New treatment approach fights deadly lung cancer

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UH practice pays off for Stark County man

Monday, July 25, 2005

Regina McEnery

Plain Dealer Reporter

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Few diagnoses cause panic like lung cancer. Patients dread the news because, though lung cancer isn't the most common cancer - it ranks third after breast and prostate cancer - it is the deadliest.

Lung cancer kills more Americans than leukemia and prostate and colon cancers combined, according to the American Cancer Society. About 60 percent of lung cancer patients die within a year; only 15 percent live more than five years.

More than 170,000 cases turned up in the United States in 2003, the most recent year for which statistics are available.

Gary Summer's was one of them.

The tumor that struck him was a non-small-cell lung cancer, a garden-variety lesion that attacks the lining of the lungs. By the time symptoms surfaced in the 51-year-old electrical engineer, the tumor had reached Stage Four, the highest and worst place to be for a patient.

Five years ago, Gary might have been a hospice candidate.

But after enduring decades of dismal survival rates, researchers have begun to slow the course of advanced cancers. They can now more successfully treat cancers like Gary's with an assortment of customized therapies and novel drugs, some new to the market and some still experimental.

In his two-story redwood Cape Cod that he built from scratch, Gary looks the picture of health. His face and arms are tan from tending the gardens on his three-acre property and he appears fit enough to climb atop a dirt bike, which he used to do regularly in the woods behind his house.

He doesn't look at all like the fatigued, ashen man who dropped by a Stark County urgent care center almost two years ago with a hacking cough and no appetite. A doctor took one look at Gary's left lung and immediately referred the Canal Fulton resident to a pulmonologist at Aultman Hospital in nearby Canton.

Surgeons split open Gary's chest after a buildup of fluid in the lungs suggested something scary. The best scenario would have been an infection treatable with antibiotics. Another possibility was congestive heart failure.

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But Gary had two strikes against him. He had smoked for 25 years. He had also worked around asbestos.

"Mrs. Summer, you need to sit down," the doctor told Deborah as Gary lay in recovery. "This is serious."

The surgeon described the layer of tumors encasing Gary's left lung as like a blanket. He told Gary's wife that the thriving colony resembled mesothelioma an asbestos-related cancer that is almost always fatal. But he also said the tumors looked a lot like non-small-cell lung cancers, the most common type of lung cancer.

The doctor had seen a lot of cases like this. He gave Gary a year to live.

As she tried to absorb the news, Deborah reached over to comfort 17-year-old Dustin, who was sobbing uncontrollably. She wondered how she was going to break the news to his 22-year-old sister Courtney, a junior biology major at Kent State University.

She wondered whether she would be able to take Gary home.

Much less spent

on lung cancer

In 2004, the National Cancer Institute spent $276 million studying lung cancer, slightly less than half of what was spent on breast cancer research and $33 million less than prostate cancer.

Some blame the disparity on society's intolerance for people who smoke. Ninety to 95 percent of lung cancer cases are due to smoking, and like obesity and AIDS, the disease carries an enormous social stigma.

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But the lopsided money picture really comes down to advocacy. While breast and prostate cancer coalitions have lobbied relentlessly for research dollars, lung cancer support groups have not been as active politically. Lung cancer researchers cite the fact that the Department of Defense has spent more money on breast cancer than on lung cancer.

Until recently, research had done little to improve outcomes for lung cancer patients. Lung cancers are hard to find during the early stages, when surgery is an option and five-year survival rates what experts consider a cure are still possible. By the time a diagnosis is made, the tumors have usually invaded other organs.

Lung cancer also tends to strike individuals with other chronic health problems, such as emphysema or heart disease. That complicates enrollment and hampers outcomes in clinical drug trials.

Aultman Hospital's staff oncologist suggested Gary try single-dose chemotherapy. Based on the stage of his disease, the treatment would be palliative at best, the doctor explained.

The Summers weren't aware that single-dose chemotherapy had become old-hat in favor of more potent two-drug cocktails. But they understood the term palliative.

Deborah couldn't accept the verdict. Not for Gary, who until now had rarely missed a day of work. Not for her children, who needed to have their father around. When she got home from the hospital, she logged on to the Internet and began searching for a second opinion.

A different

treatment approach

In University Hospitals' Ireland Cancer Center's lung cancer program, you can find nurses, social workers, technicians, radiologists, nutritionists, even a music therapist. But it's the eight-member lung cancer team three medical oncologists, one radiation oncologist, two surgical oncologists, a pulmonologist and a lung cancer coordinator that oversees the cases.

University Hospitals of Cleveland has been expanding its lung cancer team because patients are living longer and the need for clinical research is great. In Ohio, there were 7,720 cases and 7,130 deaths in 2004, according to the American Cancer Society. Next to breast cancer, lung cancer represents the second-highest percentage of patients at Ireland.

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The cancer center recruited top-notch researchers this year. By the end of summer, it will have four National Institutes of Health-funded physicians studying lung cancer, more than the comprehensive cancer programs in Detroit and Columbus.

Two years ago in October, Gary and Deborah Summer drove to Cleveland to meet Dr. Afshin Dowlati, an oncologist at Ireland who was building a national reputation for his work in developmental therapeutics, specifically drugs that cut off the blood supply of tumors.

Dowlati was the Summers' last hope. A week before, the Cleveland Clinic's Taussig Cancer Center told Gary essentially what the oncologist at Aultman had that palliative care was the only option.

Now they were at University Hospitals because Deborah had begged Dowlati's staff to see her husband.

Fortunately, Gary was eligible for a new study combining a common chemotherapy cocktail carboplatin and taxol with a novel monoclonal antibody known as bevacizumab. The antibody had been designed to target a protein found in abnormally high levels in the bloodstream of cancer patients.

The experimental therapy was being tested in patients like Gary whose tumors were too advanced for surgery but who hadn't been subjected to chemotherapy yet. Patients who have had chemotherapy often develop drug resistance, which can skew the trial results.

Dowlati's staff explained that half the 878 patients being enrolled in the national study were getting the antibody along with a standard six-month course of chemotherapy. The other half would receive only chemotherapy. It would take some doing to get permission from Gary's health insurer for the treatment, but Deborah felt her spirits lift for the first time since the awful diagnosis. Finally, there were options and by November Gary was coming to Cleveland every three weeks for chemotherapy.

Research begins

to pay off

Dowlati decided to pursue lung-cancer research because he felt he could make a difference in field that had been neglected.

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Today, lung cancer is drawing more attention at oncology meetings, where the biggest advancements in care get showcase treatment. And the weekly tumor board meetings at Ireland, where specialists discuss new or difficult cases, were centering more and more on the success of certain experimental therapies.

Bevacizumab was one obvious example, but there were others. Doctors had high hopes for two oral medications designed to target another protein on cancer cells. In a tiny subset of patients, tumors were shrinking or even melting away about half the time.

There were other encouraging developments as well.

Spiral CT technology a 6-year-old imaging tool that can detect tiny cancers was raising hopes that a reliable screening tool for lung cancer had finally been found. And chemotherapy after surgery long the standard of care in breast cancer patients was now being recommended for some lung cancer patients.

Still, it is a grim disease, as Gary Summers was discovering. He had entered the clinical trial at University Hospitals determined to put up a fight. He moved his chemotherapy treatments to Friday so he could recuperate and be back to work on Monday. He tried not to dwell on the disease.

Oncologists were cautiously optimistic that bevacizumab would provide the first real improvement in survival rates for late-stage lung cancer. Gary was in the control arm of the study, however, meaning he wasn't selected to receive bevacizumab. His monthly blood tests and CT scans showed his tumors were shrinking, and he felt pretty good. He was gaining weight and his appetite had returned. But in May 2004, two months after his treatment ended, he developed chronic back pain and breathing problems. Doctors found spots on Gary's liver and a MRI discovered a tumor on his spine.

Dowlati recommended radiation to shrink the spinal lesions. He suggested that Gary try Iressa, which targets a troublesome protein.

A number of Dowlati's patients had done remarkably well on Iressa, but there were downsides. It's expensive and patients must remain on it indefinitely.

And in the spring of 2005, the FDA dealt the manufacturer of Iressa a blow that diminished sales and patients. A government panel issued a warning to oncologists that Iressa hadn't improved survival rates as previously thought and that it should be restricted to patients who had already shown some benefit. Sales of the pill plummeted.

But Iressa proved to be the turning point for Gary Summer. In August 2004, a month after starting the medication, his backache subsided and his breathing improved. Gary took that as a sign that the treatment was working. A CT scan offered more concrete proof. The tumors on Gary's liver had faded and his lung tumors were stable.

Gary Summer is still taking Iressa once a day and undergoing periodic CT scans to monitor his lung cancer. He also takes monthly injections of Zometa to slow down the bone-destroying activity caused when his lung cancer spread to his spine. He is in remission.

To reach this Plain Dealer reporter:

rmcenery@plaind.com, 216-999-5338

[endangered but surviving]

Thanks, once again for the latest.

You are really great.

joyce