The Future Is Bright for Lung Cancer Treatments
It might be hard to see the light through these dark statistics but stick with us: Lung cancer is the deadliest cancer in the U.S., according to the Centers for Disease Control and Prevention (CDC). Compared with other common cancers, its five-year survival rate is pretty low—just 18.6%, says the American Lung Association (ALA)—partially because it’s hard to catch early. The good news? Innovations in lung cancer treatments mean people may live years longer, even when their disease is advanced. Keep reading to learn how great strides in treatment options are changing what this diagnosis means.
Say Hello to Personalized Cancer Treatment
For John Heymach, M.D., chair of thoracic oncology at MD Anderson Cancer Center in Houston, one of the most exciting things in lung cancer research is the development of new targeted therapies. “These are medicines directed to specific mutations that occur in the DNA of the tumor that make the cancer grow,” he explains. “Before, we used to treat lung cancer just as one disease. Now we’re breaking it into different subgroups and coming up with different pills that work incredibly well.” Compared with chemo, these meds can stop cancer growth for years instead of—in some case—just months.
New Drugs Attack Lung Cancer-Causing Mutations
Targeted therapies for two lung cancer-causing mutations have been around for a decade, but in the past two years, researchers have discovered five more mutations (and counting!) that drugs can block, says Dr. Heymach. Two new drugs were approved in the past year, and more are coming down the pike. “The biggest one is for the most common mutation in lung cancer, [called] KRAS,” he says. These new drugs will target a subgroup of KRAS mutations that affect about 10% to 12% of people with lung cancer, he adds, and will hopefully be available in a few years.
Immunotherapy Helps Your Body Work Smarter, Not Harder
Another exciting development in the world of lung cancer treatment? Immunotherapy. “This is very different from standard chemotherapy because it doesn’t kill cells on its own—it actually stimulates the immune system to tackle the cancer,” Dr. Heymach explains. Tumors can be smart—they learn to hide themselves from the immune system as they evolve by covering themselves in certain proteins, he says. That’s where immunotherapy drugs come in. Basically, these drugs help block these proteins so the immune system can see cancerous tumors better and attack them. The future is now!
Immunotherapy Has Been Shown to Increase Survival Rates
One immunotherapy drug called Keytruda made headlines in September 2020 in a major way. While Keytruda isn’t exactly a new kid on the cancer treatment block (it’s been FDA-approved for some uses since 2014), a recent study added to its lung cancer street cred: The results found that the five-year survival rate for patients with metastatic non-small cell lung cancer with a certain type of tumor was double that of patients who were treated with just chemo—31.9% compared with 16.3%. That’s pretty impressive and yet another reason why researchers are so excited about immunotherapy drugs for lung cancer.
Immunotherapy Combos May Be a Better Treatment for Some
While immunotherapy isn’t new, scientists are discovering new ways to use it to treat lung cancer—like not giving just one immunotherapy drug, but using two together, or combining them with chemo, Dr. Heymach says. “As that happens, we’re getting better at enhancing the immune system, shrinking tumors, and keeping them down for longer.” A recent clinical trial found combining two immunotherapy drugs with just two rounds of chemo can help people with advanced non-small cell lung cancer live months longer than chemo alone. The FDA approved this treatment as a first-line approach in May 2020.
Treatment-Resistant Lung Cancer Presents a Stubborn Challenge
In some people with mutation-driven lung cancer, targeted treatment initially works well—only to later stop working because the lung tumor has evolved to “resist” the treatment. That’s what a research lab at Moffit Cancer Center in Tampa, FL, is looking to tackle right now, says Andriy Marusyk, Ph.D., a cancer researcher at Moffit leading this effort. “For patients with metastatic advanced cancers, the vast majority of these responses [to targeted therapies], even if they last for a year or two, are still not curative,” Dr. Marusyk says. “These tumors eventually come back as therapy-resistant relapse.”
Understanding the Resistance Process Is Key
To solve this problem, researchers need to understand how tumor cells become resistant to treatment in the first place, says Dr. Marusyk: “If we understand what’s going on, we might be able to preemptively stop the development of resistance, slow it down, or even figure out how to eliminate tumors altogether.” That’s his lab’s current focus, where researchers there are studying how tumor cells change over time, publishing some findings with this focus earlier this year. While this research is ongoing, he’s hopeful that it could be applied to treatments for patients in a couple of years.
An Exciting New Treatment for Early-Stage Lung Cancer
So far, we’ve focused on treatment advancements for people with advanced lung cancer. But for those with earlier-stage disease there's great news, too, says Dr. Heymach. Typically, these folks have surgery to remove their cancer, but there’s a 50% chance it will come back. Research presented at a renowned oncology meeting in May 2020 may change that—drastically. Researchers found that a mutation-blocking drug reduced the chance of lung cancer recurring by more than 80%. “In the past, the biggest [reduction] we saw with chemotherapy was about five to 10 percent, so this is remarkable,” Dr. Heymach says.
The Big Push Is for an Increased Cure Rate
These study results are also promising on a broader scale, says Dr. Heymach. “It really tells us that we’re hopefully going to be able to start using targeted therapies not just to help just people with advanced disease live longer, but to also increase cure rates to reduce the chance of the cancer coming back.” While this new treatment hasn’t yet been FDA approved, the results are so strong that researchers are optimistic it will be available in the near future, he says.
Research on Lifestyle Choices Offers Good News, Too
Still, lung cancer research isn’t all about the drugs—there are also clinicians and researchers working to improve quality of life for people with lung cancer in other ways. For example, Carolyn Presley, M.D., a thoracic oncologist at The Ohio State University Comprehensive Cancer Center, is currently researching how lifestyle factors can have a major impact on people with lung cancer who are in long-term treatment or remission. “We think that nutrition, physical activity, and mental and emotional health are the three underpinnings of survivorship care,” she says.
The Emotional and Physical Sides of Lung Cancer Can’t Be Ignored
The hypothesis is that mental health and physical health are inextricably linked, Dr. Presley says. “We know that mental health issues such as anxiety and depression actually occur at much higher rates in people with lung cancer than in other cancer types,” she adds. In fact, one of the in-progress studies she is leading combines physical activity and muscle relaxation exercises to help people with advanced lung cancer maintain strength and resilience—physical and mental—during treatment. The hope is that this combo may boost the immune system and improve cancer symptoms.
The Future for Lung Cancer Treatment Offers Real Hope
Researchers nationwide are working hard to improve the outlook for lung cancer—and it’s working. “If you look at cancer stats the past year, it’s the biggest decrease in cancer deaths that have been seen in history, and the most reductions in cancer were seen in lung cancer,” says Dr. Heymach. Much of that progress is the result of these treatment innovations, such as new targeted therapies, he says. The future is bright, but don’t forget: Early detection is key, says Dr. Heymach. “We could reduce lung cancer deaths even more if more people got lung cancer screening.”
Clinical Trial on Exercise and Relaxation for Lung Cancer: National Institutes of Health. (2020.) “Resiliency Among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT).” clinicaltrials.gov/ct2/show/NCT04229381
Clinical Trial on Immunotherapy and Chemo Combination: ClinicalTrials.gov. (2020.) “A Study of Nivolumab and Ipilimumab Combined With Chemotherapy Compared to Chemotherapy Alone in First Line NSCLC (CheckMate 9LA).” clinicaltrials.gov/ct2/show/NCT03215706
FDA Approval of Immunotherapy and Chemo Combination: U.S. Food and Drug Administration. (2020.) “FDA approves nivolumab plus ipilimumab and chemotherapy for first-line treatment of metastatic NSCLC.” fda.gov/drugs/drug-approvals-and-databases/fda-approves-nivolumab-plus-ipilimumab-and-chemotherapy-first-line-treatment-metastatic-nsclc
Lung Cancer Statistics: The Center for Disease Control and Prevention. (2020.) “Lung Cancer Statistics.” cdc.gov/cancer/lung/statistics/
Lung Cancer Survival Rates: The American Lung Association. (2020.) “Lung Cancer Fact Sheet.” lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet
Study on Resistance to Targeted Therapies: Nature. (2020.) “Resistance to targeted therapies as a multifactorial, gradual adaptation to inhibitor specific selective pressures.” nature.com/articles/s41467-020-16212-w
Targeted Treatment for KRAS Mutation Study: Frontiers in Oncology. (2019.) “New Horizons in KRAS-Mutant Lung Cancer: Dawn After Darkness.” frontiersin.org/articles/10.3389/fonc.2019.00953/full
Osimertinib Study Results Presented at May 2020 ASCO Meeting: American Society of Clinical Oncology. (2020). “Osimertinib as adjuvant therapy in patients (pts) with stage IB–IIIA EGFR mutation positive (EGFRm) NSCLC after complete tumor resection: ADAURA.” meetinglibrary.asco.org/record/191929/abstract