Moving the Goalposts on Lung Cancer Survival

Lung cancer kills more Americans than the next three cancers—breast, colon and prostate—combined.

Despite the sometimes dramatic improvements that have been made in other cancers, lung cancer survival has only slightly improved over the past several decades. Fortunately, that’s beginning to change, as a small number of comprehensive lung cancer programs are creating breakthroughs, advances and new hope.

“We’re at an inflection point in lung cancer survival,” explains Daniel Oh, MD, medical director of the hospital’s Center for Thoracic Diseases, whose expertise in robot-assisted lung cancer surgery made Providence St. Jude one of the nation’s first centers of excellence in the groundbreaking technique. “Our progress in treating lung cancer—early detection and targeted therapies that attack cancer on a molecular level—is how we are creating meaningful advances in survival.”

With few, if any, symptoms in its early stages, lung cancer is often diagnosed at stage III or IV, 
meaning the cancer has already spread. The hospital’s Lung Cancer Screening Program is designed to make low-dose CT scans—the gold standard for detecting lung cancer at its earliest and most curable stage—convenient and easy. 

For those most at risk—former and current smokers—the screening is covered by insurance, yet nationally, only about 6% of those eligible have gotten a low-dose CT scan. Compare that with breast cancer screening, where more than 80% of eligible women have had a mammogram in the past two years.

“Screening is how we shift lung cancer diagnoses from stage IV to stage I,” explains Dr. Oh, a Harvard-trained thoracic surgeon. “It can be the difference between a survival measured in months and one measured in decades.” 

Who should be screened?
Longtime or heavy smokers between the ages of 50 and 80 are urged to consider a low-dose CT scan, even if you quit decades ago. Previous recommendations from the American Cancer 
Society excluded those who quit smoking more than 15 years ago, a restriction that was dropped after data showed that, while former smokers’ risk decreases over time, when compared with never-smokers, their risk remains three times greater even 20 or 30 years after quitting. 

The new guidelines apply to anyone who has smoked more than 20 so-called pack-years, 
the equivalent of a pack a day for 20 years or two packs a day for 10 years. “For example, 
a 60-year-old who quit at 42 after smoking two packs a day for over a decade should be screened,” Dr. Oh says.

Targeting cancer on a molecular level
The hospital’s cancer experts are also helping move the goalposts on survivability of 
later-stage lung cancers. Dozens of clinical trials at the hospital have helped bring new immunotherapies and molecularly targeted “missiles”—designed to identify and attack a cancer’s specific genetic markers—to the treatment of lung cancer.

One example of a targeted therapy generating enormous excitement is lorlatinib, a once-a-day tablet designed to attack cancer cells expressing the ALK protein. In a five-year study, lorlatinib 
stopped the cancer from spreading in 60% of patients, including just over half of patients whose cancer had already spread to the brain before the trial began—an unprecedented outcome. “It’s the longest progression-free survival ever reported for a lung cancer treatment,” explains Yung 
Lyou, MD, medical oncologist, who helps lead the hospital’s research program. “The 
potential for this line of research and treatment is enormous.”

To learn more about low-dose CT screening and whether you qualify, speak with your physician. To learn more about current lung cancer clinical trials, call 714-446-5177.

Getting an Assist from Robotics: Changing the Way Lung Cancer Is Diagnosed

An obstacle to accurately diagnosing lung cancer early is the risks and limitations of current biopsy techniques, which involve guiding a needle through the chest wall to obtain a sample of the suspicious lung nodule. 

Limitations like impossible-to-reach nodules in the outer third the lung—where most cancerous nodules are located—or testing only one of several nodules because of the risks of needle biopsies, often frustrate efforts to give patients answers. 

At Providence St. Jude, a leading-edge robotic system, called Ion, eliminates those weaknesses, offering the hospital’s lung cancer experts an invaluable new tool: robot-assisted bronchoscopy.

“Ion allows us, for the first time, to find and biopsy lesions in all 18 segments of the lung,” explains Julie Yoo, MD, a triple board-certified pulmonologist, who says the minimally invasive technique—which inserts an ultrathin catheter through the mouth—allows faster, more accurate diagnoses as well as fewer complications than with traditional biopsy techniques. “It makes testing a nodule simpler and much safer, even when those nodules are very small and 
located in difficult-to-reach areas.” 

The robotic platform uses advanced mapping techniques, 3D imaging and shape-sensing technology to identify and navigate the safest route through the lung. The precision and dexterity of the robotic arm—far exceeding that of a human hand—permits doctors to direct a catheter around tiny bends and curves in the airways, reaching nodules previously considered inaccessible. 

Meanwhile, real-time guidance from a hospital pathologist on whether the biopsy sample is adequate and, if so, whether cancer is present eliminates the need for additional procedures. With CT-guided biopsies—the most common technique used today—many patients require multiple biopsies and another procedure to stage the cancer, delaying care by weeks.

“We’re changing that,” explains Dr. Yoo, who says a wait-and-see approach for nodules that couldn’t be biopsied because of their size or location is no longer the only or best option. 
“Patients now have the convenience and peace of mind of getting the answers they need after 
a single minimally invasive procedure.”