December 23, 2015 | by Veronique de Turenne
After years of modest gains in the field of lung cancer, the leading cause of cancer-related deaths throughout the world, doctors and researchers say significant advances in treatment and screening practices point to very good news in 2016.
Here, we speak with two of City of Hope’s renowned lung cancer specialists, Karen Reckamp, M.D., and Dan Raz, M.D., co-directors of the Lung Cancer and Thoracic Oncology Program. They answer five questions about what they expect to see in lung cancer treatment and research in the coming year.
Reckamp, a thoracic oncologist who joined City of Hope in 2007, was recently named medical director for clinical research operations. She also serves as medical chair of the scientific review board, and takes part choosing and reviewing clinical trials at the medical center.
Raz, a thoracic surgeon and an assistant professor in the Division of Thoracic Surgery, recently received the V Scholar Award from the V Foundation for Cancer Research, which recognizes rising stars in the cancer field. Raz specializes in esophageal and lung cancer surgery, and is a vocal advocate for lung cancer screening for at-risk individuals.
1. What treatment advances do you expect for lung cancer patients in 2016?
The new targeted therapies are Portrazza (necitumumab), Tagrisso (osimertinib), and Alecensa (alectinib), which identify and attack cancer cells, usually while doing minimal damage to normal cells. The immunotherapy drug, Keytuda (pembrolizumab), made headlines recently when former US President Jimmy Carter announced he was cancer-free after four months of treatment with the immunotherapy drug for metastatic melanoma.
“The other advance we expect to see is a furthering of our understanding of how the immune system works in lung cancer, and using that information to improve on existing therapies,” Reckamp said.
Raz, a longtime proponent of regular screening for those at risk of lung cancer, expects to see increasing use of this vital diagnostic tool.
“Lung cancer screening is effective at preventing lung cancer death in high-risk patients, but is severely underutilized,” Raz said. “There will likely be additional information on broadening the screening criteria to include people with lighter smoking history than what is currently recommended, based on several ongoing lung cancer screening trials.”
Clinical trials presently underway for patients with early-stage lung cancer are quite promising, Raz said.
“These include trials of limited surgery for small lung cancers, stereotactic radiation for small lung cancers, and targeted therapies for locally advanced lung cancers after completing standard therapies,” he said.
2. How significant is that?
The approval of the immunotherapy drug, Keytuda, for use in lung cancer treatment is “highly significant,” Reckamp said.
“Lung cancer has been thought to not be immunogenic, and the fact is that it has now been shown that immunotherapy works and helps to shrink tumors and to improve survival rates,” Reckamp said. “In some cases, immunotherapy has been shown to be better than chemotherapy for lung cancer.”
The increase in the use of annual screening means that lung cancer, most often diagnosed when the disease has advanced, can now be caught at an earlier and more treatable stage, Raz said. This will lead to a change in surgical procedures.
“As we detect small lung cancer with lung cancer screening, we also need to change the way we treat lung cancer by performing minimally invasive surgery, and sparing lung tissue when appropriate,” Raz said.
3. How will this improve the patient experience or patient outcomes?
Lung cancer screening, which leads to early detection, saves lives and eliminates much of the pain and suffering related to lung cancer treatment, Raz said.
“By using minimally invasive techniques and lung sparing techniques, recovery is faster and quality of life is better for lung cancer survivors,” he said.
For those diagnosed with a later stage of the disease, advances in immunotherapy mean a patient’s own immune system is enlisted in the fight, Reckamp said.
“Each tumor is unique and each immune system is unique so we are working on the ultimate personalized therapy,” she said. “We are seeing patients live longer and with a better quality of life than ever before, and these are the ultimate goals.”
4. What research progress do you expect in 2016?
“To help identify the biology of a tumor, we often have to do a lot of biopsies, which can be very challenging for the patient,” Reckamp said. “We are now working toward understanding lung cancer biomarkers that may be present in the patient’s blood or urine. This would lead to a kind of liquid biopsy, and help in the work on targeted treatments and immunotherapies.”
Raz foresees a wider push in lung cancer screening awareness in the U.S.
“We are working to make lung cancer screening more available, and are studying the barriers to adoption of lung cancer screening,” he said.
5. Overall, where is the field of lung cancer treatment and research moving?
In early-stage lung cancer, Raz expects to see increased detection thanks to regular screenings, as well as minimally invasive surgery and lung-sparing surgery.
For lung cancer caught at a later stage, Reckamp expects advances in treatments that are less toxic to the patient. Thanks to recent breakthroughs in understanding the biology of individual lung cancer tumors, she sees treatment becoming more efficient.
“We are getting an understanding that every lung cancer is unique,” Reckamp said. “We are moving toward being better able to have precision medicine for each tumor and each patient – very personal treatment with less toxicity and with improved outcomes.”
The most exciting thing about these advances in screening and treatment?
“At some point, lung cancer may become a chronic disease,” Reckamp said.
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