy and with fewer side effects. Traditional chemotherapy affects rapidly dividing cells, including normal healthy tissue, whereas targeted therapy focuses treatment on the cancer cells. There are currently five drugs that treat lung cancer with these EGFR mutations with increasing effectiveness. In a disease that historically resulted in living less than a year, the current standard EGFR targeted therapy leads to survival beyond three years for most people, and more than 1 out of 4 patients experience ongoing disease control at 3-years from a treatment that typically doesn’t cause more than a mild rash. There are some individuals alive more than 10 years after being diagnosed with metastatic lung cancer by using targeted therapies for EGFR mutations. Although this is not yet enough, prior to the targeted therapy era, outcomes like these were unimaginable.
Treatment for cancer mutations beyond EGFR also exist. ALK, another cancer DNA alteration, was discovered in 2007 and already has five approved targeted therapies. A pill controls the disease for more than 3 years for many patients that also causes almost no significant side effects for the majority of people taking it. Within the last five years, FDA approvals/designations for other targeted therapies include treatments for lung cancer with mutations of ROS1, BRAF V600E, MET, and NTRK, and promising new drugs exist targeting RET and KRAS.
We’ve also seen tremendous outcomes with checkpoint inhibitor immunotherapies, which are now part of standard first-line treatment for lung cancers without a targeted option. On top of controlling cancer for longer than traditional chemotherapy, these immunotherapy drugs can be much better tolerated, and there are many people alive with impressive and lasting remissions. To quote Paul Brodeur from Siddhartha Mukherjee’s book The Emperor of All Maladies: "Statistics are human beings with the tears wiped off." The numbers described above are people – people with sisters, brothers, spouses, parents, children, friends, and neighbors – that are alive thanks to the work that continues to improve treatment of lung cancer.
There have been promising discoveries in the field of lung cancer detection as well. Lung cancer screening by CT scan has demonstrated a dramatic opportunity for preventing deaths from lung cancer with multiple studies showing earlier detection when cure is achievable. CT lung screening is recommended by the US Preventative Services Task Force, as well as many other medical organizations, for high risk individuals and is covered by private insurance and Medicare. All who qualify should talk to their doctors about undergoing lung screening, and SavedByTheScan.org is an excellent way of finding out who qualifies.
There is a common misconception that little has changed in cancer treatments over the past decades. We cannot think of cancer as a single entity. There are more types of cancer than there are organs in the body. Just because modern medicine has not discovered a panacea for all types of cancer does not mean that advancements in treatment have not occurred. Fortunately, these advancements have made it possible for some people to live much longer and with a better quality of life than what was previously imagined.
A lot of work remains in our efforts to cure cancer, but that doesn’t mean we should abandon the current path or disregard recent advances. The last 10 years have dramatically altered the treatment landscape, and I expect the next decade to include even bigger achievements. I’m optimistic that within my lifetime we will cure lung cancer. There is hope in the process.
Blog last updated: October 27, 2020