The Deadliest Cancer Is Becoming More Survivable

 

"There is more hope than ever for people diagnosed with the deadliest cancer.

Declines in smoking and the advent of screening and newer drugs have transformed the outlook for patients with lung cancer, once considered a death sentence.

And there is more to gain. More patients can fend off the disease for months or years with targeted or immune-boosting drugs, results released this weekend at a top cancer conference showed. That includes patients with forms of the disease that are notoriously tough to treat.

"It had such an abysmal prognosis. And now we have people who are being cured who we never thought would be cured," said Dr. Angela DeMichele, a medical oncologist at Penn Medicine.

AstraZeneca's drug Tagrisso can contain lung cancer nearly three years longer than chemotherapy and radiation alone for some stage-3 patients, one study released Sunday showed. Another found that some patients with aggressive disease survived nearly two years longer with the company's immunotherapy drug Imfinzi, the first advance for that lung-cancer subtype in decades.

Another study presented at the American Society of Clinical Oncology conference in Chicago found that 60% of advanced patients were alive without their disease advancing at five years after taking Pfizer's Lorbrena, a drug that targeted a genetic mutation in their tumors. That compares with just 8% of patients on an older drug with the same target.

"These results are really outstanding," said Dr. David Spigel, chief scientific officer at Sarah Cannon Research Institute in Tennessee, lead researcher on the Imfinzi trial. "A really major step forward in lung-cancer care."

Tagrisso, Imfinzi and Lorbrena are all approved by the Food and Drug Administration and in use.

Lorbrena has kept Matt Hiznay's stage-4 lung cancer at bay for nine years. Hiznay, who never smoked, was diagnosed in 2011 at 24 years old.

"Hearing that, you get old really fast," he said.

But there was some good news: His tumor tested positive for something called an ALK gene mutation, a rare finding that made him eligible for a targeted drug. Hiznay's doctor shook his hand and congratulated him on being a mutant.

Hiznay tried a string of drugs and older therapies including chemotherapy and radiation, each of which held off his disease for some time.

He joined a clinical trial for Lorbrena in 2015 and has taken the drug ever since. Between treatment, Hiznay earned a doctorate, got married and had a daughter.

"It became a bit easier to see the future again," said Hiznay, who lives in Brecksville, Ohio. He cherishes each day, even when his infant daughter wakes him up in the middle of the night.

More than 234,000 Americans are diagnosed with lung cancer annually, and some 125,000 die of the disease -- the leading cause of cancer death among men and women. The survival rate has increased by some 20% in the past five years, according to the American Lung Association.

Lung cancer has responded to newer drugs such as immunotherapies better than some other cancers, doctors said, in part because its tumors tend to have many mutations that make it easier to find and attack.

Tagrisso targets mutations on the EGFR gene, found in 15% of lung cancers in the U.S. One study presented at the conference added Tagrisso after chemotherapy and radiation for patients with the mutation whose stage-3 disease was too far along for surgery. The median time before the disease advanced in those patients was more than three years, compared with just under six months for patients who weren't on the drug.

The results show how much lung-cancer treatment has changed in the past decade, "It's like Dorothy looking around and saying, we're not in Kansas anymore," said Dr. Lecia Sequist, a lung-cancer specialist at Mass General Cancer Center who wasn't involved in the trial.

Another study showed rare progress against small-cell lung cancer, a less common and more aggressive form of the disease that is harder to treat.

AstraZeneca's Imfinzi increased median survival to around 56 months, compared with 33 months on the standard chemotherapy and radiation alone. The trial included patients with small-cell lung cancer that hadn't spread.

"To see something where we're measuring benefit in years versus months is a huge step in the right direction," said Dr. Lauren Averett Byers, a lung-cancer oncologist at MD Anderson Cancer Center in Houston, who wasn't involved in the trial.

The FDA in May approved Amgen's Imdelltra for more advanced small-cell lung cancer. Median survival with the drug was 14 months, with 40% of patients responding to the treatment.

About a quarter of lung-cancer patients are alive five years after diagnosis.

The newer treatments can give some patients with advanced disease months or years more to live, but the cancer often comes back and becomes incurable. Many lung cancers are caught late.

"When you look at the disease statistics, you have to be humbled a little bit," said Dr. Pasi Janne, a lung-cancer specialist at Dana-Farber Cancer Institute in Boston. "We still have room to go."

Through Hiznay's 13 years with lung cancer, he has seen many fellow patients die.

"The survivor's guilt, it's there, it's real," he said.

Five years after diagnosis, Hiznay rented a brewery basement for a "One Percent" party, named for his odds of survival in 2011.

He did it again after 10 years. He plans to be there for 15." [1]

1. U.S. News: The Deadliest Cancer Is Becoming More Survivable. Abbott, Brianna.  Wall Street Journal, Eastern edition; New York, N.Y.. 03 June 2024: A.3.