August 20, 2020

New treatments, better outcomes: The changing face of lung cancer research


Madison, Wis. — The bad news: lung cancer still claims more lives than prostate, breast and colon cancer combined.

The good news: it’s a disease that’s becoming more treatable, thanks in part to research taking place at the UW Carbone Cancer Center. Outcomes for patients with non-small cell lung cancer – one of the two major types of lung cancer – are better than ever before. In recent years, the FDA has cleared the way for new targeted therapies and immunotherapy treatment options, some of which have even shown results in treating rarer types of the disease.

“Lung cancer has been one of those cancers that has had so many advances in the last few years,” said Ticiana Leal, MD, a lung cancer oncologist and Director of the Medical Thoracic Oncology Program at UW Carbone. “It’s really been incredible.”

November is Lung Cancer Awareness Month, and for physicians and researchers at UW Carbone, it’s an opportunity to reflect on those successes and renew their commitment to building on that progress.

“I think what is changing the treatment of lung cancer is that we’re not treating all patients the same,” said , lung cancer oncologist and assistant professor at UW Carbone. While non-small cell makes up the vast majority of lung cancer cases, there are additional subtypes of the disease, each with unique characteristics.

In the past, non-small cell lung cancer was treated more uniformly. However, armed with a better knowledge of these subtypes and more treatment options, UW Carbone oncologists are taking a more personalized approach with each patient. “Genomic testing is key,” Leal said. “This helps us identify the subtype of non-small cell lung cancer, and once we identify subtypes, we can identify a actionable target and a therapy.”

Patients of UW Carbone have access to gene sequencing and the services of the Precision Medicine Molecular Tumor Board, where disease experts from across the state analyze and review cancer cases. All of this results in a unique treatment plan tailored to the patient.

While FDA approval of new immunotherapy drugs and targeted therapies has made treating these subtypes possible, there’s more work to be done to improve cure rates. Currently, UW Carbone has more than 60 clinical trials currently open for lung cancer patients.

There’s also been a push to get some of these same therapies approved for use in patients with earlier stage lung cancer. These are often patients who have resectable tumors, which means they are able to be removed surgically. While surgery remains a strong curative option, cancer recurrence is unfortunately not uncommon. “We’re seeing a lot of promising studies combining chemotherapy and immunotherapy, either prior to surgery or after surgery, to try to improve cure rates in those patients as well as identify a marker of response to therapy,” Leal said.

Outside of treatment, there’s also work being done at UW Carbone to improve quality of life for current lung cancer patients and survivors. In addition to her clinical work, Duma is also studying the unique challenges that women experience during lung cancer treatment.

While men and women are often treated in a similar manner for lung cancer, many women have reported unique and unexpected side effects during immunotherapy treatments – things like extreme vaginal dryness, a specific condition Duma is currently researching. “It may lead to sexual dysfunction, bleeding and urinary infections,” she said.

While these are FDA-approved treatments, Duma says the unexpected side effects might be explained by an underrepresentation of women in clinical trials. “Only 35% of all patients in immunotherapy trials were women,” she said. Because of the gender imbalance, it can be hard to understand the scope of the problem, or the specifics of what might be behind it. While more research needs to be done, Duma’s immediate goal is to help women manage the side effects.

 “You don’t have to be miserable,” she said. “Your life is more than just the cancer you’re diagnosed with.”

Both Duma and Leal are also working to overcome another issue that often comes with lung cancer: the stigma. The perception of lung cancer as a smoker’s disease remains strong, even though anyone can get it. Duma says the stigma often hits women harder, and she’s had female patients show up to her clinic wearing pink – the insinuation being that they’d rather be associated with having breast cancer.

However, a 2018 study found that lung cancer rates in young women are now higher than in young men.

Leal says it’s worth remembering that much like other cancers, early detection is key.  Low-dose computed tomography (low-dose CT scan) is recommended for lung cancer screening for a person without any symptoms, at high risk for lung cancer (i.e. have a history of heavy smoking, smoke now or have quit within the past 15 years, are between 55 and 80 years old).

In addition, for patients, that means reporting any unusual respiratory symptoms – things like chest pain, chronic cough or shortness of breath – to a healthcare provider. For healthcare providers, that means being on the lookout for the disease, even when a patient is a nonsmoker.

For patients and their families seeking more information about lung cancer, the UW Lung Cancer Program’s website has information about detecting and diagnosing the disease, support services and clinical trials.