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When I started at MedStar Health in 2008, only about 20% of patients with lung cancer lived one year after their diagnosis. At that time, treatment was limited to a choice of just four drugs. For most patients this amounted to delaying the inevitable.
Today, that percentage has flipped, and 60-80% of my patients are living longer and more active lives after cancer treatment—working, traveling, and making memories with their families.
Improvements in our understanding of how cancers grow and spread have led to powerful, precise treatments that can control advanced cancers and even cure some cancers caught at earlier stages.
According to the American Cancer Society, the overall cancer death rate fell 32% from 1991 to 2019. This amounts to about 3.5 million fewer deaths from cancer during those years, due to several factors including:
- Chemotherapy after surgery for breast and colon cancers
- Fewer people smoking cigarettes
- Improvements in prevention and early detection for some cancers
These advancements, along with targeted chemotherapy, refined immunotherapy, and powerful combination treatments, can give patients not just longer lives—but also higher quality, more satisfying lives.
Targeted chemotherapy increases survival.
Chemotherapy on its own can slow and stop the ability of cancer cells to divide, multiply, and spread. Over time, however, chemo may become less effective if cancer cells develop different ways to grow or divide.
Scientists confronted this challenge by developing personalized treatments by analyzing tumors for specific changes called driving mutations on cancer cells and providing specific targeted therapy for those mutations. About 20-40% of patients with lung cancer carry driving mutations.
This allows us to target mutations such as HER2 in breast cancer and EGFR in lung cancer that are having a real impact on outcomes for patients. Without treatment, about 10% of patients with metastatic lung cancer survive for a year—targeted chemotherapy can increase the one-year survival rate to about 90%.
Although targeted therapy is more precise than the treatments that came before, patients may experience side effects that can include:
- Fatigue
- Diarrhea
- Hair and hair color loss
- High blood pressure
- Liver problems
- Mouth sores
- Skin rash
Other treatments that have been developed for lung cancer patients include immunotherapy.
MedStar Health takes a team-based approach to cancer treatment. Bringing together experts, researchers, and specialists from across our network, we collaborate to develop treatment plans for our patients, especially those with difficult-to-treat cancers that might require advanced treatments.
Immunotherapy unlocks the body’s defenses.
To grow and spread, cancer cells must avoid the immune system, which works to prevent and slow cancer. To do this, diseased cells can:
- Undergo changes that make it harder for the immune system to identify them.
- Develop proteins on their surface that suppress immune cells.
- Alter health cells around a tumor to disrupt immune response.
These changes help cancer hide from the immune system, effectively disguising itself so immune cells don’t recognize and combat diseased cells. This works to “turns off” the body’s natural response, allowing cancer to spread.
Immunotherapy works to reengage the immune system so the body can help identify and eliminate cancer. Some of my patients with metastatic lung cancer have been able to live longer, happier lives thanks to immunotherapies such as:
- Immune checkpoint inhibitors: Drugs that boost the body’s defenses by blocking natural systems that restrict immune response.
- T-cell cell therapy: Immune cells that are removed from the tumor, selected or altered in the lab to seek and eliminate cancer cells, and reintroduced to the body.
- Monoclonal antibodies: Lab-created immune system proteins that bind to cancer cells to help the immune system identify them.
- Treatment vaccines: Medicines that help the immune system recognize unique substances called “tumor-associated antigens” that are present in cancer but not other cells.
- Immune system modulators: Medicines that stimulate the immune system. Cytokines can activate certain white blood cells and other natural responses to fight cancer and can be used to reduce side effects from other cancer treatment. Immunomodulatory drugs stimulate the immune system and can stop tumors from forming new blood vessels they need to grow.
Many immunotherapy treatments can help the immune system stay switched on so the body can recognize cancer cells in the long term, even after treatment concludes. After years of treatment, immunotherapy can help slow the spread of advanced cancers in some patients.
Side effects of immunotherapy are different for everyone, and they can occur at any point in treatment. Skin reactions like rashes are common. Some people experience inflammation symptoms in any site or organ, muscle aches, and trouble breathing. Other possible side effects could include:
- Diarrhea
- Thyroid disfunction
- Liver function changes
Approximately 20% to 30%of patients will respond to immunotherapy, and the results can be significant for long period of time. For others, a combination of chemotherapy and immunotherapy can be an effective treatment.
Related reading: After Colon Cancer Surgery, Follow-Up Visits Help Keep Recurrence at Bay.
Combination therapies can improve success.
Combining precisely targeted chemotherapy and individualized immunotherapy can provide the best results for some patients, so researchers are working to develop ways to help identify which approaches are best.
For patients with early stage lung cancer, surgery alone can cure cancer at 60-70%, Scientists are trying to improve surgical outcomes by using combined treatments. Targeted therapies and immunotherapy now are approved after surgery. Those therapies help the body remove any lingering cancer cells. For others, combination of chemotherapy and immunotherapy can help shrink a tumor to make complicated surgical procedures less risky.
The future of cancer treatment.
Advances in cancer treatment in the last 20 years have been significant. We now understand so much more about how our cells communicate, how cancer suppresses and hides from the immune system, and how to help the body respond to keep cancer from spreading—and there’s more to come.
Researchers are now studying which molecules are central to cell communication, which could aid in the development of new immunotherapies that help the body fight cancer instead of introducing chemicals that are toxic to the whole body.
Planning precise, personalized cancer treatment is a team effort. Working together, our cancer experts can identify targetable mutations for immunotherapy and determine the best treatment timeline and approach.
