New screening guidelines and improvements in diagnostics and treatment have improved outcomes in lung cancer.
Written by: Julie Cole Miller
Media contact: Bob Shepard
While lung cancer remains the leading cause of cancer deaths in the nation, doctors at the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham want patients to know about advances in diagnostic technologies and treatments, as well as the new screening guidelines, giving lung cancer patients more hope than ever.
“We’ve come a long way,” said Maya Khalil, MD, associate scientist at the O’Neal Comprehensive Cancer Center and assistant professor of medicine at the UAB Marnix E. Heersink School of Medicine Division of Hematology and Oncology. “Our options are no longer the same for everyone. We now learn a lot about the cancer biology of the specific patient in front of us to know how best to treat it. No two patients are truly the same.
Lung cancer is a particularly deadly form of cancer. There are two main types: non-small cell lung cancer, which makes up the majority of all lung cancers, and small cell lung cancer, which is the more aggressive form. Risk factors may include smoking, a family history of lung cancer, or exposure to carcinogens. In some less common cases, people can develop lung cancer without any of the known risk factors.
In 2022, the American Cancer Society estimates there will be approximately 236,740 new cases of lung cancer. The five-year survival rate depends on the stage of the disease. Early diagnosis and treatment are essential.
The latest therapies
“Fifteen years ago, everyone had chemotherapy,” Khalil said. “But over the past five to seven years, immune therapy has come to the forefront.”
Immune therapy involves infusions of antibodies designed to activate the patient’s immune system to kill cancer cells. This is now one of the mainstays of lung cancer treatment, particularly in the metastatic setting. This type of therapy can also occur before or after surgical removal of the cancer, usually in combination with or after chemotherapy. Immune therapies are generally more tolerable and less toxic to the patient.
For some patients who fail to respond to immune therapy, doctors may now be able to change the biology of their cancer cells to make them more likely to respond, usually by using new therapies in clinical trials.
Equally important, there are targeted therapies that seek out and block certain pathways that drive cancer growth caused by genetic mutations in cancer cells. This involves precision medicine, or highly specialized pills, which target specific proteins in cancer cells and inhibit their otherwise uncontrolled division and growth. There are many new generations of these drugs with many different targets. Khalil says he has treated patients who have been living with metastatic cancer for five, six and seven years with these targeted therapies.
“The options available to us today have changed the prognosis for lung cancer,” he said. “What is critical is performing molecular or genetic testing of cancer tissue from patients presenting with metastatic lung cancer to identify these drivers early.”
The role of clinical trials
“This is how UAB is moving the needle on cancer. It is very dear to my heart,” Khalil. Together with her colleague Aparna Hegde, MD, an associate scientist at O’Neal Comprehensive Cancer Center, she has been looking to expand the portfolio of studies to allow for testing options for nearly every patient who comes to their clinic.
“Clinical trials are how we achieved these therapeutic advances — advances that are now standard of care,” Khalil said. “They didn’t come out of the vacuum. We test new therapies with clinical trials, and in addition to moving the needle, they allow us to have these therapies available sooner for our patients.
If patients are concerned about taking part in clinical research, Khalil reassures them that their care is complete.
“We follow these patients rigorously,” he said. “There is a team of coordinators, nurses and others who take any symptoms seriously. It is very careful monitoring: we want to identify side effects early to reverse them and minimize any complications due to a new drug and maximize safety for our patients in these studies.
Patients from across the state or in surrounding states can be referred to O’Neal Comprehensive Cancer Center to participate in clinical trials. In many of these cases, the patient trial is managed at the UAB with regular communication and collaboration with the community oncologist at home. Upon exiting the study, patients typically continue their treatment pathway with standard therapies with their primary oncologist.
As a result of the results of the last decade’s National Lung Screening Trial, in which UAB physicians participated, physicians can recommend screening for patients who are asymptomatic but meet certain criteria.
“There is no blood test or swab to check for lung cancer,” said Nina Terry, MD, a professor in the Department of Radiology. “It’s along the lines of breast cancer. You have to get the picture. If you wait until you have symptoms, the likelihood that you have something incurable is high.
Screening recommendations include low-dose computed tomography for patients aged 50 to 80 (or 50 to 77 if the patient is covered by Medicare), have a history of smoking 20 packs per year and are current smokers or quit less than 15 years ago. Because the CT scan is a low-dose scan, it can be done every year. If a lung nodule that needs closer monitoring is identified, more frequent scans may be warranted, as well as a biopsy if it’s suspicious enough.
National study researchers reported a 20 percent reduction in mortality with screening, which brought up to today’s standards.
Effective screening requires a degree of nuance in which UAB radiologists specialize.
“Our radiologists are full-time chest radiologists. That’s all we do,” said Terry of UAB Medicine specialists. “And we know that if we detect it when it’s localized, our patients get better outcomes.”
Evaluation of biopsies
When an abnormality is found on a CT scan, an interventional pulmonologist will biopsy the suspicious lump. Aline Zouk, MD, assistant professor specializing in interventional pulmonology in the Department of Medicine Division of Pulmonary, Allergology, and Critical Care Medicine, says there are different types of biopsy techniques; but the new robotic bronchoscopy allows UAB doctors to get answers in a less invasive way, a way that allows patients to go home in just over an hour after surgery. A state-of-the-art portable cone beam CT is used during the procedure, providing a high degree of accuracy during the biopsy. In many cases, it allows for a high yield from biopsies on tiny nodules, which was not possible a few years ago.
UAB Medicine physicians also participate in a weekly cancer council, a panel of specialists — including medical and radiation oncologists, thoracic surgeons, interventional pulmonologists, radiologists, and pathologists — who impart the treatment plan and specific nuances of the patient scenarios they they are lifted.
“We all work closely together as colleagues,” Zouk said. “It’s a good working relationship that benefits patients as we evaluate their path forward.”
The importance of early diagnosis or, better still, prevention
Lung cancer is the leading cause of cancer deaths in Alabama, with more deaths occurring each year than deaths from breast, colorectal and prostate cancer combined. Alabama has a particularly low survival rate, something doctors and researchers at O’Neal Comprehensive Cancer Center hope to improve.
“Prevention – this is the most important piece of this puzzle,” said Zouk. “That and screening. What we’re trying to do is shift the timeline, to diagnose this cancer at an early stage. We know that, when it’s local, patients have a much higher survival rate.”
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Schedule an appointment with the doctors at UAB’s O’Neal Comprehensive Cancer Center.