Deborah Howell (Host): Hello and welcome to the show. You’re listening to the Weekly Dose of Wellness brought to you by MemorialCare Health System. I’m Deborah Howell and today’s guest is Dr. Robert Nagourney. He is board certified in internal medicine, medical oncology and hematology, and practices at Long Beach Memorial. Doctor Nagourney is also the founder of Rational Therapeutics, where he pioneered the use of functional profiling to create the world’s first personalized cancer therapy program. Welcome, Dr. Nagourney.

Dr. Robert Nagourney (Guest): Thank you very much.

Deborah: Today’s topic is lung cancer. Of course, two words no one wants to hear. So, let’s start at the beginning. What exactly is lung cancer?

Dr. Nagourney: Well, you see, the lung is exposed to the outside world. We breathe in and out 15, 20 times a minute and if we smoke cigarettes, or expose to toxins, the cells within the lining of the lungs can become changed ultimately to malignant cells. And these are cancers that arise from a lining of the lung.

Deborah: So, what are the signs and the symptoms of lung cancer?

Dr. Nagourney: Most commonly, patients will complain initially of cough. It can be shortness of breath, and often in the later stages, a patient will say that they’ve coughed up a small amount of blood. Deborah: Okay, anything else?

Dr. Nagourney: Well, as the disease progresses, chest pain. And as the symptoms worsen, weight loss; a very common problem in lung cancer patients is rapid and almost irreversible weight loss.

Deborah: Wow. Okay. Now, what are the causes and the risk factors besides smoking for lung cancer, or is that really the only one?

Dr. Nagourney: Interestingly, lung cancer is a changing disease. In the past, when cigarette smoking was more common, one type of lung cancer, known as squamous cell, was a predominant type. Then we find a new biology, where adenocarcinoma, glandular cancer is becoming more common. And also, interestingly, there are a substantial number of 15 to 20 percent of patients with lung cancer who themselves have no known history of exposure. They’re non-smokers very often, they’re young and very often they’re women. And these are cancers given by genetic factors that we’re coming to understand.

Deborah: So, let me ask you a question. If my mother smoked heavily and had lung cancer and I never smoked a cigarette in my life, am I prone to it?

Dr. Nagourney: Well, there is exposure to secondhand smoke, and that is most likely, again, a toxin that could cause it. Clearly, it’s preferable to have secondhand smoke to smoking full-on cigarette habit. But, yes, that is a risk.

Deborah: I was actually speaking to the genetic pattern, not actually the exposure to smoke.

Dr. Nagourney: Well, yes, there’s also predisposition at the genetic level. In that regard, those are relatively weak; as I mentioned, there is a small number of people who have a cancer driven by a mutation, but we think those are somatic mutations, mostly arriving in the individual, not from their parents.

Deborah: Okay, got it. What’s the average survival rate for someone diagnosed with lung cancer?

Dr. Nagourney: Well, obviously lung cancer survival is highly dependent on how late stage it is at diagnosis. If it’s early stage, if it’s a small nodule and removed surgically, patients can have 70 to 80-plus percent chance of survival. That’s why we’re so interested in early detection. However, as the disease progresses, in about half of patients present with inoperable disease, at that point if it is already spread, the survival is measured usually at about one year.

Deborah: One year. Okay. And you can keep the patient comfortable for that year?

Dr. Nagourney: Oh, absolutely, I mean, comfort management is becoming increasingly good, but my goal as a therapist is not to comfort the patient so much as to cure him.

Deborah: Okay. Well, we are living at a good age for that.

Dr. Nagourney: And better and better.

Deborah: Which brings me, of course, to my next question. What are the latest advancements in the treatment of lung cancer?

Dr. Nagourney: I think recognizing that lung cancer is not a disease, but many diseases, and that each patient and each disease may require a different form of therapy. At the first level, we know now that squamous cells, which I mentioned earlier, and adenocarcinomas may have somewhat different biology. So, that’s the first level. Secondly, we know that about 15 to 20 percent of lung cancers carry specific targetable mutations, and if there is any really exciting breakthrough, it’s recognizing these mutations and secondarily, developing drugs that are highly specific for those mutations. These would be drugs like crizotinib, known as Xalkori, or the drug erlotinib, known as Tarceva. These are highly effective, but only in those patients who have the exact target. The final point, and interestingly we’ve just published a paper in October, is that each patient even with conventional chemotherapy can be better matched if you analyze the behavior and biology of their individual tumor.

Deborah: Okay. Does lifestyle also a factor to the individual cancer treatments?

Dr. Nagourney: Well, I think that we recognize increasingly that cancer may in fact be a function of lifestyle. Our dietary habits, our exercise programs, even our sleep habits may influence our general well-being. There’s an increasing recognition; for example there’s a connection between diseases like heart disease and cancer, diabetes and cancer, obesity and cancer. And so, yes, I think lifestyle plays into this quite a lot, and preventing cancers of almost all types can be better achieved with healthy lifestyle, healthy diet, regular exercise, a good nutrition.

Deborah: And what about the role of stress?

Dr. Nagourney: I think that there’s less complete understanding of the role of stress. One of the most famous experts, the original descriptions of this, was named Hans Selye. From the University of Montreal. And he described this stress, which was where your body was out of sync because you were stressed in any level of emotional and personal way. There may well be a possibility that that can influence the levels of corticosteroids in the bloodstream, it may again influence your ability to perform exercise activities. So, yes, I think there is a general immunosuppressive quality to stress and that may increase the specific cancer [causes].

Deborah: Right. That certainly can’t help the situation. How does functional profiling work?

Dr. Nagourney: Well, we realized for many years that patients are distinct and unique. Each patient’s cancer is as unique as the fingerprint. The problem is that we have a tendency to put everyone on the same treatments or combination. What we began to be interested in is could we match patients, could we basically fingerprint everyone and look for the profile, the pattern that gave us input for drug combinations. So, what we did was take pieces of cancer patients at the time of surgery, not even in the laboratory, and then measure which drug resulted in greatest effect. We then used those drugs, in the particular study that I mentioned, and we doubled the response and nearly doubled the survival in this population.

Deborah: So, when you’re talking about doubling the survival rates, what kind of figures are we looking at?

Dr. Nagourney: In extent of 20 months on average, and here, as I mentioned, the best literature in the world today is 13.5 months. So, we’re pushing towards a two-fold improvement and that’s not by using new drugs or new combinations. It’s really entirely by reshuffling the same deck of cards. All we did was to play the same drugs in combination; we just matched them to the patients individually.

Deborah: Well, that would make sense, because a child of four with leukemia would certainly require a different set of parameters than a 50-year-old female.

Dr. Nagourney: Not only that, but two children of four with leukemia would each require a different treatment.

Deborah: Exactly. Well, it’s wonderful that you’ve been able to do this fingerprinting and profiling. What else would you like our audience to know today about functional profiling and their chances of a cure in case they are diagnosed with lung cancer?

Dr. Nagourney: Well, I think, first of all, lung cancer patients have to realize this is not hopeless. And then when they are diagnosed, instead of worrying about the bad outcome that they anticipate, they should seek out the expertise of people at good centers conducting smart treatments. Secondly, I think that people should recognize the technique such as genetic profiling or a functional profiling and provide very useful information on the selection of treatments. And finally, patients should realize that they have a part in their own good outcome, if they maintain a smart lifestyle, remain active, eat well, maintain good micro-nutrition and also have a good spiritual and personal take on their disease; they have much better chance of surviving this rather dreaded problem.

Deborah: We are really looking more at the whole person these days, aren’t we?

Dr. Nagourney: Absolutely.

Deborah: It’s not just the function of symptoms, and it’s not just the function of drugs; it’s really a whole regimen, beginning with eating, lifestyle, stress reduction, the wonderful new medications that are out and really sticking to the plan, right?

Dr. Nagourney: Yes, I would say that the patients have a much larger role in their own good outcome than they’ve ever realized. You were mentioning earlier stress. If a patient is emotionally and spiritually prepared to respond to their disease, I guarantee they will do better.

Deborah: Well, it's been very heartening to speak with you. I want to thank you so much for all your work and your development of new ideas, new technologies, looking at the whole person; it’s certainly a better age to be a cancer patient, especially a lung cancer patient in the year 2013 than it has been in the past, for sure.

Dr. Nagourney: I couldn’t agree more.

Deborah: We’ve been speaking with Dr. Robert Nagourney about advances in lung cancer treatment. I hope you’ve learned something you can share with friends and family members. Thank you so very, very much. Again, Dr. Robert Nagourney, he’s board certified in internal medicine, medical oncology and hematology and practices at Long Beach Memorial. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. I’m Deborah Howell. Have a great week.