At first glance, the statistics for lung cancer may seem dire. But look closer and there’s more — much more — to the story. It’s true that lung cancer remains the leading cause of cancer death among men and women worldwide. Each year, more people die of lung cancer than of colon, breast and prostate cancers combined — an estimated 156,000 people in the U.S. in 2018 alone.
However, these grim numbers have been steadily improving. After decades of increases, rates of lung cancer deaths began to decline in the early 1990s and have been falling, on average, 2.5% each year between 2005 and 2014.
A lung cancer diagnosis, even at the most advanced stage, is no longer an automatic death sentence.
“Previously, when I saw a stage IV patient, I told them that the lung cancer almost certainly was going to be the cause of their death. But now, even stage IV lung cancer can be curable for certain patients,” said Jorge Nieva, MD, associate professor of clinical medicine at the Keck School of Medicine of USC.
USC Norris Comprehensive Cancer Center and Keck Medicine of USC are front and center in this evolving revolution, which is one of the reasons they are the highest-ranked cancer care provider in Southern California according to the 2018-2019 U.S. News and World Report “Best Hospitals” rankings.
Once a week, patients can see all the subspecialists they need to on the same day in one location in a multidisciplinary clinic, coordinated by an experienced nurse navigator.
These subspecialists — including oncologists, thoracic surgeons, interventional pulmonologists, radiologists, pathologists and radiation oncologists — meet twice a week to discuss cases and determine the best course of action.
“Thanks to our team’s expertise, we can identify the therapy or combination of therapies best suited for each patient,” said Anthony W. Kim, MD, MS, professor of clinical surgery at the Keck School. Kim adds that the approach is aggressive. “Patients know we’re jumping into the trenches and we’re going to fight with them. That brings a lot of peace of mind.”
USC Norris specialists are equipped with a bigger arsenal these days, including a first-ever screening for lung cancer. A nationwide clinical trial published in 2011 showed that low-dose CT screening of high-risk patients with a history of smoking can result in 20% fewer deaths from lung cancer by identifying it earlier, before it spreads. USC Norris is home to one of these accredited screening sites.
Immunotherapy — harnessing the immune system to kill cancer cells — is one of the biggest breakthroughs in recent years. Research shows that that these innovative therapies are particularly effective in current or former smokers.
Tobacco use is implicated in about 80 to 90% of lung cancer deaths in the U.S. But, more than 20% of Americans who die of lung cancer have never smoked or used any kind of tobacco. The majority of these people have genetic mutations in their tumors. “Many of these DNA changes are increasingly treatable with targeted medications in pill form,” Nieva said. Surgery remains the go-to option for early-stage lung cancer and, increasingly, is being strategically deployed for advanced stages in combination with other therapies.
For many patients, stereotactic radiation therapy is an alternative to surgery, delivering targeted radiation in fewer high-dose treatments. Other tools are replacing invasive ways to diagnose and stage tumors, including a fluid biopsy that uses a simple blood sample and GPS-like navigational tools that lead pulmonology experts to hard-to-reach areas of the lung.
Finding out whether a particular tumor has any biomarkers — molecules that can indicate the presence of a disease or abnormal process — can be critical to survival. The team begins by making sure all patients have appropriate genetic testing, and they are searching for even more biomarkers to expand this benefit to more patients.
One of the biggest game changers in lung cancer care at USC Norris is the growing slate of clinical trials, including inventive uses of immunotherapy (by itself and with chemotherapy and/or radiation), along with other novel treatments.
USC Norris doctors link patients with experimental therapies from clinical trials whenever possible. “It’s like reaching into the future,” Nieva said, “to bring back a drug treatment that people need today.”
To learn more or schedule an appointment, call (800) USC-CARE or visit KeckMedicine.org/lung-cancer.
— Candace Pearson