Each year, 220,000 Americans are diagnosed with lung cancer, making it one of the most common cancers in the United States.
However, with timely diagnosis and appropriate therapies, the disease can be effectively treated with minimal impact to quality of life.
Listen in as Karen Reckamp, MD explains City of Hope's lung cancer treatment program.
Selected Podcast
The Latest in Life Saving Lung Cancer Research And Treatment
Featured Speaker:
Karen Reckamp, MD
Karen Reckamp, MD is the Co-director, Lung Cancer and Thoracic Oncology Program
and an Associate Professor, Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA.
Transcription:
The Latest in Life Saving Lung Cancer Research And Treatment
Melanie Cole (Host): Each year, 220,000 Americans are diagnosed with lung cancer, making it one of the most common cancers in the United States. However, with timely diagnosis and appropriate therapies, the disease can be effectively treated with minimal impact to quality of life, and there is extensive collaboration between lung cancer clinicians and researchers to develop and evaluate new therapies designed to improve new survival and quality of life outcomes. My guest today is Dr. Karen Reckamp. She is the co-director of lung cancer and thoracic oncology program at City of Hope. Welcome to the show, Dr. Reckamp. Speak a little bit about what you think are the most exciting and innovative research and techniques going on in the lung cancer world today.
Dr. Karen Reckamp (Guest): At this time in lung cancer, we’re exploding in our knowledge of the biology of lung cancer, and that includes both genomic aspects—so the genes that are involved with the development and progression of lung cancer—and also the immune system and its relationship to lung cancer and the development and progression of lung cancer. So those are probably the two biggest areas of excitement in research of lung cancer right now.
Melanie: So why don’t you start with immune treatments and immune therapy? Because the immune system is seen in so many diseases today and it’s such a powerful part of our physiology. Speak about what’s going on in immunotherapy.
Dr. Reckamp: So in general, the immune system is suppressed in a person who has lung cancer, and the lung cancer has developed mechanisms to hide itself from a person’s immune system. There are new therapies now that can activate a person’s own immune system against lung cancer, so blocking these mechanisms that the cancer has had to evade the immune system. Now, most of them are antibodies. They block that evasion and activate a patient’s own immune system against the specific of the cancer that that patient has. So it’s pretty exciting. And generally in lung cancer, we don’t think of it as a highly immune type of disease, but these new therapies have shown some substantial responses in tumor shrinking, and also long-term, durable improvements for patients with otherwise incurable lung cancer. So it’s an exciting time for understanding this therapy.
Melanie: What about targeted therapies? How are they being used in lung cancer research today, and treatment?
Dr. Reckamp: Targeted therapies really get to what drives the lung cancer. Again, in the genomic era of cancer and understanding the human genome, we now know that there are specific genes that drive lung cancers. These happen more commonly in people who have had less smoking exposure, but it can happen in people with smoking exposure also. Some of these mutations are what we call driver mutations, so a specific mutation in the gene causes the growth and progression of a cancer. And when that’s the case, we have specific targeted therapies. Most of these are oral therapies. Some of them are IV, but most of them are oral. They can go in and block the cancer where the signaling is happening right inside the cell to stop the cancer growth. And there are probably about 60 percent of people with an adenocarcinoma type of lung cancer that has some specific mutation, and most of these have some specific target that can be used. And some of these are still in clinical trial and some of these are available today. And each year we have new developments and new treatments that are available for these types of targeted lung cancers.
Melanie: Now, when we’re speaking about treatment and even diagnosis, Dr. Reckamp, what about real-time tumor imaging? What’s going on that is very exciting in being able to diagnose, catch it early, and spot lung cancer?
Dr. Reckamp: One of the most important areas of lung cancer is, first, stopping smoking if you smoke. But even beyond that is finding it early. Because lungs are deep inside your body, they are difficult to biopsy and difficult to -- you don’t see anything or feel anything generally until lung cancer is far advanced. In the past year now, the US preventative task force has recommended low dose CT screening as a screening method for people with high risk of development of lung cancer. So those are patients with a history of smoking and patients over the age of 55. But if we can detect the cancers early, then we have a better chance of finding something early that can be cured. I know from a randomized trial that by doing these low-dose CT scans on an annual basis, we can improve survival from lung cancer. We can also improve overall survival from all cancers that cause mortality.
Melanie: And where does screening fit in? Who should get screened, Dr. Reckamp?
Dr. Reckamp: So right, now it’s the people that are at highest risk for developing lung cancer. Because still, when you’re getting a scan, there is a possibility of getting what we call a false positive, so that would be some kind of nodule or something that they would see on the scan that has nothing to do with lung cancer. But if found, it may need further follow up, may need biopsies, may need some kind of intervention. So the higher risk you have—and that is generally people that have a what we call 30 pack year smoking history. So somebody who’s smoked a pack a day for 30 years, that’s how we calculate the pack year. So more than 30 pack years and over the age of 55 are kind of the general guidelines for people who should get screened. And patients, people who have less than that, they have a higher risk of finding these false positives and maybe having to undergo a procedure or multiple scans that won’t end up finding lung cancer.
Melanie: And if lung cancer is diagnosed, what are some of the techniques that you’re using at City of Hope for surgery and radiation therapy to help combat the disease?
Dr. Reckamp: We are more and more able to do targeted types of treatment even with surgery and radiation therapy. So, surgery is becoming less and less invasive and smaller incisions, then robotics being used to take out tumors. And this decreases the time a person is in the hospital and improves the recovery rate for people and gets them back into their lives quickly. It used to be that people had to be in the hospital for many days to a week or more and would have to take a significant amount of time off of work, and now they’re back into their lives and into their work and what they need to be doing. For radiation, it’s a similar story. We have modalities that can do short courses of radiation effectively. So what may have taken several weeks now takes a day or several days. They can target the radiation. Of course, in the lung, as you breathe, there is movement. And radiation is targeting a specific area, and it’s much harder to target as you’re breathing and the lung’s moving. You can get radiation to areas that may not be involved with the cancer and cause damage to the lung, which we don’t want to do. So by doing these targeted therapies over short courses of time, we can improve the functioning of the lung and decrease the amount of damage that’s done, and again, improving patients’ lives.
Melanie: So in just the last minute, Dr. Reckamp, please give your best advice and hope to those listening who might have a loved one with lung cancer for the most exciting things going on there today in treatment and research.
Dr. Reckamp: The most remarkable thing to me is that we know things today about lung cancer and how it grows and how it progresses that we didn’t know even a year or two ago. So the progress is being made. We need to make more, there’s no doubt, but we will have new drugs, we are going to learn how the immune system fits into the development of lung cancer, and we may move some of these immune therapies earlier on to try and cure more people with lung cancer. And that’s always our goal. So we’re getting more targets, we’re understanding the genes and the biology, we’re understanding the immune system, and then, again by getting screening out to more and more people, hopefully we can prevent these advanced stage lung cancers. So I think there’s a lot to be excited for and a lot to hope for for people who are dealing with lung cancer, which is such a challenging disease.
Melanie: Thank you so much. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org, that’s cityofhope.org. This is Melanie Cole. Thanks so much for listening, and have a great day.
The Latest in Life Saving Lung Cancer Research And Treatment
Melanie Cole (Host): Each year, 220,000 Americans are diagnosed with lung cancer, making it one of the most common cancers in the United States. However, with timely diagnosis and appropriate therapies, the disease can be effectively treated with minimal impact to quality of life, and there is extensive collaboration between lung cancer clinicians and researchers to develop and evaluate new therapies designed to improve new survival and quality of life outcomes. My guest today is Dr. Karen Reckamp. She is the co-director of lung cancer and thoracic oncology program at City of Hope. Welcome to the show, Dr. Reckamp. Speak a little bit about what you think are the most exciting and innovative research and techniques going on in the lung cancer world today.
Dr. Karen Reckamp (Guest): At this time in lung cancer, we’re exploding in our knowledge of the biology of lung cancer, and that includes both genomic aspects—so the genes that are involved with the development and progression of lung cancer—and also the immune system and its relationship to lung cancer and the development and progression of lung cancer. So those are probably the two biggest areas of excitement in research of lung cancer right now.
Melanie: So why don’t you start with immune treatments and immune therapy? Because the immune system is seen in so many diseases today and it’s such a powerful part of our physiology. Speak about what’s going on in immunotherapy.
Dr. Reckamp: So in general, the immune system is suppressed in a person who has lung cancer, and the lung cancer has developed mechanisms to hide itself from a person’s immune system. There are new therapies now that can activate a person’s own immune system against lung cancer, so blocking these mechanisms that the cancer has had to evade the immune system. Now, most of them are antibodies. They block that evasion and activate a patient’s own immune system against the specific of the cancer that that patient has. So it’s pretty exciting. And generally in lung cancer, we don’t think of it as a highly immune type of disease, but these new therapies have shown some substantial responses in tumor shrinking, and also long-term, durable improvements for patients with otherwise incurable lung cancer. So it’s an exciting time for understanding this therapy.
Melanie: What about targeted therapies? How are they being used in lung cancer research today, and treatment?
Dr. Reckamp: Targeted therapies really get to what drives the lung cancer. Again, in the genomic era of cancer and understanding the human genome, we now know that there are specific genes that drive lung cancers. These happen more commonly in people who have had less smoking exposure, but it can happen in people with smoking exposure also. Some of these mutations are what we call driver mutations, so a specific mutation in the gene causes the growth and progression of a cancer. And when that’s the case, we have specific targeted therapies. Most of these are oral therapies. Some of them are IV, but most of them are oral. They can go in and block the cancer where the signaling is happening right inside the cell to stop the cancer growth. And there are probably about 60 percent of people with an adenocarcinoma type of lung cancer that has some specific mutation, and most of these have some specific target that can be used. And some of these are still in clinical trial and some of these are available today. And each year we have new developments and new treatments that are available for these types of targeted lung cancers.
Melanie: Now, when we’re speaking about treatment and even diagnosis, Dr. Reckamp, what about real-time tumor imaging? What’s going on that is very exciting in being able to diagnose, catch it early, and spot lung cancer?
Dr. Reckamp: One of the most important areas of lung cancer is, first, stopping smoking if you smoke. But even beyond that is finding it early. Because lungs are deep inside your body, they are difficult to biopsy and difficult to -- you don’t see anything or feel anything generally until lung cancer is far advanced. In the past year now, the US preventative task force has recommended low dose CT screening as a screening method for people with high risk of development of lung cancer. So those are patients with a history of smoking and patients over the age of 55. But if we can detect the cancers early, then we have a better chance of finding something early that can be cured. I know from a randomized trial that by doing these low-dose CT scans on an annual basis, we can improve survival from lung cancer. We can also improve overall survival from all cancers that cause mortality.
Melanie: And where does screening fit in? Who should get screened, Dr. Reckamp?
Dr. Reckamp: So right, now it’s the people that are at highest risk for developing lung cancer. Because still, when you’re getting a scan, there is a possibility of getting what we call a false positive, so that would be some kind of nodule or something that they would see on the scan that has nothing to do with lung cancer. But if found, it may need further follow up, may need biopsies, may need some kind of intervention. So the higher risk you have—and that is generally people that have a what we call 30 pack year smoking history. So somebody who’s smoked a pack a day for 30 years, that’s how we calculate the pack year. So more than 30 pack years and over the age of 55 are kind of the general guidelines for people who should get screened. And patients, people who have less than that, they have a higher risk of finding these false positives and maybe having to undergo a procedure or multiple scans that won’t end up finding lung cancer.
Melanie: And if lung cancer is diagnosed, what are some of the techniques that you’re using at City of Hope for surgery and radiation therapy to help combat the disease?
Dr. Reckamp: We are more and more able to do targeted types of treatment even with surgery and radiation therapy. So, surgery is becoming less and less invasive and smaller incisions, then robotics being used to take out tumors. And this decreases the time a person is in the hospital and improves the recovery rate for people and gets them back into their lives quickly. It used to be that people had to be in the hospital for many days to a week or more and would have to take a significant amount of time off of work, and now they’re back into their lives and into their work and what they need to be doing. For radiation, it’s a similar story. We have modalities that can do short courses of radiation effectively. So what may have taken several weeks now takes a day or several days. They can target the radiation. Of course, in the lung, as you breathe, there is movement. And radiation is targeting a specific area, and it’s much harder to target as you’re breathing and the lung’s moving. You can get radiation to areas that may not be involved with the cancer and cause damage to the lung, which we don’t want to do. So by doing these targeted therapies over short courses of time, we can improve the functioning of the lung and decrease the amount of damage that’s done, and again, improving patients’ lives.
Melanie: So in just the last minute, Dr. Reckamp, please give your best advice and hope to those listening who might have a loved one with lung cancer for the most exciting things going on there today in treatment and research.
Dr. Reckamp: The most remarkable thing to me is that we know things today about lung cancer and how it grows and how it progresses that we didn’t know even a year or two ago. So the progress is being made. We need to make more, there’s no doubt, but we will have new drugs, we are going to learn how the immune system fits into the development of lung cancer, and we may move some of these immune therapies earlier on to try and cure more people with lung cancer. And that’s always our goal. So we’re getting more targets, we’re understanding the genes and the biology, we’re understanding the immune system, and then, again by getting screening out to more and more people, hopefully we can prevent these advanced stage lung cancers. So I think there’s a lot to be excited for and a lot to hope for for people who are dealing with lung cancer, which is such a challenging disease.
Melanie: Thank you so much. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org, that’s cityofhope.org. This is Melanie Cole. Thanks so much for listening, and have a great day.