Earlier detection and new treatments are bringing hope to thousands at risk of an suffering from lung cancer. Here's how one surprising new treatment is amazing doctors around the world.
When Ann Long, from Liverpool, started smoking at about 17, she never imagined that she was putting herself in danger.
In the years after cigarettes first became popular, tobacco companies campaigned furiously to cast doubt on findings about a lung cancer-smoking link. And it worked. By the time the evidence was so overwhelming that all doubt was gone, the seeds of cancer had been planted in millions of lungs—dormant, sometimes, for decades, but almost always deadly.
In 1976 Ann, by then a mother of six mostly school-aged children, lost her husband George, a heavy smoker, to lung cancer. And although she smoked far less and gave up entirely before 1993, Ann herself got the terrifying diagnosis late in 2003.
Today, dread haunts the minds of many women, smokers as well as ex-smokers: Will I get it too?
Early detection is crucial
Lung cancer accounts for about 20 per cent of all cancer deaths in Europe. In the UK and Poland, where women started smoking earlier than in most other EU countries, it might soon overtake breast cancer as the leading cause of cancer mortality in women.
Although smoking is behind the vast majority of lung malignancies—90 per cent in men and 80 per cent in women—exposure to certain substances, including asbestos, radon and diesel fumes, can also increase risk, as can genetic mutations. Genes are often to blame when the illness strikes younger people, says Dr Rafael Rosell of the Catalan Institute of Oncology, Barcelona. And genes help determine which treatments work best for each individual.
It’s detecting cancer early, before it’s had a chance to spread, that gives individuals the best chance of long-term survival. In recent years there’s been a push to screen for early signs with annual low-dose CT scans for those at increased risk.
A large study in 2011 found that early detection via such screenings resulted in a 20-per-cent reduction in lung-cancer deaths, thanks to quick treatment.
Screening is important because often, at the early stage, people will have no symptoms at. Others might have vague symptoms such as a cough, shortness of breath or weight loss that can easily be dismissed.
Just a cough?
It was a vague symptom—one she could easily have ignored—while brushing her teeth that sent Ann Long to the doctor.
“As I was rinsing my mouth out, I saw a little spot and it looked a bit like an amoeba,” recalls Ann. She noticed that this “spot” had a tiny red speck at its centre. She’d recently developed a slight cough, but otherwise she felt as fit as ever. Nevertheless, she made an appointment with her GP, who sent her for an X-ray, followed by a CT scan and a bronchoscopy (an ultrasound-guided procedure to see lesions in the lung and lymph nodes).
About a week before Christmas, she got the bad news. And she thought back to how devastating losing her husband George had been for her family. She remembers, “How was I going to tell my kids?”
On January 3, 2004, Ann had half her left lung removed and has been cancer-free since. Surgery is often a good option for people whose cancers are detected early, as Ann’s was. And a newer, less-invasive type of operation, video-assisted thoracic surgery, lets surgeons remove diseased tissue with a much smaller incision, reducing trauma and recovery time.
However, if the cancer is metastatic, meaning it’s spread to other parts of the body, surgery might not always be the best therapy. But there are numerous treatments today that can prolong life even in people with more advanced cancers.
The new approach
“We’ve changed quite a lot in how we think about lung cancer,” says Dr Mina Gaga, medical director of the Athens Chest Hospital, Greece.
“When people have a good health status then it’s worth trying all types of therapies because people may respond quite strikingly.”
Standard chemotherapy drugs and radiation can slow a tumour’s growth, shrink tumours and kill cancer cells. These therapies are often used after surgery to mop up any malignancy that might have been missed and are also typically the first-line treatments used for more advanced tumours when surgery isn’t feasible.
It’s been found that precision or personalised chemotherapy can help. Just like normal cells, cancer cells need “growth factors”—hormones, proteins and other substances that occur naturally in all of our bodies—in order to thrive.
“We do a genetic analysis of tumour tissues,” says Dr Eric Haura, a physician-scientist at the Moffitt Cancer Centre, Florida. If this shows that a cancer is being fuelled by particular growth factors, targeted drugs can block the cancer cell from accessing its “fuel” source.”, says Dr Haura.
He points out though that these drugs aren’t cures, as cancers eventually develop resistance to these and other drugs.
New drugs, tailored to the mutating cancer, can in some cases replace the ones it’s developed resistance to. These are designed to behave like a super-charged version of your body’s own immune defences. The two most used are bevacizumab or cetuximab. Each blocks cancer cells from growing by denying access to the growth factors they need.
Current immune therapies only benefit about 20 to 30 per cent of lung-cancer patients. But when they do work, the results can be amazing. “In some cases, most of the tumour goes away,” says Dr Haura. And the effects can sometimes last for years.
A breakthrough vaccine
One of the most promising findings in the history of lung cancer is a new vaccine called CimaVax, developed in Cuba and soon to be tested on patients in the US and later in Europe. CimaVax produces an antibody that latches onto EGF, a naturally occurring growth factor. It nabs these molecules and whisks them off to the liver, where they’re eliminated before cancer cells can use them.
Without EGF, “the cancers starve and essentially stop growing”, says Dr Kelvin Lee, the chairman of immunology at Roswell Park Cancer Institute in Buffalo, New York. In tests of CimaVax on people with aggressive late-stage cancers, for those who responded to the vaccine, the average survival time was 18 months, versus only six for those who didn’t get the vaccine.
“The other amazing thing,” says Dr Lee, “is that at five years after they start the therapy, about 20 per cent of the patients who got the vaccine are still alive.” CimaVax also has virtually no toxicity, he says. “It’s just a shot in your arm once a month.
“We think the most exciting piece of this is in prevention of lung cancer. The idea, at least initially, would be to vaccinate people that don’t have lung cancer but we know are at high risk to get it.”
Dr Lee will be testing CimaVax on people with lung cancer in clinical trials in the US, sometime this year.
Put down the cigarettes
You can improve your odds of not getting lung cancer right now. If you smoke, stop. Within ten years of giving up smoking the risk of dying from lung cancer drops by half. But it won’t drop to the levels of someone who’s never smoked.
Dr Haura says: “We think that cancer is a process that began many decades before, where cells and their DNA were damaged.” As we age, our immune systems, which might protect us against the consequences of such damage for all those decades, eventually become less robust.
Nonetheless, people with lung cancer who stop smoking live about 50 per cent longer than those who continue to smoke. And the sooner you get diagnosed and treated, the better your odds.
Ann Long is a testament to all of the above. Now aged 80, more than 20 years after she stopped smoking and more than ten after the surgery to remove half her lung, she leads an active life, travels widely, exercises more than some people half her age and has a positive attitude.
But what saved her might have been her willingness to face her worst fears and go straight to the doctor. “I know from talking to people, they’re so terrified they might have cancer, they don’t go.”
When Ann thinks back to losing her husband in 1976 to the same disease, she remembers that doctors could offer him nothing other than painkillers. Medicine has progressed exponentially since then.
“I just realise how fortunate I am,” says Ann, “to be living at the time that I am.”