Women experience lung cancer differently than men do. Narjust Florez, MD, and Isabel Preeshagul, DO, MBS, addressed women’s concerns during our May #TogetherSeparately livestream. Dr. Florez is Associate Director of the Cancer Care Equity Program and thoracic medical oncologist at Dana-Farber Brigham Cancer Center.
Watch the recording below.
Nine years ago, in January 2015, Donna Preston was diagnosed with stage 4 lung cancer. Her only symptom was a cough that wouldn’t quit.
“I really wanted to just live my life and keep things normal,” Donna said. “At the time I was diagnosed, my five children were 9-18 and it was a scary time for them. We were always honest with the kids but we also kept life running as normal. Family and friends were understanding and supportive.”
Donna found out her tumor tested positive for ALK mutation. “I knew nothing about genetic mutations like ALK,” she explained. “I was devastated when I was first diagnosed at stage 4 and I thought I would never get to see my children grow up. But as my doctor explained my genetic mutation and how we can manage it, I realized that I did have a future. Nine years later, I am still here and going strong. I was able to see my oldest daughter get married last year!”
“I know that if the targeted therapy medication I’m currently using fails and the cancer spreads there are more medications that I can use. Cancer research continues to advance new treatment options.”
> Learn about genetic mutations and biomarker testing
> Find a patient support group
> Donate to fund lung cancer research
The FDA recently approved alectinib as adjuvant treatment for patients after surgical removal of early stage (IB-IIIA) anaplastic lymphoma kinase – positive (ALK+) non-small cell lung cancer (NSCLC).
ALK rearrangements occur in approximately 5% of patients with NSCLC. Adjuvant treatment is therapy given after surgery to prevent the cancer from returning. Despite the development of targeted therapy specific for ALK+ NSCLC, chemotherapy was the recommended adjuvant treatment for patients after surgery. The Alina trial was a Phase 3 clinical study in which 257 patients with early stage ALK+ NSCLC received alectinib (an oral therapy for ALK+ cancer) or chemotherapy after surgery1. The results showed that 93.8% of the patients in the alectinib group were alive and free of cancer at 2 years compared to 63% of the patients who received chemotherapy alone. The brain is a common site of metastases after surgery and alectinib was also able to significantly control the spread of disease to the brain. alectinib was well tolerated with no new safety concerns.
This is the first targeted therapy approved for use after surgery for ALK+ lung cancer without the need for chemotherapy. This is an important advancement because it allows patients to be treated with a therapy that specifically targets ALK without the added side effects of chemotherapy. The results are early so it will be a while before it is known whether patients live longer because of the treatment. Patients were treated for 2 years with alectinib, so another outstanding question has to do with the optimal length of treatment. This trial also brings up the importance of molecular testing of lung cancer even when it presents at an early stage.
There will be updates on the results of the Alina trial over the next few years. There will also likely be attempts at answering outstanding questions such as how long to treat patients. Look for adjuvant trials that will evaluate targeted treatment in other types of lung cancer. There is also an interest in evaluating targeted therapy before surgery is done. This approach is called neoadjuvant treatment. Clinical trials are ongoing in this area.
1 New England Journal of Medicine, Volume 390, pages 1265-1276, 2024
NEW YORK, NY (April 30, 2024) – The Lung Cancer Research Foundation (LCRF) has expanded its Scientific Advisory Board (SAB) by five new members. Led by Katerina Politi, PhD, Professor of Pathology and Internal Medicine, Yale School of Medicine, the Scientific Advisory Board’s primary purpose is to review, evaluate and select lung cancer research proposals worthy of financial investment. In addition, members of the SAB provide opinion and guidance on relevant lung cancer data.
“We are honored and delighted to have these exceptional lung cancer experts join our SAB,” commented Dr. Politi. “Advancing the most promising science in lung cancer is of utmost importance to the SAB and we are thrilled to have these leaders committed to fostering lung cancer research join the Board. This expansion is an important step as we work towards meeting our current strategic objective of tripling LCRF’s research investment by the end of 2024 and meeting our future strategic priorities.”
LCRF’s newest members of its Scientific Advisory Board:
Shirish M. Gadgeel, MD
Chief of Division of Hematology and Oncology,
Associate Director, Henry Ford Cancer Institute/Henry Ford Health
Dr. Shirish Gadgeel is the Chief of Division of Hematology/Oncology at Henry Ford Health. A medical oncologist by training, his area of interest is lung cancer research in general and drug development in lung cancer, in particular. He has conducted and participated in many lung cancer-specific trials and in phase I trials, including investigator-initiated trials based on laboratory research. Dr. Gadgeel has also been a principal investigator of a Southwest Oncology Group trial, S0528, S1507 and NCI protocol 7389 and co-author on major phase III trials ALEX and Keynote 189 which changed the standard of care. He has also engaged in many epidemiologic studies in the field of lung cancer, publishing on features of lung cancer in African Americans and in young patients. He served as the co-leader of the Molecular Therapeutics Program of the Core Cancer Center Grant of Karmanos Cancer Institute before joining University of Michigan and was the site PI for the NO1 grant awarded to the California Cancer Consortium. Subsequently, he was co-leader of the Thoracic Oncology Research Program and the Mary Lou Kennedy Research Professor in Thoracic Oncology at the University of Michigan prior to joining Henry Ford Cancer. Dr. Gadgeel’s clinical research experience spans 20 years. He is a member of the steering Committee of the Lung Cancer Committee of Southwest Oncology Group (SWOG). In addition, he is a member of the Editorial Board of Clinical Lung Cancer and a reviewer for many journals including New England Journal of Medicine, Journal of Clinical Oncology, Lancet Oncology and Journal of Thoracic Oncology. He has served as faculty for the annual meeting of the American Society of Clinical Oncology (ASCO) and as a member of the Education Committee of ASCO, as well as a member of the Career Development Committee of the International Association of Study of Lung Cancer (IASLC). Dr. Gadgeel received the NCI Cancer Clinical Investigator Team Leadership Award in 2012.
Aaron Hata, MD, PhD
Assistant Professor of Medicine
Massachusetts General Hospital, Harvard Medical School
Dr. Aaron Hata is an Assistant Physician in Hematology-Oncology at Massachusetts General Hospital and Assistant Professor of Medicine at Harvard Medical School. He is Principal Investigator of a translational and basic research laboratory in the MGH Krantz Family Center for Cancer Research. Dr. Hata’s research focuses on understanding mechanisms of drug sensitivity and resistance to targeted therapies for lung cancer. His group has discovered mechanisms of clinical acquired drug resistance in EGFR, ALK, ROS1, RET and KRAS-driven lung cancers, and he has played an instrumental role in the development of novel therapeutic approaches for overcoming drug resistance. His research has also yielded important insights into how tumor cells persist and evolve during therapy. Dr. Hata received his MD and Ph.D. degrees from Vanderbilt University and completed an Internal Medicine residency at Brigham and Women’s Hospital and Medical Oncology fellowship at Dana Farber Cancer Institute and Massachusetts General Hospital. Dr. Hata is also an Associate Member of the Broad Institute of Harvard and MIT, an Investigator in the Ludwig Center of Harvard, and a member of the Dana Farber Harvard Cancer Center Lung Cancer SPORE. In 2023, he was elected to the American Society for Clinical Investigation. Dr. Hata is also a 2012 grant recipient of LCRF’s legacy organization, United Against Lung Cancer (UALC).
David MacPherson, PhD
Professor, Human Biology Division
Fred Hutchinson Cancer Center
Dr. David MacPherson’s lab applies genomic approaches and in vivo models to understand the molecular underpinnings of small cell lung cancer (SCLC). His lab studies patient tumor samples and employs genetically engineered mouse (GEM) models as well as patient-derived xenograft (PDX) models in their interrogation of genes that drive SCLC initiation and progression. They also employ GEM and PDX models in efforts to understand and improve responses to novel and to standard therapies, with an eye towards clinical translation. Dr. MacPherson co-leads the Fred Hutch Cancer Center Lung Program, and he co-leads a Lung Cancer NIH SPORE project focused on inhibition of the LSD1 demethylase in SCLC and translation of this therapeutic approach to the clinic. He is a member of the SWOG Lung Committee and member of the Gene Regulation in Cancer NIH Study Section. Dr. MacPherson is also an Affiliate Associate Professor in the Department of Genome Sciences at the University of Washington. He is committed to training and teaches an introductory graduate course, MCB539, The Biology of Neoplasia.
Taofeek Owonikoko, MD, PhD
Marlene and Stewart Greenebaum Professor in Oncology & Executive Director
University of Maryland Greenebaum Comprehensive Cancer Center
Taofeek K. Owonikoko, MD, PhD, is the Marlene and Stewart Greenebaum Professor in Oncology at the University of Maryland School of Medicine and the Executive Director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center at the University of Maryland Medical Center. He also holds the role of Senior Associate Dean of Cancer Programs at the School of Medicine and the Associate Vice President of Cancer Programs at the University of Maryland, Baltimore. A translational physician-scientist, board-certified in Medical Oncology, Hematology, and Internal Medicine, he has a clinical focus on the management of patients with lung cancer. His research interests span the spectrum of preclinical experimental therapeutics, biomarker discovery, and translation of promising laboratory findings into lung cancer clinical trials.
He is currently an elected member of the Board of the American Society of Clinical Oncology (ASCO) and the Treasurer-Elect of ASCO. He serves as an Editorial Board Member for several highly regarded academic journals including Cancer, Journal of Thoracic Disease, and Translational Lung Cancer Research. Dr. Owonikoko is a member of the American College of Physicians, American Society for Hematology, the Society for Immunotherapy of Cancer, and the International Association for the Study of Lung Cancer. Lastly, he has been an NIH Study Section Member for the past 11 years and is a chartered member for the NIH Clinical Oncology Study section.
Dr. Owonikoko has authored/co-authored more than 250 peer-reviewed original manuscripts including reports of original research in leading journals such as the New England Journal of Medicine, Lancet, Cell, Science, Nature, JCO, Lancet Oncology, Cancer Discovery, and Cancer Cell. His work has been broadly cited with more than 50,000 citations and an h-index of 85. He has received peer-reviewed extramural grant funding in support of his research from the US National Institutes of Health, Department of Defense, private foundations, and pharmaceutical partners.
Rocio Sotillo, PhD
Professor, Faculty of Medicine, Heidelberg University
Head of the Division of Molecular Thoracic Oncology
German Cancer Research Center, DKFZ
Dr. Rocio Sotillo, a Pharmacist from the University San Pablo-CEU in Madrid, made significant contributions to cancer research during her Thesis at the Spanish National Cancer Center (CNIO) and her postdoc at Memorial Sloan Kettering Cancer Center. Her work illuminated the roles of cyclin dependent kinases and mitotic checkpoints in tumor development.
In 2010, she established her lab at the EMBL-Mouse Biology Unit in Italy, funded by the Howard Hughes Medical Institute (HHMI) and the European Research Council (ERC). In 2015, she became a full Professor at the German Cancer Research Center, focusing on understanding the mechanisms that drive lung and breast cancer development, progression, and therapy response. Her recent achievements include developing unique mouse models to induce different oncogenes in somatic lung epithelial cells in vivo using CRISPR/Cas9 that will serve as preclinical models to study the most efficient combinational therapies in lung cancer. Dr. Sotillo is a 2009 grant recipient from LCRF’s legacy organization, United Against Lung Cancer (UALC.)
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About the Lung Cancer Research Foundation (LCRF)
The Lung Cancer Research Foundation® (LCRF) is the leading nonprofit organization focused on funding innovative, high-reward research with the potential to extend survival and improve quality of life for people with lung cancer. LCRF’s mission is to improve lung cancer outcomes by funding research for the prevention, diagnosis, treatment, and cure of lung cancer. To date, LCRF has funded 419 research grants, totaling nearly $44 million, the highest amount provided by a nonprofit organization dedicated to funding lung cancer research. For more information about the LCRF grant program and funding opportunities, visit LCRF.org/research.
By Joanne Gaget
April 2024
So how did I get lung cancer? Well, if you’re a lung cancer patient like me, I’m certain that this all too common question has played over and over in your mind as well; much like an endless repeat of a badly broken record (and yes, in light of today’s technology I am unabashedly dating myself here)! Walking back through the last six decades of my life, I reflected on the remarkable strength of my respiratory system and the fact that I never had a cough…except when I contracted the first variant of Covid in 2020. Oh and yes, there was that one time I had bronchitis due to an issue with mold. Moreover, I had always taken excellent care of my general health, staying fit and eating an exceptionally well, pesco-pollo vegetarian diet, in addition to long-held restrictions on processed, fast foods and sugar. So what gives?
Following my diagnosis, I came to understand that in general there is an assumption of guilt and shame that accompanies a diagnosis of lung cancer, especially for smokers and former smokers. But what about the never smokers? Why are they unceremoniously lumped into this mark of disgrace? Having dwelled in this self-sabotaging space as a former smoker, I too have put myself through these paces, questioning everything in a fruitless plight to identify exactly where I went wrong. I thought….
My lung cancer journey began back in February 2021, by happenstance. I didn’t have any of the classic symptoms, other than I didn’t feel well and I was unusually tired. I reluctantly caved to a trip to the local emergency room for what appeared to be an abdominal hernia or aneurysm. The physician ordered an angio CT scan that revealed a lung mass in the upper lobe of my right lung, which lucky for me was not accompanied by a suspected aortic aneurysm. After many consultations and further testing, it was agreed that the first phase of my cancer treatment plan was to remove the upper right lobe using robotic assisted surgery.
In determining staging, it is now customary to send the tumor specimen for additional testing of genetic mutations, as lung cancer can be managed for many patients with targeted therapy or immunotherapy, in addition to traditional chemotherapy and radiation. If you happen to come up positive as I did, it was said that this finding was like winning the lottery…although I must admit that I didn’t quite feel the sort of exuberance one might expect. However, I did feel that a bit of my Irish luck had come back my way, in the sense that I would be given yet another weapon in my arsenal. In reading and re-reading the pathology reports through a broad range of emotions, I came to better understand my diagnosis of non-small cell lung cancer, subtype adenocarcinoma with a positive EGFR (epidermal growth factor receptor) exon deletion 19 mutation. Patients, in particular females with this type of lung cancer, tend to have minimal or no smoking history and currently represents about 10-15% of lung cancers in the United States (although interesting is this subtype is significantly more prevalent in the Asian populations).
Since my cancer had spread to a lymph node and invaded the visceral pleura, my second phase of treatment was chemotherapy (4 rounds of Cisplatin/Carboplatin and Alimta), followed by the third phase of targeted therapy with the medication Tagrisso, a tablet taken daily for up to 3 years. I dove head first into reading and understanding all that I could get my hands on about my disease, which included all published works on many other genetic mutations and respective treatments related to lung cancer. What I learned more importantly is that lung cancer is the leading cancer killer of both men and women in the United States, causing more deaths each year than colon, breast and prostate cancers combined. Yet awareness of this fact is low, and lung cancer does not have nearly the resources, support and public empathy that many other diseases have. This is likely due in large part to the strong, pervasive stigma associated with lung cancer.
Given all of my efforts in retracing time, place, behaviors and events, I now know that I will never come to understand precisely whether my cancer was the result of one cause or a combination of factors, including the genetic mutation. With that conclusion, I chose not to waste precious time beating myself up over my past personal choices or environmental circumstances that were beyond my control. In keeping with self-care, I chose to focus my energies on the big business of living in peace and gratitude with the finest human being I’ve ever known…my extraordinary husband Bruno, along with my strong faith in God, who mercifully guides my every step. In feeling enormously blessed by the love, support and connection to family, friends, healthcare providers, the staff at Ann’s Place and to those who travel alongside me or similarly, I remain committed to being a voice, no matter how small, in creating awareness wherever and whenever an opportunity arises. Like so many, I too once harbored ill-informed perceptions about the causations of lung cancer. But today, with the recent advances in treatment, this widespread cancer is not an immediate death sentence, nor should it be perceived as a well deserved punishment for every lung cancer patient in equal measure. Through compassion and education we can all do our part to banish the stigma against those most in need of our sincerest empathy regardless of smoking status, thus leaving painful and wrongful judgments forever a notion of the past.
Patients, caregivers, and others interested in lung cancer research gathered at The RiverMarket Kitchen and Bar in Tarrytown, NY on April 13 to hear about the latest developments and important topics in lung cancer. LCRF Together New York offered an opportunity for the community to connect while learning about promising therapies for treatment.
Brendon Stiles, MD, and Balazs Halmos, MD, MS, from Montefiore Einstein Comprehensive Cancer Center had a lively discussion with the group and moderator Isabel Preeshagul, DO, MBS, Memorial Sloan Kettering Cancer Center. Dr. Stiles is the Vice Chair of LCRF’s Board of Directors and Scientific Advisory Board, Dr. Preeshagul is the Chair of LCRF’s Education & Engagement Committee, and Dr. Halmos is a previously funded LCRF researcher.
The panel began with an important discussion around lung cancer screening – why it’s so essential to be screened if you are eligible, and their strategies for increasing awareness and screening rates in their own practices. Early-stage lung cancer was the subject of some especially compelling conversation, particularly around recent studies that provide practice-changing guidance around how we treat early-stage disease using neoadjuvant therapy.
The speakers also touched upon the role of next generation sequencing (NGS) testing in the early-stage setting and how that can impact care. With the approval of adjuvant osimertinib based on the ADAURA data and new ALINA data published in the New England Journal of Medicine (NEJM) for those harboring ALK fusions, the importance of NGS testing regardless of staging is becoming increasingly imperative. The event closed out with updates on targeted therapies and antibody drug conjugates, and excitement around what’s coming down the pipeline for small cell lung cancer. As always, those gathered had many insightful questions, which also provided an opening for getting to know others in the lung community.
Dr. Stiles shared his excitement around the incredible progress in lung cancer treatment during the last decade, highlighting the critical role that LCRF and the research we have funded over the years has contributed to these significant advancements and improved outcomes for patients.
“Gatherings like this one are so essential for the lung community because not only are we are able to learn from experts in the space but more importantly hear from patients, caregivers and advocates the true needs and areas where we can be most impactful.”, said Dr. Preeshagul.
Be on the lookout for other events happening near you, as well as our #TogetherSeparately livestream talks.
Special thanks to our sponsors:
Bristol Myers-Squibb | Genentech, a member of the Roche Group
April 2024
Caroline, a nurse practitioner who lives in Louisiana, was more familiar with lung cancer than she cared to be. “About 15 years ago, my maternal aunt was diagnosed with stage 4 lung cancer – in her 40s – and died a year later. And she was a never smoker, very healthy,” she explained.
“We all thought, ‘okay, that’s random.’ Fast forward to 2021, my maternal grandmother was also diagnosed with stage 4 lung cancer. Another never smoker. Thankfully, my grandmother lives in Houston and got into MD Anderson. They mentioned the EGFR mutation, so she got tested and was positive. That led to my mom getting tested – she tested positive for the gene. Then I tested positive.”
Her mother, who lives in New Jersey, was treated at Memorial Sloan Kettering for stage 1 lung cancer. “I actually was pregnant at the time she had her surgery. After I had my baby, I had my first CT scan, which showed all the nodules.”
Fortunately, Caroline had already decided that if she needed treatment, she wanted to go to her mom’s thoracic surgeon. “I had surgery in October 2022, and I actually had a lot of complications. I had a chest tube for two months, and I had to go back to the operating room twice,” she said. “Even though I loved my team at MSK, I live in New Orleans. I’m going to need surveillance for the rest of my life, and it’s too far away.”
Caroline found a thoracic surgeon at MD Anderson, and is very happy with her new medical team. She undergoes screening every 6 months to monitor her remaining nodules.
To cope with the uncertainty, “I surround myself with a strong network of family and friends,” she said. “I focus on the present by finding joy in small daily activities and cherishing any positive moments.” She is especially grateful for her husband, her two young boys, and her family and friends.
“My husband has always been by my side and able to advocate for me when I physically or mentally was unable to myself. I am also fortunate to have a large group of girlfriends from my hometown that are still my best friends. We get together often and talk daily through a group chat. I am impressed and blessed with how supportive they have been – visiting me while I was in the hospital, helping with my kids, and always there for advice or if I needed to vent.”
As a urologic oncology NP, Caroline is keenly interested in research developments. Dr. Geoff Oxnard, a thoracic medical oncologist in Boston, has developed techniques in cancer genomics and has a special interest in the EGFR T790m germline mutation. When Caroline found out she had the mutation, she decided to fly to Boston and meet with him.
“He’s the one who really inspired me to get involved. He told me that as a doctor, he can only do so much to raise awareness… it’s going to take a patient to share their story and get the word out.”
> Learn more about biomarker testing
> View the web series, Your Path Forward after a Lung Cancer Diagnosis
For our April #TogetherSeparately livestream talk, Julia Rotow, MD, and Isabel Preeshagul, DO, MBS, discussed resources available to patients and caregivers, assembling and managing a care team, and questions to ask at appointments. Dr. Rotow is Clinical Director, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, and Assistant Professor of Medicine, Harvard Medical School.
Watch the recording below.
The FDA recently granted approval to tepotinib for the treatment of advanced non-small cell lung cancer (NSCLC) with MET exon 14 skipping alterations.
MET alterations occur in 3-4% of patients with NSCLC, and those alterations are responsible for driving the development of the cancer. Patients who have MET exon 14 skipping alterations are typically older individuals at 70 years or greater. The Vision trial was a Phase 2 study that evaluated tepotinib in different groups of patients. In those with exon 14 skipping alterations who were not previously treated, 57% had at least a 50% shrinkage of their cancer, and the control of the disease lasted for a median of 46 months. For patients who had previously received treatment, the response rate was 45%, and in many the cancer control lasted for more than 12 months (JAMA Oncology, Volume 9, pages 1260-66, 2023). The drug was also beneficial for patients with brain metastases. The treatment was well tolerated with leg swelling as the most common side effect.
Tepotinib represents an effective oral treatment for patients with advanced MET exon 14 mutated NSCLC. This is particularly important since these patients tend to be older individuals. Prior to this advancement, chemotherapy had been the standard treatment. This also emphasizes the value of doing biomarker testing to evaluate newly diagnosed lung cancer patients for abnormalities such as MET exon 14 skipping mutations so that the appropriate treatment can be prescribed. It is interesting to note that the Vision trial also allowed the use of liquid biopsy (blood sample) to detect the MET alteration.
Research continues to be done involving tepotinib as well as other novel MET inhibitors. It is important to note that these agents are being tested in other MET abnormalities in addition to the MET exon 14 skipping alterations. There is always room for improvement for these patients to extend their survival.
Read about LCRF grantees who currently are working on MET-related projects:
Meet the newest member of LCRF’s science team, and hear a quick update on the foundation’s research program as well as news from the lung cancer space. Watch the video below.
Featured:
Aubrey Rhodes, LCRF Executive Director
Dhru Deb, PhD, Senior Director, Research & Administration
Antoinette (Toni) Wozniak, MD, Chief Scientific Officer
