Amanda Wilde (Host): Ahead, an updated guide to lung cancer therapies and we'll dispel some myths about treatment, in a conversation with Dr. Praveen Namireddy, Thoracic Oncologist at WakeMed Cancer Care. This is WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm Amanda Wilde. Dr. Namireddy, welcome. Thank you for being here to talk about lung cancer treatment.

Praveen Namireddy, MD: Absolutely. Thanks for having me.

Host: Now, cancer treatment, technology and techniques have evolved greatly in recent years. So, many people still associate lung cancer treatment with harsh chemotherapy. How true is that today?

Praveen Namireddy, MD: That's a great question. That used to be the case. Chemotherapy was once the only option. However, today it's different. While chemo is still important in some settings, many patients now receive newer treatments like targeted therapies, immune therapy, which can be more precise, better tolerated, and sometimes more effective.

Host: Can you explain what that term targeted therapy means and how it works?

Praveen Namireddy, MD: Think of targeted therapy like a key fitting into a lock. Some lung cancers grow because of specific spelling mistakes in their DNA. If we find the exact mistake, we may have a pill that locks into it and shuts it down, slowing or even shrinking the cancer. Unlike chemo which affects all fast growing cells, targeted therapy focuses mainly on the cancer cells' weak spot.

Host: Ah, so you are not killing healthy cells along with the cancer cells.

Praveen Namireddy, MD: That is correct. So we are focusing on the cancer cells. The targeted therapy specifically works on these cancer cells without causing many side effects, like chemotherapy.

Host: Now you had mentioned targeted therapy. What are some of the other big advances in lung cancer treatment over the past decade?

Praveen Namireddy, MD: The past 10 to 15 years, I would say, have been very transformative, along with targeted therapy, which include oral pills that block cancer driving mutations like EGFR, ALK or KRAS, BRAF. There are at least more than 10 mutations now we can target. Other than these, we have immune therapies.

These are the drugs that activate body's own immune system to fight cancer. Screening with low dose CT scans, which has been catching up, to catch cancer earlier. Together, these advances mean many people are living longer and with a better quality of life.

Host: And talk a little bit about immunotherapy. How has that changed the outlook for people with lung cancer?

Praveen Namireddy, MD: Immune therapy is a game changer. Immune therapy drugs, take the brakes off of the immune system so it can recognize and attack the cancer. For some patients, immune therapy has led to long-term control, even years of remission. Something rarely seen before in advanced lung cancer.

Host: A lot of people believe only smokers get lung cancer. That's somewhat accurate, but are they in the majority or to what extent do smokers get lung cancer and what are the risks for non-smokers?

Praveen Namireddy, MD: Smoking is still the biggest risk factor. But it's not the whole story. About, 10 to 20% of lung cancers occur in people who never smoked. To answer your question, the other risk factors could be radon gas, air pollution, workplace exposure, or sometimes genetic factors. So anyone with concerning symptoms should be evaluated, not just the smokers.

Host: Are those non-smokers symptoms going up in recent years?

Praveen Namireddy, MD: That is correct. Yeah. We have seen recently, uh, a lot of, not even lung cancers, other cancers also, we do see that younger population are getting more and more cancers.

Host: Now, some people think if I have cancer, I'll feel sick right away, but it's not always true that you know when you have cancer. But what signs should people watch out for?

Praveen Namireddy, MD: Early lung cancer often causes no symptoms at all, which is why screening can be lifesaving. When symptoms do appear, they may include a persistent cough or coughing of blood or chest pain, or shortness of breath, or unexplained weight loss. Many people dismiss these as something minor, but it's important not to ignore them.

Host: You mentioned the importance of early detection. How does detection impact treatment options and does it affect outcomes?

Praveen Namireddy, MD: Early detection is everything. Cure is better than treatment. If lung cancer is caught at an early stage, it can often be surgically removed or treated with curative intent leading to a far better survival. Once it spreads, most of the times, treatment is usually not curative, but can still extend and improve quality of life.

That's why screening with low dose CT scans is recommended for people at higher risk.

Host: Do you have a patient success story that illustrates these new treatments and how far treatment has come?

Praveen Namireddy, MD: Yes. You know, compared to 15 years ago, the treatments are much, much different. I have treated a patient who's in her sixties, she had advanced lung cancer, but we detected, uh, ALK mutation; 10, 15 years ago their outlook would've been months. Now with the recent advances, we started target therapy, and avoided chemotherapy for years.

And, her goal was to travel and spend time with their family. And, her main goal was to attend her granddaughter's graduation party, which she was able to attend, after several years of the treatment also. So these stories are, you know, not universal, but shows how far we have come.

Host: Well along that line, that's a very hopeful story and I wanted to ask if you had a message, a hopeful message you'd share with people who may be worried about lung cancer or who may be under the impression that the treatment options are not as variable as they now are.

Praveen Namireddy, MD: So my message is there is a hope. Lung cancer is no longer the automatic death sentence it once was. With screening, targeted therapies, immune therapy, outcomes are improving dramatically. The best thing you could do is to be proactive, whether that's getting screened or seeking care early, or asking about the latest treatment options.

Host: So screening is everything for most diseases that you can be screened for so you can catch it early and have the most effective and least invasive treatments.

Praveen Namireddy, MD: That's correct. So, the screening for lung cancer particularly is right now there are several guidelines, but if you follow United States Preventive Service Task Force guidelines. People who are between the ages 50 and 80, who has about 20 pack year history of smoking, who has quit within the last 15 years, we recommend, annual low dose CT scan of the chest. That will detect early cancers.

Host: So, yeah. You mentioned low dose scans a little bit earlier. That is one of the newer treatments. As we end, are there any common myths you would like to dispel? Other than the one we started off with, which is that chemotherapy is the only treatment. That is no longer true, obviously, and also we have dispelled the myth that you would feel necessarily feel symptoms.

 So screening is therefore more important. Is there anything else that's sort of in the common knowledge that actually is not true?

Praveen Namireddy, MD: In pertaining to lung cancer, I think the biggest points you touched already, screening is catching up. Screening will prevent a lot of deaths. And then only smokers will get lung cancer. That's another myth. Even non-smokers can get lung cancers. And then stage four lung cancer is a death sentence. That's not true anymore. We have a lot of advanced treatments available, and people are living longer and also their quality of life is much better.

Host: Well, Dr. Praveen Namireddy, thank you for making this information on treatments for lung cancer so accessible. Appreciate your time.

Praveen Namireddy, MD: Thank you very much for having me.

Host: To learn more about lung cancer treatment, visit wakemed.org. If you found this podcast helpful, please share it and check out our entire podcast library for other topics of interest. I'm Amanda Wilde with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.