Hope on the Horizon: New Advancements in Lung Cancer Treatment

Lung cancer is the third most common type of cancer and the leading cause of cancer-related deaths in the US. Thomas Guerrero-Garcia, MD, a board-certified medical oncologist and hematologist with the Phelps Health Delbert Day Cancer Institute (DDCI), discusses new approaches to lung cancer treatment.

Traditional treatment and beyond

At the DDCI, our cancer care team offers a variety of treatment options for lung cancer. Patients whose cancer is resectable – meaning it can be surgically removed – would first talk to one of our surgeons. So, surgery is one option for some patients.

Our medical oncology team delivers different types of cancer therapies. Gone are the days where chemotherapy was our only option. Today, we also have targeted therapy and immunotherapy; we're finding more ways of treating cancer. We talk with our radiation oncologists about how to treat a particular lung cancer, and often, we take a multidisciplinary team approach. Our team will discuss various ways of delivering lung cancer therapy and then proceed with the best pathway for that particular patient.

Bottom line: Every patient is different in terms of their potential treatment options, but lung cancer treatment can include surgery, radiation, chemotherapy, immunotherapy or the newer, more targeted therapy.

New developments in lung cancer research

Immunotherapy treatment uses certain parts of a person’s immune system to fight diseases such as cancer. Immunotherapy was first used in stage 4 cancers but is now being incorporated all the way down to stage 1 cancers. The goal is to find new therapies that work better than just chemotherapy alone. It's not that chemotherapy doesn't work, or that it’s out of the picture, but we are seeing better cancer outcomes when combining immunotherapy with chemotherapy. Two major studies support this finding, and we take this approach, as well. Our surgeons also are calling us more about giving these therapies first for resectable patients, given the findings of the research.

In another landmark study, researchers were studying lung cancer patients, post-surgery. Researchers have been asking, “Can we do something other than chemotherapy?” Multiple studies say that immunotherapy, or another type of treatment called targeted therapy, also can be given to patients in the early stages of lung cancer.

Cancer biomarkers

Cancer biomarkers are biological molecules produced by the body or tumor in a person with cancer. Biomarker testing helps characterize alterations in the tumor. When cancer grows, it has a particular way of growing. If we identify that pathway, and we have a drug for that pathway, we shut down cancer by actually targeting that pathway. Biomarkers are extremely specific and not considered chemotherapy. We examine these biomarkers after lung cancer surgery.

Research began with checking biomarkers in later stages of lung cancer. Now, the field is rapidly moving to the early stages, where we are treating these biomarkers in an individualized way. Once biomarkers are identified, the next step is to determine if any of the alterations are actionable – that is, whether there’s a genetic change driving tumor growth that can be targeted with an FDA-approved, available drug. Biomarkers are definitely changing how we treat lung cancer.

Immunotherapy and immune checkpoint inhibitors

An important part of the immune system is its ability to distinguish between normal cells in the body and those it sees as “foreign” (such as germs and cancer cells). This allows the immune system to attack the foreign cells while leaving normal cells alone.

The immune system makes this distinction by using “checkpoint” proteins on immune cells. The checkpoints act like switches that need to be turned on or off to start an immune response. However, cancer cells sometimes find ways to use these checkpoints to avoid being attacked by the immune system; cancer is clever in this way. Medicines can be designed to target these checkpoint proteins. These drugs are called immune checkpoint inhibitors (or checkpoint inhibitors).

Immunotherapy is a new way of treating cancer across the board (not just lung cancer), and it’s effectively working in the early and advanced stages.

Does immunotherapy cure lung cancer? No, immunotherapy isn’t currently perceived as a cancer cure, but it is prolonging life and changing outcomes for many patients. We are seeing some remarkable responses that we've never seen before. You can find a lot of positive stories about immunotherapy online. On the flip side, you’ll find negative accounts, but overall, immunotherapy represents an excellent option in terms of other lung cancer treatment options.

New targeted therapies

We’ve started checking for particular driver mutations against genetic abnormalities inside a cancer cell. (A driver mutation is a change in the DNA sequence of genes that cause cells to become cancer cells and grow and spread in the body.) We find these genetic abnormalities and target them with specific drugs. Now, this is not something new. We have been doing this for over a decade, but we started with the discovery of one genetic driver mutation in lung cancer, which was EGFR (epidermal growth factor receptor.) So, we targeted that particular mutation. EGFR is a protein on cells that helps them grow. A mutation in the gene for EGFR can make it grow too much, which can cause cancer.

For example, we may tell a patient, "Your lung cancer is not growing because of your smoking history, but because of this driver mutation called EGFR." At the DDCI, we're expanding that testing to search for multiple mutations, to try to target the pathway(s) with these therapies.

Most of these new therapies are oral medications (pills), as opposed to IV (intravenous) therapy or infusions. So, now we're treating lung cancer with a pill, something that was not happening in decades past. And there are many different medications out there. It's another area of research that is expanding with the discovery of new mutations, which is really exciting.

Whether you have stage 1, 2, 3 or 4 lung cancer, we need to check your biomarkers. We need to see what the cancer is telling us and then approach it in specific, targeted ways.

Cutting-edge treatments, close to home

We are fortunate to have these new targeted therapies and treatment options available at the DDCI in Rolla. We have the FDA-approved drugs, and patients are taking them. No drug, of course, is without side effects, but these medications seem to be well-tolerated overall. And they’re effective. For example, the response rate of one of the therapies that targets the EGFR has a response rate of over 85%.

Clinical trials for lung cancer

Clinical trials are another way of treating cancer and can be extremely effective. The DDCI offers clinical trials for lung cancer, which is exciting in a town of just over 20,000 people. While we are not the largest cancer center in the state, we do offer clinical cancer trials and ones specific to lung cancer. We continue to expand our clinical trials. Patients have to first meet stringent criteria. At the DDCI, we have a team solely dedicated to screening patients for trials. This team helps patients select the best trial for them and navigate their way through the trial. Our team also stays on top of the latest research, to bring to our attention to other trials that we could potentially offer our patients.

At the DDCI, we look beyond what's currently available in the community and FDA approved, to experimental trials, as well. (You might expect to have to travel to larger cities for these trials, but we have them locally.) While clinical trials are not right for everyone, we work hard to determine which trials are best suited to which patients.