It didn’t take long after the woman was brought to a Midwestern hospital emergency room in October 2023 for doctors to determine her prognosis was poor.
A heavy smoker for 25 years, whose name is being withheld for privacy reasons, was experiencing life-changing symptoms and battling several comorbidities. Diagnostic tests later revealed the woman had two masses on her lungs that biopsies confirmed were cancer and couldn’t be removed by surgery.
So how is it possible that less than six months after her initial diagnosis, that same woman, who is in her 60s, has no evidence of cancer with no debilitating symptoms?
In this article we’ll explore this lung cancer case study and related topics, including:
- Lung Cancer Second Opinion Leads to New Options
- Combination Treatment Started Two Days Later
- No Evidence of Disease Four Months Later
- Why Early Lung Cancer Diagnosis Is Important
- Lung Cancer Diagnosis and Treatment at City of Hope Chicago
If you or a loved one has been diagnosed with lung cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.
Lung Cancer Second Opinion Leads to New Options
When the woman entered the emergency room, she was experiencing weakness and fatigue, lightheadedness and an irregular heartbeat. She was also battling type 2 diabetes, high blood pressure, a heart murmur and anemia. Doctors learned she smoked two packs of cigarettes a day for 25 years.
A computed tomography (CT) scan of her lungs revealed two masses in the lower lobe of her left lung. A CT scan-guided biopsy determined that the large mass in her lung was a squamous cell carcinoma. The smaller tumor was an adenocarcinoma. Neither tumor could be removed surgically.
Her condition and disease required immediate treatment that she felt she was not receiving from her current care team in Ohio. So, the patient sought a second opinion and speed to care elsewhere. She landed at City of Hope® Cancer Center Chicago about a month after her initial ER visit.
By the time she had come to City of Hope, her condition had worsened considerably. She had lost 30 pounds, was using a wheelchair, was unable to eat and could not perform many of life’s daily tasks by herself.
Enter Ajaz Khan, M.D., M.B.A., C.P.E., chair of the Department of Medical Oncology at City of Hope Cancer Centers Atlanta, Chicago and Phoenix. Dr. Khan ordered a new set of tests to confirm the previous lung cancer diagnosis and stage the disease. New biopsies revealed the large tumor was stage 3a non-small cell lung cancer with affected lymph nodes. The small tumor was at stage 1. Advanced genomic testing revealed that the tumors had no actionable biomarkers, meaning there were no specific cell mutations in her tumors that could be treated with a targeted therapy.
“Typically, the first-line therapy for advanced NSCLC without targetable EGFR or ALK mutations is platinum-based chemotherapy," Dr. Khan writes in a recent Doximity article on his case study. "However, studies have shown that a combination of immunotherapy or targeted therapy with systemic chemotherapy may greatly increase the overall survival and progression-free survival for this subset of patients. In some instances, this combination treatment may also allow for a significant enough clinical response to permit a once unresectable tumor to be removed surgically."
Combination Treatment Started Two Days Later
After consulting with his patient, Dr. Khan began a treatment regimen of chemotherapy with the drugs carboplatin and paclitaxel combined with the immune checkpoint inhibitor drug pembrolizumab (Keytruda®).
Combination therapies to treat cancer are not new. Doctors have combined surgery, chemotherapy and/or radiation therapy to treat cancer for decades. In some cases, radiation or chemotherapy may be used before surgery to shrink tumors and make them easier to remove. In other cases, chemotherapy or radiation may be used after surgery to kill cancer cells that may have been left behind after an operation.
Combination therapies, in theory, are like a one-two punch against cancer. They are designed to attack multiple receptors or pathways and weaken cancer cells' ability to escape the immune system or resist treatment. The discovery of precision cancer treatments, such as targeted therapy and immunotherapy drugs, is offering researchers dozens of new combinations to explore.
Examples of treatment combinations may include:
- Immunotherapy and chemotherapy
- Radiation therapy and immunotherapy
- Targeted therapy and chemotherapy
- Radiation therapy and hormone therapy
And the list goes on. Given the vast number of drugs and therapies now available, the combinations are almost endless.
Combinations don’t always involve using different types of drugs or therapies together. Doctors may use two different chemotherapy drugs or two different immunotherapy drugs in combination to fight cancer. For instance, the checkpoint inhibitor Nivolumab (Opdivo®) targets a receptor called PD-1 while the checkpoint inhibitor ipilimumab (Yervoy®) targets the CTLA-4 receptor. Used together, the two drugs have delivered positive results for some patients with melanoma or lung cancer.
Two targeted therapies — neratinib (Nerlynx®) and trastuzumab (Herceptin®) — used together may reduce the risk of relapses in women with HER2-positive breast cancer.
As new drugs are approved to treat more cancers, new cancer therapy combinations may soon be available and produce even more durable responses.
“The new drugs and new therapies expected to come out over the next year or two are showing even higher responses than the type of immunotherapies we're giving right now,” Dr. Khan says.
No Evidence of Disease Four Months Later
Within four months, the patient responded so well, surgeons were able to remove what was left of her cancer.
Over time, her recovery became even more impressive. Her breathing improved, she was able to swallow and eat normally and her wheelchair was stowed away.
It’s important to remember that Dr. Khan’s case study, while chronicling the actual results of his patient, may not be typical, nor should it set expectations for other patients that they may experience the same results. Every cancer, just like every patient, is different and responds differently to treatments.
Still, the case also demonstrates the power of hope and perseverance and the notion that even with the most severe cases of cancer, doctors may find a treatment plan that may at least extend life and return patients’ quality of life.
Why Early Lung Cancer Diagnosis Is Important
Research clearly shows that delays in cancer care may have catastrophic consequences for patients.
After reviewing thousands of cases of the most common cancers, including lung cancer, researchers at Queen’s University at Kingston in Canada concluded that “a treatment delay of four weeks is associated with an increase in the risk of death.
For surgery, this is a 6-8% increase in the risk of death for every four-week delay.”
Speed to quality care may make a significant difference in patient outcomes. While lung cancer accounts for more cancer deaths than any other form of the disease, survival rates improve dramatically if the disease is caught early. Consider:
- The five-year survival rate for all lung cancer patients is 27%
- The five-year survival rate for patients with localized lung cancer is 64%
- The five-year survival rate for patients with metastatic lung cancer is 9%
Delays in cancer care may also result in worsening symptoms and impact a patient’s quality of life, as it did with Dr. Khan’s patient.
“She was so debilitated from her cancer,” Dr. Khan says. “She was in a wheelchair and had lost a tremendous amount of weight. Her tumor was so large she couldn’t eat. And her son was just watching his mom just wither away, which is just terrible.”
Lung Cancer Diagnosis and Treatment at City of Hope Chicago
Lung cancer is the deadliest cancer in the state of Illinois. More than 9,000 Illinoisans will be diagnosed with cancer every year and more than 5,000 will die from the disease.
Still, fewer than 7% of all eligible state residents are screened for lung cancer.
City of Hope recognizes the importance of early detection for lung cancer to catch and treat the disease early when more treatment options may lead to positive outcomes.
For those whose lung cancer has already advanced, or for patients seeking a second opinion, the Lung Cancer Center at City of Hope Chicago offers leading edge diagnostic tests and treatments for every stage of the disease, including the following.
Lung cancer screening: Low-dose CT scans are available for eligible patients who may be at high risk. The Lung Cancer Center at City of Hope Chicago is a designated Lung Cancer Screening Center™ by the American College of Radiology®.
Imaging and lab tests: These tests help pinpoint the location of a lung tumor and determine if it has any biomarkers or gene mutations that may be driving its growth.
Ion by Intuitive: This is a robotic-assisted tool that allows doctors to obtain biopsies from hard-to-reach places in the lung.
The Rapid Lung Nodule Diagnosis Program: This City of Hope program aims to determine quickly if a nodule on the lung is cancerous or benign.
If you or a loved one has been diagnosed with lung cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.