Lung cancer is the leading cause of cancer death among men and women. Its victims have had to battle not only the disease, but a long-standing belief that this is a self-inflicted illness.
“There’s been a big stigma because of cigarettes,” said Dr. Estelamari Rodriguez, thoracic oncologist with Mount Sinai Comprehensive Cancer Center.
Smoking is responsible for 80 to 90 percent of lung cancer cases, though most of those are former smokers, according to the Lung Cancer Alliance. Nearly 20 percent of lung cancer patients are non-smokers. Lung cancer has been the leading cancer killer of women since 1987.
“Each year, 30,000 more women die from lung cancer than breast cancer,” said Dr. Miguel A. Villalona-Calero, deputy director and chief scientific officer at Miami Cancer Institute at Baptist Health South Florida. “The message has not been conveyed well.
“The level of funding for research in lung cancer is far, far off of what it is for breast cancer,” Villalonao said. “Maybe part of the reason is smoking. But women who never smoked are getting lung cancer.”
Villalona, among other physicians and patient advocates, urges the public to drop the negative bias against smokers — as well as non-smokers who develop lung cancer — to fight a disease that’s expected to kill about 160,000 people in 2016.
There is reason for optimism in that fight, as there have been encouraging new advances in both the detection and treatment of lung cancer. With these new breakthroughs, the hope is to “change lung cancer from a death sentence to a chronic disease,” Rodriguez said.
How non-smokers get lung cancer remains a mystery — radon gas, second-hand smoke and environmental issues are considered possible causes.
Early detection is a big part of improving a patient’s chances. The National Lung Screening study, which included more than 50,000 people, “finally proved that doing CAT scans every year in higher-risk patients decreased mortality by 20 percent,” said Dr. Luis Raez, medical director of Memorial Cancer Institute. “So why is nobody doing this?”
In February 2015, the Centers for Medicare & Medicaid Services gave certain Medicare beneficiaries immediate coverage for low-dose CT scans. Patients must be between 55 and 77 years of age; show no signs or symptoms of lung cancer; have a smoking history of at least one pack a day for 30 years; and be a current smoker or have quit smoking within the past 15 years.
Cancer centers, including Memorial, also offer low-cost CT screening for $99.
“Everybody wants their cholesterol checked or their prostate or a mammogram,” Raez said. “We have few people coming in for lung cancer CT screenings, and we should be getting tons of them. We need more awareness.”
Another advance is what’s known as liquid biopsies. These tests involve extracting cancer cells or cancer DNA from the blood or urine to get genetic information about tumors that will allow physicians to choose targeted therapies. Liquid biopsies avoid a more invasive tissue biopsy procedure that needs to be repeated sometimes because “close to 20 percent of the time because there’s not enough tissue for adequate genetic testing,” Raez said.
Also, liquid biopsies can help monitor how cancer patients are responding to treatment, detect early warning signs of recurrence or mutations, and detect the first signs of cancer in healthy people.
“A healthy person is not supposed to have tumor cells in the blood,” Raez said.
Physicians and researchers are also battling lung cancer with new and promising drugs, including oral medications.
“2015 has been a great year for lung cancer research, with five new drugs approved by the FDA,” Raez said. “Three of them are targeted agents that [facilitate] the control or destruction of the tumor with minimum toxicity. They are named: necitumumab, osimertinib and alectenib.”
Targeted therapy, a more personalized approach, has been gaining traction for years. Some drugs are geared to specific gene mutations, while others block proteins that promote cancerous cells.
One of the mutations is Epidermal Growth Factor Receptor, known as EGFR, which is more common in women and non-smokers, experts said.
EGFR inhibitors can often shrink tumors for several months or more, but eventually the drugs stop working for most people, usually because the cancer cells develop another mutation in the EGFR gene, physicians said. One such mutation is known as T790M. But some newer EGFR inhibitors also work against cells with that mutation.
“Now we have a set of succession of treatment,” Villalona said. “We want to keep buying time until there are new discoveries.”
Physicians and researchers are hopeful that immunotherapy will be another effective tool for fighting lung cancer. Immunotherapy got a lot of attention recently when Jimmy Carter, who has been fighting melanoma, announced his great results using the immunotherapy treatment Keytruda, known as Pembrolizumab.
“People are asking for the Jimmy Carter drug,” Rodriguez said. The drug has primarily been used for melanoma patients.
Reaching more lung cancer patients, who might be eligible for clinical trials, is also important, physicians said. Most cancer centers are increasingly offering these trials, which can make drugs accessible to patients without having to wait three or four years for them to be approved by the FDA, Villalona said.
Memorial Sloan Kettering Cancer Center and the Miami Cancer Institute at Baptist Health South Florida recently announced an alliance to improve patient access to the latest information and care.
“Important discoveries are happening,” Villalona said. “It’s very important to advocate for patients, and for funding, so that these discoveries come in time for those who need them.”