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Discussion 1: Investigating a Disease Process

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Discussion 1: Investigating a Disease Process

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1. Through this semester I plan to learn more about cancer.

2. I chose cancer because it has always been an interest of mine.

3. Cancer can affect almost any organ or body system, the location depends on the type and the severity.

4. Cancer occurs when a cells grow and spread throughout the body in an abnormal and uncontrollable way.

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Lung Cancer is the overgrowth of cells in the lungs that causes tumors that can ultimately disrupt breathing and can spread to other organs.

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Signs of Lung Cancer, such as abnormal breathing (sound) or finding a tumor through some sort of scanning, are observable or obvious indicators of a disease that can be noticed by someone other than the patient.

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Symptoms, such as chest pain, fatigue, or shortness of breath can only be noticed by the patient.What are symptoms

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The most common signs and symptoms of lung cancer include having a cough that does not go away, coughing up blood (also known as hemoptysis), a shortness of breath, dysphonia, and chest pain that intensifies when coughing, laughing, or breathing deeply. Some other examples patients may face include, an unexplained weight loss, a loss of appetite, and having frequent respiratory infections like bronchitis or pneumonia.

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Overview

Lung cancer is a type of cancer that begins in the lungs. Your lungs are two spongy organs in your chest that take in oxygen when you inhale and release carbon dioxide when you exhale.

Lung cancer is the leading cause of cancer deaths worldwide.

People who smoke have the greatest risk of lung cancer, though lung cancer can also occur in people who have never smoked. The risk of lung cancer increases with the length of time and number of cigarettes you've smoked. If you quit smoking, even after smoking for many years, you can significantly reduce your chances of developing lung cancer.

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Symptoms

Lung cancer typically doesn't cause signs and symptoms in its earliest stages. Signs and symptoms of lung cancer typically occur when the disease is advanced.

Signs and symptoms of lung cancer may include:

A new cough that doesn't go away

Coughing up blood, even a small amount

Shortness of breath

Chest pain

Hoarseness

Losing weight without trying

Bone pain

Headache

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

If you smoke and have been unable to quit, make an appointment with your doctor. Your doctor can recommend strategies for quitting smoking, such as counseling, medications and nicotine replacement products.

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Causes

Smoking causes the majority of lung cancers - both in smokers and in people exposed to secondhand smoke. But lung cancer also occurs in people who never smoked and in those who never had prolonged exposure to secondhand smoke. In these cases, there may be no clear cause of lung cancer.

How smoking causes lung cancer

Doctors believe smoking causes lung cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately.

At first your body may be able to repair this damage. But with each repeated exposure, normal cells that line your lungs are increasingly damaged. Over time, the damage causes cells to act abnormally and eventually cancer may develop.

Types of lung cancer

Doctors divide lung cancer into two major types based on the appearance of lung cancer cells under the microscope. Your doctor makes treatment decisions based on which major type of lung cancer you have.

The two general types of lung cancer include:

Small cell lung cancer. Small cell lung cancer occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer.

Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for several types of lung cancers. Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma.

Risk factors

A number of factors may increase your risk of lung cancer. Some risk factors can be controlled, for instance, by quitting smoking. And other factors can't be controlled, such as your family history.

Risk factors for lung cancer include:

Smoking. Your risk of lung cancer increases with the number of cigarettes you smoke each day and the number of years you have smoked. Quitting at any age can significantly lower your risk of developing lung cancer.

Exposure to secondhand smoke. Even if you don't smoke, your risk of lung cancer increases if you're exposed to secondhand smoke.

Previous radiation therapy. If you've undergone radiation therapy to the chest for another type of cancer, you may have an increased risk of developing lung cancer.

Exposure to radon gas. Radon is produced by the natural breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Unsafe levels of radon can accumulate in any building, including homes.

Exposure to asbestos and other carcinogens. Workplace exposure to asbestos and other substances known to cause cancer - such as arsenic, chromium and nickel - can increase your risk of developing lung cancer, especially if you're a smoker.

Family history of lung cancer. People with a parent, sibling or child with lung cancer have an increased risk of the disease.

Complications

Lung cancer can cause complications, such as:

Shortness of breath. People with lung cancer can experience shortness of breath if cancer grows to block the major airways. Lung cancer can also cause fluid to accumulate around the lungs, making it harder for the affected lung to expand fully when you inhale.

Coughing up blood. Lung cancer can cause bleeding in the airway, which can cause you to cough up blood (hemoptysis). Sometimes bleeding can become severe. Treatments are available to control bleeding.

Pain. Advanced lung cancer that spreads to the lining of a lung or to another area of the body, such as a bone, can cause pain. Tell your doctor if you experience pain, as many treatments are available to control pain.

Fluid in the chest (pleural effusion). Lung cancer can cause fluid to accumulate in the space that surrounds the affected lung in the chest cavity (pleural space).

Fluid accumulating in the chest can cause shortness of breath. Treatments are available to drain the fluid from your chest and reduce the risk that pleural effusion will occur again.

Cancer that spreads to other parts of the body (metastasis). Lung cancer often spreads (metastasizes) to other parts of the body, such as the brain and the bones.

Cancer that spreads can cause pain, nausea, headaches, or other signs and symptoms depending on what organ is affected. Once lung cancer has spread beyond the lungs, it's generally not curable. Treatments are available to decrease signs and symptoms and to help you live longer.

Prevention

There's no sure way to prevent lung cancer, but you can reduce your risk if you:

Don't smoke. If you've never smoked, don't start. Talk to your children about not smoking so that they can understand how to avoid this major risk factor for lung cancer. Begin conversations about the dangers of smoking with your children early so that they know how to react to peer pressure.

Stop smoking. Stop smoking now. Quitting reduces your risk of lung cancer, even if you've smoked for years. Talk to your doctor about strategies and stop-smoking aids that can help you quit. Options include nicotine replacement products, medications and support groups.

Avoid secondhand smoke. If you live or work with a smoker, urge him or her to quit. At the very least, ask him or her to smoke outside. Avoid areas where people smoke, such as bars and restaurants, and seek out smoke-free options.

Test your home for radon. Have the radon levels in your home checked, especially if you live in an area where radon is known to be a problem. High radon levels can be remedied to make your home safer. For information on radon testing, contact your local department of public health or a local chapter of the American Lung Association.

Avoid carcinogens at work. Take precautions to protect yourself from exposure to toxic chemicals at work. Follow your employer's precautions. For instance, if you're given a face mask for protection, always wear it. Ask your doctor what more you can do to protect yourself at work. Your risk of lung damage from workplace carcinogens increases if you smoke.

Eat a diet full of fruits and vegetables. Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Avoid taking large doses of vitamins in pill form, as they may be harmful. For instance, researchers hoping to reduce the risk of lung cancer in heavy smokers gave them beta carotene supplements. Results showed the supplements actually increased the risk of cancer in smokers.

Exercise most days of the week. If you don't exercise regularly, start out slowly. Try to exercise most days of the week.

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Learn about the approaches doctors take to treating this deadly form of cancer, including minimally invasive surgery, targeted therapy and immunotherapy.

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Lung Cancer Facts and Statistics You Should Know | LCFA

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Lung cancer accounts for more deaths than any other cancer - and more than breast, prostate, and colon cancer combined. Know the facts and statistics.

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Lung cancer is mainly caused by smoking, but secondhand smoke, exposure to harmful chemicals, age, and genetics also play a role.

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Men historically had higher rates, but smoking trends among women have narrowed the gap. Older adults are at higher risk.

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Hundreds of thousands of new cases occur each year in the U.S., and millions worldwide, making it a leading cause of cancer deaths.

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Places with poor air quality or exposure to chemicals, especially workplaces like construction or manufacturing, increase risk.

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Lung cancer is not contagious; it develops due to behavior and environmental exposure rather than person-to-person transmission.

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Lung cancer facts - Lung Cancer Research Foundation

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Lung Cancer is the leading cause of cancer death worldwide. View our lung cancer facts and learn more about the symptoms and risk factors, and how you can help fund cancer research.

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Lung Cancer | Lung Cancer Symptoms | MedlinePlus

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Lung cancer is one of the most common cancers in the world. Common symptoms of lung cancer include: constant chest pain and coughing blood. Read more.

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Find information about lung cancer from the Cleveland Clinic. Learn about stages, types, diagnosis, and treatment.

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Doctors use CT scans, PET scans, biopsies, and genetic tests to find and monitor lung cancer

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Lung cancer can be treated with surgery, chemotherapy, radiation, immunotherapy, targeted therapy, and supportive care like acupuncture or meditation

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Researchers are testing new targeted drugs, stronger immunotherapies, tumor-infiltrating lymphocyte therapy, liquid biopsies, and personalized cancer vaccines, but more trials and funding are needed

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Avoiding smoking, limiting secondhand smoke, checking for radon, and regular CT screening for high-risk people can help prevent lung cancer

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Diagnosis

Testing healthy people for lung cancer

People with an increased risk of lung cancer may consider annual lung cancer screening using low-dose CT scans. Lung cancer screening is generally offered to people 55 and older who smoked heavily for many years and are otherwise healthy.

Discuss your lung cancer risk with your doctor. Together you can decide whether lung cancer screening is right for you.

Tests to diagnose lung cancer

If there's reason to think that you may have lung cancer, your doctor can order a number of tests to look for cancerous cells and to rule out other conditions.

Tests may include:

Imaging tests. An X-ray image of your lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in your lungs that might not be detected on an X-ray.

Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.

Tissue sample (biopsy). A sample of abnormal cells may be removed in a procedure called a biopsy.

Your doctor can perform a biopsy in a number of ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted tube that's passed down your throat and into your lungs; mediastinoscopy, in which an incision is made at the base of your neck and surgical tools are inserted behind your breastbone to take tissue samples from lymph nodes; and needle biopsy, in which your doctor uses X-ray or CT images to guide a needle through your chest wall and into the lung tissue to collect suspicious cells.

A biopsy sample may also be taken from lymph nodes or other areas where cancer has spread, such as your liver.

Careful analysis of your cancer cells in a lab will reveal what type of lung cancer you have. Results of sophisticated testing can tell your doctor the specific characteristics of your cells that can help determine your prognosis and guide your treatment.

Tests to determine the extent of the cancer

Once your lung cancer has been diagnosed, your doctor will work to determine the extent (stage) of your cancer. Your cancer's stage helps you and your doctor decide what treatment is most appropriate.

Staging tests may include imaging procedures that allow your doctor to look for evidence that cancer has spread beyond your lungs. These tests include CT, MRI, positron emission tomography (PET) and bone scans. Not every test is appropriate for every person, so talk with your doctor about which procedures are right for you.

The stages of lung cancer are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to the lung. By stage IV, the cancer is considered advanced and has spread to other areas of the body.

Treatment

You and your doctor choose a cancer treatment plan based on a number of factors, such as your overall health, the type and stage of your cancer, and your preferences.

In some cases, you may choose not to undergo treatment. For instance, you may feel that the side effects of treatment will outweigh the potential benefits. When that's the case, your doctor may suggest comfort care to treat only the symptoms the cancer is causing, such as pain or shortness of breath.

Surgery

During surgery your surgeon works to remove the lung cancer and a margin of healthy tissue. Procedures to remove lung cancer include:

Wedge resection to remove a small section of lung that contains the tumor along with a margin of healthy tissue

Segmental resection to remove a larger portion of lung, but not an entire lobe

Lobectomy to remove the entire lobe of one lung

Pneumonectomy to remove an entire lung

If you undergo surgery, your surgeon may also remove lymph nodes from your chest in order to check them for signs of cancer.

Surgery may be an option if your cancer is confined to the lungs. If you have a larger lung cancer, your doctor may recommend chemotherapy or radiation therapy before surgery in order to shrink the cancer. If there's a risk that cancer cells were left behind after surgery or that your cancer may recur, your doctor may recommend chemotherapy or radiation therapy after surgery.

Radiation therapy

Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing radiation to precise points on your body.

For people with locally advanced lung cancer, radiation may be used before surgery or after surgery. It's often combined with chemotherapy treatments. If surgery isn't an option, combined chemotherapy and radiation therapy may be your primary treatment.

For advanced lung cancers and those that have spread to other areas of the body, radiation therapy may help relieve symptoms, such as pain.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that you can recover.

Chemotherapy is often used after surgery to kill any cancer cells that may remain. It can be used alone or combined with radiation therapy. Chemotherapy may also be used before surgery to shrink cancers and make them easier to remove.

In people with advanced lung cancer, chemotherapy can be used to relieve pain and other symptoms.

Radiosurgery

Stereotactic body radiotherapy, also known as radiosurgery, is an intense radiation treatment that aims many beams of radiation from many angles at the cancer. Stereotactic body radiotherapy treatment is typically completed in one or a few treatments.

Radiosurgery may be an option for people with small lung cancers who can't undergo surgery. It may also be used to treat lung cancer that spreads to other parts of the body, including the brain.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Many targeted therapy drugs are used to treat lung cancer, though most are reserved for people with advanced or recurrent cancer.

Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy treatments are generally reserved for people with advanced lung cancer.

Palliative care

People with lung cancer often experience signs and symptoms of the cancer, as well as side effects of treatment. Supportive care, also known as palliative care, is a specialty area of medicine that involves working with a doctor to minimize your signs and symptoms.

Your doctor may recommend that you meet with a palliative care team soon after your diagnosis to ensure that you're comfortable during and after your cancer treatment.

In one study, people with advanced non-small cell lung cancer who began receiving supportive care soon after their diagnosis lived longer than those who continued with treatments, such as chemotherapy and radiation. Those receiving supportive care reported improved mood and quality of life. They survived, on average, almost three months longer than did those receiving standard care.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Coping with shortness of breath

Many people with lung cancer experience shortness of breath at some point in the course of the disease. Treatments such as supplemental oxygen and medications are available to help you feel more comfortable, but they aren't always enough.

To cope with shortness of breath, it may help to:

Try to relax. Feeling short of breath can be scary. But fear and anxiety only make it harder to breathe. When you begin to feel short of breath, try to manage the fear by choosing an activity that helps you relax. Listen to music, imagine your favorite vacation spot, meditate or say a prayer.

Find a comfortable position. It may help to lean forward when you feel short of breath.

Focus on your breath. When you feel short of breath, focus your mind on your breathing. Instead of trying to fill your lungs with air, concentrate on moving the muscles that control your diaphragm. Try breathing through pursed lips and pacing your breaths with your activity.

Save your energy for what's important. If you're short of breath, you may become tired easily. Cut out the nonessential tasks from your day so that you can save your energy for what needs to be done.

Tell your doctor if you experience shortness of breath or if your symptoms worsen, as there are many other treatments available to relieve shortness of breath.

Alternative medicine

Complementary and alternative lung cancer treatments can't cure your cancer. But complementary and alternative treatments can often be combined with your doctor's care to help relieve signs and symptoms.

The American College of Chest Physicians suggests people with lung cancer may find comfort in:

Acupuncture. During an acupuncture session, a trained practitioner inserts small needles into precise points on your body. Acupuncture may relieve pain and ease cancer treatment side effects, such as nausea and vomiting, but there's no evidence that acupuncture has any effect on your cancer.

Hypnosis. Hypnosis is typically done by a therapist who leads you through relaxation exercises and asks you to think pleasing and positive thoughts. Hypnosis may reduce anxiety, nausea and pain in people with cancer.

Massage. During a massage, a massage therapist uses his or her hands to apply pressure to your skin and muscles. Massage can help relieve anxiety and pain in people with cancer. Some massage therapists are specially trained to work with people who have cancer.

Meditation. Meditation is a time of quiet reflection in which you focus on something, such as an idea, image or sound. Meditation may reduce stress and improve quality of life in people with cancer.

Yoga. Yoga combines gentle stretching movements with deep breathing and meditation. Yoga may help people with cancer sleep better.

Coping and support

A diagnosis of cancer can be overwhelming. With time you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:

Learn enough about lung cancer to make decisions about your care. Ask your doctor about your lung cancer, including your treatment options and, if you like, your prognosis. As you learn more about lung cancer, you may become more confident in making treatment decisions.

Keep friends and family close. Keeping your close relationships strong will help you deal with your lung cancer. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.

Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your doctor about support groups in your area. Or check with local and national cancer organizations, such as the National Cancer Institute or the American Cancer Society.

Preparing for your appointment

If you have signs and symptoms that worry you, start by seeing your family doctor. If your doctor suspects you have lung cancer, you'll likely be referred to a specialist. Specialists who treat people with lung cancer can include:

Doctors who specialize in treating cancer (oncologists)

Doctors who diagnose and treat lung diseases (pulmonologists)

Doctors who use radiation to treat cancer (radiation oncologists)

Surgeons who operate on the lung (thoracic surgeons)

Doctors who treat signs and symptoms of cancer and cancer treatment (palliative care specialists)

What you can do

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. To help you get ready, try to:

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Note when your symptoms began.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins or supplements you're taking.

Gather your medical records. If you've had a chest X-ray or a scan done by a different doctor, try to obtain that file and bring it to your appointment.

Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Write down questions to ask your doctor.

Questions to ask if you've been diagnosed with lung cancer

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For lung cancer, some basic questions to ask include:

What type of lung cancer do I have?

May I see the chest X-ray or CT scan that shows my cancer?

What is causing my symptoms?

What is the stage of my lung cancer?

Will I need more tests?

Should my lung cancer cells be tested for gene mutations that may determine my treatment options?

Has my cancer spread to other parts of my body?

What are my treatment options?

Will any of these treatment options cure my cancer?

What are the potential side effects of each treatment?

Is there one treatment that you think is best for me?

Is there a benefit if I quit smoking now?

What advice would you give a friend or family member in my situation?

What if I don't want treatment?

Are there ways to relieve the signs and symptoms I'm experiencing?

Can I enroll in a clinical trial?

Should I see a specialist? What will that cost, and will my insurance cover it?

Are there brochures or other material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

When did you first begin experiencing symptoms?

Have your symptoms been continuous or occasional?

How severe are your symptoms?

Do you wheeze when breathing?

Do you have a cough that feels like you're clearing your throat?

Have you ever been diagnosed with emphysema or chronic obstructive pulmonary disease?

Do you take medications for shortness of breath?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

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People with an increased risk of lung cancer may consider annual lung cancer screening using low-dose CT scans. Lung cancer screening is generally offered to people 55 and older who smoked heavily for many years and are otherwise healthy. Discuss your lung cancer risk with your doctor.

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Personalized cancer vaccines: A new frontier in lung cancer treatment and prevention - Mayo Clinic

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Researchers at Mayo Clinic are studying vaccines that target HER2 and MUC1, which are overexpressed in many cancers, such as lung cancer. These advances aim to prevent, treat and reduce recurrence.

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Lung cancer is the second-most common cancer and remains the leading cause of cancer death in the United States. But a variety of new treatments, many of them developed or tested at Memorial Sloan Kettering Cancer Center (MSK), are helping to bring down the number of deaths.

We recently spoke with Mark Awad, MD, PhD, Chief of MSK's Thoracic Oncology Service about the latest advances in lung cancer treatment and the advantages of coming to MSK when you are first diagnosed.

How is the treatment of lung cancer changing?

Exciting new treatments have emerged in recent years - both for early-stage tumors (stage 1, 2, or 3) that can be surgically removed, and for more advanced stage 4 lung cancers that have spread (metastasized).

Non-Small Cell Lung Cancer Advances

Advances in treating stage 1, 2, or 3 NSCLC

Non-small cell lung cancer (NSCLC) is by far the most common type of lung cancer, compared with small cell lung cancer (SCLC). When detected early, NSCLC is usually treated by surgery, and MSK offers minimally invasive options that can speed recovery. If you have early-stage NSCLC, our surgeons will remove the tumor while sparing as much of the healthy lung as possible.

At MSK, more than 90% of lung cancer surgeries for early-stage disease (stage 1) now use minimally invasive approaches such as video-assisted thoracic surgery (VATS) and robotic-assisted surgery. This usually results in less pain and fewer complications. It also enables patients who may need chemotherapy or radiation therapy to start treatment sooner.

Advances in treating stage 4 NSCLC

Many lung cancers are diagnosed at stage 4, after they have already spread to other parts of the body. For people with later-stage cancers, many new treatment options have been developed. These include new chemotherapy treatments, new targeted therapies that are matched to specific genetic mutations found within the lung cancer tumor, new immunotherapies, and novel cellular treatments.

How is MSK using genetic testing to determine the treatment for lung cancer?

We perform comprehensive genetic testing of tumors in all patients with non-small cell lung cancer. This is now a routine part of diagnosis and staging for every MSK patient with NSCLC. We are one of only a handful of centers in the world with in-house genomic testing for hundreds of potential gene mutations. This is a crucial step in the workup of lung cancer because finding the right treatment requires finding potential molecular changes causing the cancer. This is why I truly believe patients are better off when they come to MSK - to ensure that their cancer is tested with the most cutting-edge sequencing technologies available.

The analyses we do at MSK allow us to make a more nuanced diagnosis and determine the vulnerabilities of a specific cancer. Based on what we find in your tumor, we may have an approved targeted therapy that's effective against the mutations that are driving your cancer's growth. Or you may be able to join a clinical trial that is testing a new drug or combination of drugs.

How are new targeted therapies for specific genetic mutations improving lung cancer treatment?

We are getting new targeted therapies approved every year for genes that were long thought to be "undruggable." For example, the cancer gene KRAS is responsible for about one-quarter of lung cancers. Scientists had studied it for almost 40 years but were unable to develop effective treatments. But research published in 2016 by MSK physician-scientists Piro Lito, MD, PhD, and Neal Rosen, MD, PhD, showed how it was possible to target KRAS in cancer cells - a major breakthrough.

By 2021, we had approval for the first KRAS-targeting drug in non-small cell lung cancer. This drug, called sotorasib (Lumakras™), is available for adult patients with a specific mutation called KRAS G12C. Another drug called adagrasib (Krazati®) was also recently approved for these mutations.

In addition to KRAS, there are many other lung cancer genetic mutations for which we have approved treatments. They include EGFR, ALK, ROS1, BRAF, RET, MET, NTRK, and HER2. We have also found additional mutations that are responding to new drugs that are currently in clinical trials.

Our goal for people with metastatic lung cancer is to help them live much longer, with a much higher quality of life that isn't disrupted by the cancer therapy.

What's the latest on immunotherapy to treat lung cancer in 2025 and beyond?

Several forms of immunotherapy to treat lung cancer have become the standard of care or are being tested in clinical trials:

Checkpoint Inhibitors: A class of immunotherapy drugs called checkpoint inhibitors are often prescribed as an initial treatment for lung cancer, either alone or in combination with chemotherapy. We also now give immunotherapy before surgery to shrink tumors and help prevent recurrence of cancer after surgery. MSK's surgeons and medical oncologists played an important role in the first clinical trial testing the effectiveness of this approach. In many cases, that means no cancer cells are left behind after the tumor is taken out.

TIL Therapy: A new type of immunotherapy called TIL therapy is also showing promise. TIL (pronounced "till") stands for tumor-infiltrating lymphocytes, a specialized type of white blood cell. The approach involves removing TIL cells from the tumor, growing them into large numbers outside the body, and then putting them back into the patient. There, the TIL cells can seek out and destroy cancer cells anywhere in the body. In 2024 MSK lung cancer specialist Adam Schoenfeld, MD, reported results from a clinical trial showing that TIL therapy was effective in some patients with small cell lung cancer.

Lung Cancer Vaccines: We have two clinical trials testing a therapeutic lung cancer vaccine after surgery to prevent recurrence of non-small cell lung cancer. The approach is similar to a vaccine being tested in pancreatic cancer using messenger RNA (mRNA). After surgery, tumor samples are used to design a personalized vaccine based on the specific mutations in the individual patient's cancer. The vaccine is given along with the checkpoint inhibitor pembrolizumab to prevent the lung cancer from returning. One trial is actively enrolling at MSK, and the other will likely begin enrolling in 2025. The Olayan Center for Cancer Vaccines at MSK, recently established, will help support the development of more lung cancer vaccines going forward.

New Immunotherapy Treatments for Small Cell Lung Cancer

For small cell lung cancer (SCLC), which is less common than NSCLC, immunotherapy is now added to standard drugs. In addition to checkpoint inhibitors, a new immunotherapy drug called tarlatamab (Imdelltra™) was recently approved for SCLC. It targets a protein on cancer cells called DLL3.

Physician-scientist Charles M. Rudin, MD, PhD, has been at the forefront of developing and testing new SCLC treatments. A collaboration between the lab of Dr. Rudin and radiochemist Jason S. Lewis, PhD, has led to a new imaging technique that detects DLL3 on cells. This could help identify patients who might respond well to tarlatamab and similar drugs that target DLL3.

Early detection and screening improves lung cancer survival rates

The best way to improve the prognosis for lung cancer is early detection. According to the American Cancer Society, the overall five-year survival rate for non-small cell lung cancer is 28%. But if detected early, the rate jumps to 65%.

Smoking remains a high-risk factor for lung cancer. For current and former smokers, MSK's Lung Cancer Screening Program provides low-dose lung CT screening to current and former smokers. We hope to encourage more people to take advantage of this important screening tool, which is still greatly underused.

Our researchers are investigating other new methods for early detection:

A team led by MSK thoracic surgeon Gaetano Rocco, MD, is testing a screening method known as "E-nose." Still in an experimental phase, this device detects certain chemical compounds in a person's breath that indicate lung cancer may be developing.

Our researchers are helping to develop noninvasive tests known as "liquid biopsies," which can detect the presence of cancer cells, or DNA from these cells called circulating DNA (ctDNA), that may linger after surgery. Liquid biopsies are already used in the treatment of stage 4 lung cancers, which produce high levels of ctDNA. Because early-stage lung cancers do not shed much DNA, thoracic surgeon James M. Isbell, MD, is leading a trial of a liquid biopsy test that analyzes the entire cancer cell genome. It looks for multiple genetic variants on the same fragment of ctDNA. This greatly increases the power of the test, enabling it to conclusively identify cancer DNA even in the tiniest amounts.

We are still in the early days of these newer approaches, but they could make a huge difference in early detection - in 2025 or beyond. If these tests could be routinely offered by primary care physicians, they would catch many lung cancers when the disease is easier to treat.

Overall, it's an exciting time, and we've seen tremendous progress in the treatment of lung cancer. My colleagues and I are exclusively focused on treating this disease, and even within lung cancer, there are important advantages to going to a place with subspecialization based on the different genomic subtypes. MSK has always been at the forefront of exploring new approaches to save more lives and improve their quality.

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New Lung Cancer Treatments Aim to Reduce Deaths in 2025 and Beyond

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Learn about the latest advances in lung cancer treatment at MSK.