When medical oncologist Ticiana Leal, MD , speaks at the UW Carbone Cancer Center’s Lung Cancer Awareness Night on November 29, she is excited to bring her cautious optimism to the patients and families in attendance.
“In the past year alone, there have been many advances in lung cancer treatment, and several presentations of impact in clinical research that have already changed the standard of care,” Leal says. “These advances in immunotherapy have only been coming since 2015 when we had the approval of the first immunotherapy in lung cancer; before then most patients received chemotherapy.”
For a disease that had a five-year survival rate of only five percent for advanced stages, the addition of immunotherapy has improved that rate to 16 percent, and Leal expects it to keep increasing.
UW Carbone has participated in and is leading lung cancer immunotherapy clinical trials, and it has been enlightening to see patients derive benefit from their participation. For example, patients with advanced non-small cell lung cancer (NSCLC, of which 85 percent of all lung cancers are) whose tumors test high for levels of an immune-blocking protein, PD-L1, immunotherapy was shown to be superior compared to chemotherapy.
“And then there are the 15 percent of patients with small cell lung cancer. We saw no advances in treatments for this population in nearly 30 years,” Leal says. “In a recent trial that we participated in, patients who received immunotherapy plus chemotherapy, compared to chemotherapy alone, lived longer and had improved tumor control and good tolerability. That treatment strategy is likely to be approved by the FDA soon. We also look forward to seeing other immunotherapy combinations move forward.”
Another area of research making huge strides is in targeted therapies, and Leal calls lung cancer the “poster child” for these directed treatments in the era of Precision Medicine.
“Our prior way of practicing was that all lung cancers are the same, and they all get treated the same way,” Leal says. “One of the breakthroughs was understanding there are alterations within tumor cells that may be driving the cancer, and more importantly that we can identify that pathway and block it with a drug.”
For example, mutations in the EGFR or rearrangement in the ALK genes are present in approximately twenty percent and five percent, respectively, of patients with a subtype of NSLCL. New EGFR and ALK-targeted therapies are now approved for use in the clinic, and patients are living months to years longer, with fewer side effects and better quality of life. As new genetic alterations are identified in small subsets of the NSCLC population, Leal stresses the importance of genomic testing in lung cancer therapy.
“Some of these alterations are quite rare. We know around one percent of patients have a ROS-1 fusion and there is an approved therapy,” Leal says. “If you don’t test for it routinely in patients with lung cancer, you’re unlikely to identify and understand the impact that this can make in an individual’s life. But then you find one patient who derives benefit and you’re like, ‘That’s a game changer.’”
Leal is careful to stress the need for continued and improved research, as she and other lung medical oncologists at UW Carbone are not currently able to provide these breakthrough treatment options for all patients they see.
“Looking for really refined biomarkers is a very important topic in lung cancer,” Leal says. “Additionally, another area of active investigation is in patients with earlier stage lung cancer who undergo surgery in order to improve cure rates. There are still improvements to be made in the field”
But, she adds, “The significant impact research is having in the lives of patients…It’s been amazing to see that in my career.”
UW Carbone’s Lung Cancer Awareness Night will be held Thursday, November 29 at the Holiday Inn West, 1109 Fourier Drive, in Madison. The reception begins at 6pm and the program begins at 7pm.