Talking Hope: The changing lung cancer story: What you need to know

Darrin Godin: Hello everybody and welcome to Talking Hope. I'm Darrin Godin and I'm pleased to be speaking with Dr. Jyoti Malhotra. She's the director of thoracic medical oncology at City of Hope, Orange County. Dr. Malhotra specializes in caring for patients with lung cancer and other thoracic malignancies. Her research interest involve precision medicine and experimental therapeutics, and she has led multiple phase one trials investigating novel agents and combination therapies for cancer. Dr. Malhotra, thank you so much for joining us on the podcast today.

Dr. Malhotra: Thank you for inviting me.

Darrin Godin: Today, the focus of our discussion is going to be on how the lung cancer story is changing and how it's really all about hope. So why don't we start with what are the most important things people need to know about the changing lung cancer story?

Dr. Malhotra: That's a great question, Darrin. The lung cancer story is really changing very fast. We are discovering and bringing newer therapies for patients in the clinic, and the outcomes for patients with lung cancer have significantly improved. So now there is a lot of hope for patients who are diagnosed with lung cancer even when it is advanced lung cancer, and we have been trying to help all these patients at the City of Hope Orange County by making more trials accessible to patients by incorporating precision medicine and immunotherapeutics in the treatment plans, and also supporting our patients by using all the other supportive care services that we have.

Darrin Godin: Well, that's exciting. So the biggest takeaway I heard you saying is that we are getting better at treating it and we're giving people more hope for living longer, even if they're more in advanced stages. That's exciting. It's a personal thing for me as well. My grandfather passed away of lung cancer when I was a teenager in high school, and I think about him all the time working here at City of Hope. So that's very exciting news. I'm glad you're sharing that. So what is most important for people who think they may have something going on in their lungs? What should they do?

Dr. Malhotra: The most important thing is to get evaluated as quickly as possible. Connect with your primary care physician. Go seek either a first or a second opinion at a comprehensive cancer center. Seek an expert who can really guide you through the initial diagnostic procedures so that you can get started on the appropriate treatment as quickly as possible. The other thing is to understand that with all these newer therapies getting approved and being available for patients, it's really important to work with the multidisciplinary team of experts so you can get access to all these new therapies such as surgical techniques, radiation oncology, immunotherapies, precision medicine-based therapies very quickly.

Darrin Godin: The precision medicine and immunotherapy you're talking about, I know those are your areas of research of interest as well. So can you tell us a little bit more. What exactly is precision medicine and what is immunotherapy? How are the two of those coming together in the lab or in the clinic to benefit patients with cancer?

Dr. Malhotra: So that's a great question. In the last decade or so, we have made a lot of headway in understanding how lung cancer develops and evolves. So our approach at City of Hope is to understand what is driving the tumor for each patient. So we use precision medicine by identifying exactly what changes or what mutations are there in each patient's tumor, and then tailor our treatment plan using that information so that we are using a treatment plan for each patient that's really tailored to their specific lung cancer and using that approach, we are really able to match patients with the appropriate targeted therapies or immunotherapies, and they have really worked very well for many of our patients.

Darrin Godin: Thank you for that. How big of a problem is lung cancer in Orange County?

Dr. Malhotra: In Orange County, we have lower smoking rates, but lung cancer is a cancer that can develop in anyone who has lungs, and we are seeing more and more patients being diagnosed even when they do not have a significant smoking history in the past. Therefore, any patient who develops any symptoms such as cough or shortness of breath should definitely get it evaluated and patients who have smoking history should follow up regularly for lung cancer screening. This is a cancer which if not treated appropriately, can be a serious condition and therefore it needs to be taken urgently, in terms of working up any symptoms.

Darrin Godin: Are there populations that have a higher level of lung cancer or propensity for lung cancer, and are there perhaps barriers for them in seeking specialized care?

Dr. Malhotra: So historically, lung cancer has been a disease which has been associated with smoking, and we see in the past that almost all of the patients diagnosed were those with smoking history. So that definitely continues to be a risk factor. However, in recent years, we are seeing more and more patients developing lung cancer, especially patients from Asian ethnicity or backgrounds, which even though when they do not have a smoking history are at increased risk for lung cancer, and we are doing our best to reach out to all these communities in Orange County and leverage our resources to really get the message across that any lung symptoms need to be evaluated even when there is not a prior history of smoking or there is no prior history of exposure to any chemicals or carcinogens.

Darrin Godin: So to educate those who may not know they're at risk. You've talked about smoking, so what are some of the other risk factors for lung cancer?

Dr. Malhotra: So in addition to smoking, there are a number of other chemicals or exposures which can lead to lung cancer, such as asbestos and radon. Air pollution is also a significant factor, and then there are factors such as age because we know that as the age advances the risk for lung cancer increases and then family history can also play a role.

Darrin Godin: Here in Orange County, we recently had a fire of a historic hangar in Tustin area and they closed down a lot of local schools and so forth because of exposure to asbestos and other heavy metals. Dr. Malhotra, is it a one-time exposure for people that could lead to this or is it more of a continued exposure? Should people be concerned with the recent fire and the stuff that was put into the air?

Dr. Malhotra: Well that is something we are still trying to learn. For smoking, we know that the exposure needs to be continuous and long-term and then some chemicals such as asbestos, even a one-time exposure can be carcinogenic and as we do not understand in detail the composition of air pollution or for example, the incident that you mentioned. The best way is to try to be vigilant and pay attention to any symptoms that may arise or linger on, as well as try to avoid exposure as much as possible.

Darrin Godin: Thank you for that. We ask this question of all our guests who come on the show, and I'm wondering from your perspective as a physician and as an oncologist, what does hope or the concept of hope mean to you?

Dr. Malhotra: The concept of hope for me means that we go above and beyond of what we have done in the past and try to help our patients by getting the best treatments available to them in a speedy manner. There have been more than 25 new drugs approved for lung cancer within the last five to 10 years. So there is definitely hope at the end of their tunnel. Patients are living longer. Patients have good quality of life when they are on many of these treatments. So I think we are going in the right direction in terms of our research, in terms of our patient care efforts, and we just have to keep on doing that.

Darrin Godin: And what are some of the things you're excited about right now in the area of clinical trials or research related to lung cancer?

Dr. Malhotra: So there is a lot of new developments ongoing. One is immunotherapy. So we are developing newer and newer immunotherapies, which are leveraging the patient's own immune system to kill the cancer and we are looking and exploring different ways of doing that. So there is a lot of new immunotherapies that are being developed and the good thing is that with immunotherapy, the responses are very long-lasting and therefore they can be very effective ways of controlling the cancer. So that is really very exciting.

Darrin Godin: So the changing story is there's a lot more coming out that is helping patients not only defeat the cancer but live longer and really survive. That's exciting.

Dr. Malhotra: Exactly, and I think there is a lot of ways we can help our lung cancer patients, and that's what we are trying to do at City of Hope Orange County, and we are a team and we have a lot of experts and then more importantly, we try to offer clinical trials to all our patients tailored very specifically to their tumor type and to their prior history, and it is really exciting to work together with a great team and make a difference.

Darrin Godin: We're so glad that you're a part of that team. What is your message today to our listeners?

Dr. Malhotra: So my message will be do not ignore any symptoms. Seek help, seek urgent care with your doctors, seek care with an expert or with a comprehensive cancer center if you are diagnosed with lung cancer, and the best way to treat lung cancer is to prevent it. So no smoking and if you have smoked in the past, make sure you're getting lung cancer screening regularly.

Darrin Godin: Awesome. Thank you so much for your time today, Dr. Malhotra, and thank you for the care and the great service that you provide all of our patients. We hear so many good things about you and the care that you do provide and we're excited that you're part of that comprehensive team that we have and thank you all for listening today to Talking Hope and we hope that you'll join us on our next episode. Have a great day.