Cedars-Sinai Magazine
Lung Cancer: Reasons for Optimism
Oncologist Navid Hafez, MD, is feeling optimistic.
"This is an exciting time for early drug development and advances in lung cancer treatment," said the director of Precision Medicine and Thoracic Oncology at The Angeles Clinic and Research Institute, an affiliate of Cedars-Sinai Cancer.
That’s particularly true when it comes to the treatment of early-stage lung cancers, he explained, before they metastasize, or spread beyond the lung.
"These are cancers we can cure. And new treatment paradigms are significantly improving our cure rates for people whose lung cancers are caught in the early stages."
For many years, a lung cancer diagnosis left little room for optimism. It’s still the number one cause of deaths by cancer. But new developments in treatment are starting to turn the tide.
"This is an exciting time for early drug development and advances in lung cancer treatment. That’s particularly true when it comes to the treatment of early-stage lung cancers. These are cancers we can cure."
The Importance of Early Detection and Screening
About 90% of people diagnosed with lung cancer during stage 1 survive past their 5-year checkup. But for those whose cancer is detected in stage 4, that number drops to about 25%.
Only about half of lung cancers are discovered before they reach stage 4.
"By the time people start having symptoms, they're often already at the late stage, locally advanced or stage 4 disease," explained Ani Balmanoukian, MD, Cedars-Sinai Cancer thoracic oncology lead at Tarzana. "That’s why screening is so important for this disease."
The good news is that routine screening is available and covered for all high-risk patients: people who smoke or with a smoking history. Unfortunately, fewer than 1% of eligible patients in California take advantage.
Cedars-Sinai has mobilized significant resources behind its Lung Cancer Screening Program. Balmanoukian said many of the early-stage patients she sees had their lung cancer detected through the program.
But Balmanoukian is also concerned about a rise in the number of her lung cancer patients who have no history of smoking. She said that mirrors trends in other countries. No one knows why these numbers have increased, though pollution is thought to be a possible contributor. Early detection for these low-risk patients has now become a significant focus of research.
Periodic CT scans are not currently recommended for low-risk patients. Private companies are instead developing blood tests to identify low-risk patients who should be screened. These tests are already available, but Balmanoukian and Hafez were unsure of their accuracy. Both doctors are looking for further development and research in this area.
Former Smokers Take Note
All primary care doctors should be sending patients who smoke for regular lung cancer screening. But this doesn’t always come up for patients who have stopped smoking and think that they are no longer at risk.
If you’re a former smoker, you may still be at high risk for lung cancer and should talk to your doctor about screening options.
Reasons for Optimism
Immunotherapy, which helps mobilize the body’s own immune system to fight cancer, has been used in late-stage lung cancer treatment for a decade. Today, oncologists are using immunotherapy as an early-stage treatment.
"It's a practice-changing development," Hafez said. "We can greatly increase cure rates by giving people immunotherapy prior to surgical removal of early-stage lung cancers."
Unfortunately, cancer can, over time, develop resistance to immunotherapy treatments. So, researchers at Cedars-Sinai are looking for mechanisms to unlock that resistance, as well as ways to refine the targeting of immunotherapy and chemotherapy treatments, even tailoring them to an individual and their particular cancer.
According to Kamya Sankar, MD, co-medical director of the Thoracic Disease Research Group at Cedars-Sinai Cancer, the use of biomarkers is helping with this effort to personalize treatment.
"We have identified certain biomarkers that predict poor prognosis and more aggressive tumor behavior," she said. "These biomarkers help identify patients with more aggressive disease who need intensified treatments or clinical trial enrollment."
In the future, Hafez said, we will also see more cellular therapies in use, in which cells themselves become a cancer-fighting tool. TIL cells, tumor infiltrating lymphocytes, are the patient’s own cells that have proven their ability to identify and attack the cancer. Lab technicians can extract a few of these cells, grow more of them in the lab, and then reinfuse them back into the patient to go after the tumor.
Similarly, Chimeric Antigen Receptor, or CAR T cells, are immune cells modified in a lab to recognize and kill specific cancers. They are already being used against blood cancers, but Hafez said they will soon become available to fight lung and other solid tumors.
"I feel very confident because there's so much happening in the pipeline now that if you're giving someone an extra three years, well, over those three years new treatments can emerge, which then can reset the clock again."
