Lucy lived a busy life as a successful artist. The last thing she expected to hear when she was rushed to the hospital with a suspected heart attack in 2017 was that she had lung cancer. Lucy’s diagnosis changed everything. It left her unable to do many of the things she loved, including painting – her passion and hobby of 50 years.
Lung cancer remains one of the most common cancers in Canada, with an average of 78 Canadians diagnosed every day. It is also the leading cause of death from cancer, with more people dying from the disease in 2017 than colorectal, breast and prostate cancers combined — a fact that Lucy knows all too well.
Lung cancer is generally divided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), with a number of subtypes in each category. NSCLC is the most common. Although less common, SCLC is the most aggressive type of lung cancer and in many cases has already spread to other parts of the body by the time it is diagnosed, making it notoriously difficult to treat and leading to devastating consequences.
Lucy had no signs or symptoms before her diagnosis — as is typical of lung cancer — and her family was devastated when they learned that the cancer was Stage 4 and had already spread to her brain. Lucy was given two months to live and told to get her affairs in order while her doctor worked diligently to put a treatment plan in place. Through it all, Lucy remained positive. In the words of her husband, Lucy “was a real trooper from day one” as she underwent radiation and chemotherapy.
Exploring A New Alternative
For Lucy, and many lung cancer patients, considering multiple treatment options is a crucial step in their treatment journey. While her initial radiation therapy was successful in slowing the growth of lesions in her brain, the first round of chemotherapy left Lucy unwell. A second type of chemotherapy left her feeling slightly better, but in 2018 her doctor began to look at emerging therapies to personalize the approach to Lucy’s treatment.
In the past, cancer was categorized simply according to its location in the body and many patients with a particular tumour type were treated uniformly with surgery, radiation or chemotherapy, just as Lucy was. Now, thanks to molecular testing, advances in next generation sequencing, and our ever-evolving understanding of the biology of various types of cancer, we have a greater knowledge of the disease than ever before. This improved understanding has given way to the development of personalized approaches to treating many different types of cancer, including lung.
A step forward in lung cancer treatment came with the development of immunotherapy, which works with the immune system to shrink advanced or metastatic NSCLC tumours. Immunotherapy can help the body recognize and destroy tumour cells by interfering with targets associated with cancer, for example a protein called programmed death-ligand 1 (PD-L1).
Beyond PD-L1, there are a number of other biomarkers that can have an impact on treatment approaches in lung cancer. For example, two mutations that can help determine appropriate therapy include the rearrangement of the anaplastic lymphoma kinase (ALK) gene, and the epithelial growth factor receptor (EGFR) mutation. ALK rearrangement occurs in about 5% of NSCLCs and produces an abnormal ALK protein that causes the cells to grow and spread. EGFR is a protein on the surface of cells which normally helps cells grow and divide, and is present in approximately 20% of patients with NSCLC in Canada.
Having gone through her previous chemotherapy treatments, Lucy and her healthcare team decided it was time to try this new, molecular approach. Now research shows that this type of therapy can even be appropriate for patients with metastatic NSCLC earlier in their journey.
Researchers continue to explore the role biomarkers play in driving cancer, and how personalized healthcare can aim to stop cancer growth through targeted therapies. Healthcare teams often conduct biomarker testing for patients like Lucy to help determine the right treatment for their type of cancer. In this devastating disease, where patients often face a poor prognosis, it is encouraging to see how biomarkers are being used to match patients to the most appropriate treatments.
Looking to the Future
The more we learn about the characteristics of a tumour, the more targeted treatments can be. This level of precision also allows healthcare providers to more accurately predict how a patient is likely to respond to a particular treatment. With next-generation genomic sequencing and biomarker testing, an even greater level of personalized medicine can be achieved, leading treatment approaches away from a one-size fits all model and ensuring that the right treatment is provided to the right patient at the right time.
For Lucy, personalizing treatment has made her believe that there is more to life for her. She continues to play in the bridge club she’s been a member of for 34 years and has also started to paint again. She takes commissions, exhibits her work in art shows and even teaches painting to her palliative care nurse, who she’s kept in touch with since her time in the hospital. Immunotherapy has allowed Lucy and her husband to make plans for the future, and they look forward to celebrating milestones like family birthdays, holidays and their 50th wedding anniversary. Lucy stays positive and hopeful, living every day to the fullest.
June 10, 2019
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