Precision Medicine: Where Are We In Lung Cancer?

-
Lung cancer is the most common cause of cancer mortality globally, responsible for nearly 1 in 5 cancer-related deaths, or an estimated 1.6 million people. In the U.S., lung cancer is by far the leading cause of cancer-related death among both men and women; more deaths are caused by lung cancer every year than by breast, prostate, and colon cancer combined.  But after years of modest growth in new treatment options, there is much cause for hope. In 2015, the FDA approved six new drugs for the treatment of lung cancer—a one-year record – including two new immunotherapy drugs, nivolumab (Opdivo®) and pembrolizumab (Keytruda®). These approvals were landmark events for the treatment of lung cancer in 2015.

And the scientific evidence is accumulating that genomic testing and targeted therapies for lung cancer patients, particularly those who have advanced, or metastatic non-small cell lung cancer (NSCLC) make a significant difference in outcomes.  The most useful biomarkers for predicting the efficacy of targeted therapy in advanced NSCLC are genomic alterations called "driver mutations”.  Genomic tests for driver mutations have become an increasingly standard part of the diagnostic work-up for NSCLC patients, and the testing is useful in choosing whether a patient receives chemotherapy (if there is not a targetable driver mutation) or an FDA-approved targeted therapy up-front.  The best characterized of these biomarkers are epidermal growth factor receptor (EGFR) mutations and (anaplastic lymphoma kinase) ALK translocation. Identification of these biomarkers has led to highly targeted treatments that have resulted in major advances in prolonging survival - without the harsh side effects of chemotherapy. Patients with specific genetic mutations may benefit from targeted therapies such as the EGFR blockers erlotinib (Tarceva®), afatinib (Gilotrif®), and gefitinib (Iressa®), to name a few.
Lung cancer treatments are advancing so fast that it’s important to get tested to find out if a patient has an identifiable mutation. Patients with advanced NSCLC, and their caregivers need to have the conversation with their care team about getting tested and understand the abnormality that is causing the cancer. If a therapy exists patients are having good outcomes. If there is not a targetable mutation, patients can find clinical trials that may help prolong life. Not every driver has an effective treatment, but according to the LCMC II study nearly 60% of NSCLC adenocarcinoma patients are likely to have a driver gene that can be targeted with approved drugs or those in a clinical trial. This is amazing progress in lung cancer treatment, and made possible by cancer research. The basic research done 10 years ago is leading to breakthroughs today. It’s why I support the vision of the #CancerMoonshot program’s aim “to make a decade worth of advances in cancer prevention, diagnosis and treatment in five years."
A recent article by Dr. Lecia Sequist (Associate Professor of Medicine, Harvard Medical School) and Dr. Joel  Neal (Assistant Professor of Medicine–Oncology, Stanford University/ Stanford Cancer Institute) shares good information about the professional medical organizations that recommend analyzing either the primary NSCLC cancer tumor or a metastatic tumor for EGFR and ALK, regardless of patient characteristics (such as age, race, or smoking history). And The National Comprehensive Cancer Network guidelines for metastatic non-small cell lung cancer strongly recommend testing for alterations in EGFR, ALK, and ROS1 genes, as well a broader genomic panel to look for driver genes that might have clinical trials available. In this shifting landscape in lung cancer treatment, molecular testing may identify a targeted treatment, or help find a clinical trial. Patients need to be their own health care advocates.
#CancerResearchEvangelist

Popular posts from this blog

A Bowl of Gratitude

-
Image
I was introduced recently to Lynne Sarnoff-Christensen by her cousin, and my friend Jeffrey Cohen. You see, she makes pottery and well, more specifically she make “bowls of gratitude”. So of course, Jeffrey knew that I would hit it off with Lynne because he knows I live a life full of gratitude. Another friend, Keith Spiro said I just had to buy a bowl – so I did. The idea is to put notes in the bowl about things you are grateful for. So it’s my new thing. I’ve long been a fan of Shawn Achor and I’ve gotten into the habit of writing down things that I am grateful for. So this bowl of gratitude will be where I put my notes. And I will encourage my family to also add their notes to the bowl. We have a tradition on Thanksgiving to go around the table before we dig in to our meal, to share what we are thankful for. We shouldn’t just do this at Thanksgiving! When I called Lynne, she explained her philosophy and I get it: “You didn’t get from there to here without people believ...
Read more

The Power of Community: The White Ribbon Project

-
Image
The Greek meaning of evangelist is "bringing the good news." It's why I call my podcast the Research Evangelist Podcast. I love to share stories about people in life sciences who are doing amazing work to advance cancer research. And it's why The White Ribbon Project has captured my attention. The White Ribbon Project is a grassroots movement of lung cancer patients, advocates, clinicians, researchers friends and families with a mission to change the public perception of lung cancer by spreading awareness that anyone with lungs can get lung cancer. No one deserves lung cancer whether you smoked or not. But lung cancer is not just a smokers disease, as more and more people are getting lung cancer with no smoking history. The White Ribbon Project is proving that the power of a community that cares can be unleashed by individuals who wanted to make a difference - people that didn't set out to start a movement. It's because their story is so sincere and authentic...
Read more

Time to Move Beyond the Ribbons?

-
This past week, I had the pleasure of meeting Massachusetts Senator Ed Markey and Harvard Medical School Professor of Genetics, Dr. Fred Alt. They were both in Washington, DC for the presentation of the 2015 NFCR Szent-Györgyi Prize for Progress in Cancer Research, which was awarded to Dr. Alt and keynoted by Sen. Markey.   The common theme I heard from both of these distinguished leaders was captured in a Huffington Post article written by Sam Stein , who attended the event . Stein succinctly wrote that “U.S. Science has never been more imperiled”. He noted that the lack of funding for basic scientific research not only prevents new discoveries, but it also means that we are losing promising scientists whose work can’t get funded.    10 years ago, nearly a third of qualified research was funded by NIH.   Now that number is only 14% (actually even lower for oncology, near 9%).   As Sen. Markey said, “sadly, support for scientific research in our countr...
Read more