Much is changing in the treatment of lung cancer and Susan Scott, M.D., a fellowship-trained medical oncologist specializing in treating lung cancers at the Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital, is very excited.

“More than 50% of patients with lung cancer are diagnosed at an early stage, before it's metastatic and has spread outside the chest,” says Dr. Scott. “These patients have been treated the same way for about 30 years, with little improvement. Just in the past year, we've had some exciting developments in how we help these patients.”

Historically, following diagnosis, patients with early-stage lung cancer had surgery sometimes followed by chemotherapy. A recent FDA-approved treatment that combines chemotherapy and immunotherapy, given before surgery, is bringing new hope.

Early Attack Before Surgery

This new treatment is given through an IV over the course of six to nine weeks. The patient receives a combination of two chemotherapies and one immunotherapy agent that work together to jumpstart the immune system to fight the cancer. When the patient is ready for surgery, their immune system is already primed to act as a surveillance mechanism to attack the cancer and prevent it from growing again. These targeted treatments before surgery provide an opportunity to start treating the cancer and shrinking the tumor while it is still in place.

“Even patients who are diagnosed before their disease spreads outside of the chest still have a high risk of the cancer coming back,” says Dr. Scott. “That is scary, and we want to minimize that risk as much as we can. The more can do at the beginning of treatment to essentially cure the cancer is where our research lies and where these exciting new changes come into play.”

Screening for Early Stage Lung Cancer

The identification of early stage lung cancer has increased significantly in the past five years because of low-dose CT screening for smokers. The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose CT for people who:

• Have a 20 pack-year or more smoking history, and
• Smoke now or have quit within the past 15 years, and
• Are between 50 and 80 years old.

This screening often finds tumors before they spread outside the lung or cause any symptoms. Dr. Scott notes, “In the Washington, D.C., population we serve, about half of the patients we're seeing have never smoked.” For patients who don't smoke, lung cancer is sometimes found incidentally when they have a CT scan for another reason. Even though some patients present with symptoms, many of these patients will still have cancer that has not yet spread outside the chest and can benefit from this new therapy.

Hope for the Future

“Many lung cancer patients today are now managed like those who have a chronic disease,” says Dr. Scott. “The average life expectancy, even for patients with stage four disease, has tripled in the last several years. In 2021, there were more than 10 new drugs approved for lung cancer alone. That is astronomical for cancer. With clinical trials available at different stages of disease and different phases of treatment, and so many new approaches, we are providing more hope for our patients.”

The Sidney Kimmel Cancer Center at Sibley Memorial Hospital’s multidisciplinary team is comprised of thoracic surgeons, radiation oncologists, medical oncologists, interventional pulmonologists and pathologists who work together to develop a treatment plan tailored for each patient. For more information, visit hopkinscancerdc.org.