Treating Advanced Lung Cancer

Dr. Subari: There are two major subtypes of lung cancer. The most common one is non-small cell lung cancer, and the second type of lung cancer that we see is a lot less common and is a more aggressive subtype called small cell lung cancer. Dr. G: We don't do surgery for small cell lung cancer. Usually, it's a combination of chemotherapy and radiation. Dr. Kazmi: Non-small cell lung cancer, if the cancer is early stage, surgery is the mainstay of the therapy. If, however, it's more advanced, sometimes surgery is not enough. When a cancer is metastatic, patients need systemic treatments, such as chemotherapy, immunotherapy, or targeted therapy. Dr. G: Targeted therapy is based on the idea that there are specific gene mutations that drive a person's cancer. If we can figure out what those gene drivers are for that particular patient's cancer, we can then find a drug that can then target that gene mutation. Dr. Rohs: One of the really nice things about these pills is that they are well-tolerated and they can get to disease that other treatments can't get to. Dr. Subari: If we're not able to identify a genetic abnormality that we can match with a pill, we're then going to talk to you about chemotherapy and/or immunotherapy. The way that we decide which one to use depends on something called PD-L1 that sits on the surface of the cancer cell, and if you have a high level of this PD-L1, we generally recommend immunotherapy first, and if a person has a low level, we're going to recommend chemotherapy and immunotherapy as the first treatment option. Dr. G: Chemotherapy is treatment basically that kills cancer cells, but it also kills the good cells. Dr. Kazmi: Chemotherapy tends to work really well for certain cancers. However, it has side effects on the body in terms of the blood counts, the hair, the weakness, so it's not a long-term, sustainable plan. Dr. Lackey: The newest evolution of therapy is what's called immunotherapy. Our immune system is probably the best tool we have to keep our bodies healthy. Question always was, why can't the person's immune system fight off the cancer? Dr. Subari: Cancer is able to fool the immune system to prevent it from recognizing it. With immunotherapy, we're able to move the disguise, remove the brakes from the immune system, to then allow the immune system to better recognize and attack the cancer. Dr. Kazmi: Immunotherapy comes in a variety of forms. The most common of these are called checkpoint inhibitors or PD-L1 inhibitors. They are the drugs that turn on the immune system and turn your T-cells on to go and attack cancer. Dr. Rohs: Immune therapy, one of the most amazing parts of it is that it's very tolerable. Many patients don't have many side effects. Sometimes, they're a little bit more tired, their appetite can be down, and they can have something called immune phenomena. Because we're using your own immune system to attack the cancer, occasionally the immune system gets a little confused, and it can attack your own body. Dr. Subari: I think this is an extremely exciting time in the treatment of people with lung cancers. Dr. Kazmi: Immunotherapy has been a beacon of hope that cancer has needed for decades. Dr. Rohs: The pace of discovery for lung cancer right now is so staggering. I think we really are coming into the era of personalized medicine where we can hopefully minimize treatments and maximize benefits for our patients and have them live longer and live better.