Years ago, a diagnosis of lung cancer years ago didn’t come with a wealth of treatment options; however, the outlook has brightened. Jonathan Thompson, MD, medical oncologist, explains that surgery, radiation therapy, medical therapies and clinical trials offer innovative options and hope. When standard treatment is no longer effective, people with certain types of lung cancer may turn to immunotherapies — groundbreaking treatments that train the immune system to eliminate cancer cells.
What are important and developing treatments for lung cancer?
Dr. Thompson: Interventional pulmonology expertise, coupled with advanced diagnostics and treatment with state-of-the-art technology, is an advantage for accurate treatment planning. Minimally invasive robotic surgery is available for people who can have surgery. Different ways of combining radiation therapy with drug agents are being explored. We’re seeing rapid development in targeted therapies, as well as with cellular therapies like immunotherapy, which uses a person’s own immune system to fight their cancer. Genetic evaluation to direct targeted therapy is another key component guiding treatment decisions.
Tell us more about “targeted therapy” and how a person’s genes make a difference in the way they’re treated for lung cancer.
Dr. Thompson: Tissue biopsies have been the gold standard for telling us if a person’s lung cancer is linked to a gene mutation. Now, as much as possible, we do that evaluation with a liquid biopsy. These blood tests pinpoint unique factors in a person’s lung cancer. If we find genetic mutations, we use targeted therapies — drugs that go after a person’s specific mutation — rather than treating with a broader-based chemotherapy drug.
Are immunotherapies or targeted therapies better than chemotherapy?
Dr. Thompson: Chemotherapy is still an effective treatment and may be combined with other treatment such as immunotherapy. However, for some patients, immunotherapy or targeted therapies can be used without chemotherapy and can control cancer much longer than chemotherapy. We determine which people are most likely to benefit from these treatments by looking at the genetic and protein makeup of a person’s cancer. Most of our clinical trials aim to improve outcomes
Are clinical trials a “last-ditch” effort when other lung cancer treatments don’t work?
Dr. Thompson: That is a misconception. Clinical trials can help lung cancer patients at any time in treatment. Trials offer options that may work better when added to standard treatment or after a recurrence. We have the largest portfolio of lung cancer clinical trials in eastern Wisconsin — some unique to our Cancer Network. We review each patient’s situation to match them with a clinical trial if it will benefit them.
What are some examples of your team’s ongoing research?
Dr. Thompson: New forms of immunotherapies and new antibody drug conjugates are available through Froedtert & MCW clinical trials for different types of cancer. In an early-phase national clinical trial, we are using two new medications to treat small cell lung cancer, also called SCLC. SCLC is the most aggressive and hardest to treat form of lung cancer. One medication is called gocatamig. This new form of immunotherapy attaches to a protein called DLL3 on a cancer cell. It also attaches to a protein on an immune cell called a T cell. Essentially, gocatamig works by dragging the T cell to the cancer cell to eliminate it.
We have seen prolonged cancer control with gocatamig, but we’ve found even better tumor shrinkage rates when we combine gocatamig with an antibody drug conjugate called ifinatamab deruxtecan (I-DXd). Antibody drug conjugates are targeted chemotherapies that attach to proteins found mostly on cancer cells. I-DXd targets a cancer protein called B7H3. This protein is found in high levels on most small cell cancer cells. Once I-DXd attaches to the cancer protein, it can deliver chemotherapy directly into the cancer cell. Antibody drug conjugates concentrate chemotherapy within cancer cells and spare healthy cells better than traditional chemotherapy.
Because our experts focus on lung and other cancers in the chest, research new treatments and publish results of clinical trials, we stay current on every advance affecting lung cancer patients. Through clinical trials, patients have access to new options that may not be widely available.
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