Lung Cancer - Advancements in Treatment, Early Detection and Research

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello, and welcome to the show. You're listening to the Weekly Dose of Wellness, brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Robert Nagourney. He is board certified in Internal Medicine, Medical Oncology, and Hematology, and practices at Long Beach Memorial. Dr. Nagourney is also the founder of Rational Therapeutics, where he pioneered the use of functional profiling to create the world's first personalized cancer therapy program. Welcome, Dr. Nagourney.

Robert Nagourney, MD: Thank you very much.

Deborah Howell (Host): Today's topic is lung cancer. Of course, two words no one wants to hear. So let's start at the beginning. What exactly is lung cancer?

Robert Nagourney, MD: Well, obviously the lung is exposed to the outside world. We breathe in and out, you know, 15, 20 times a minute. And if we smoke cigarettes or are exposed to toxins, the cells within the lining of the lung can become changed ultimately to malignant cells, and these are cancers that arise from the lining of the lung.

Deborah Howell (Host): So what are the signs and the symptoms of lung cancer?

Robert Nagourney, MD: Most commonly patients will complain initially of cough. Subsequently shortness of breath, and often in the later stages, a patient will state that they've coughed up a small amount of blood.

Deborah Howell (Host): Okay, anything else?

Robert Nagourney, MD: Well, as the disease progresses, chest pain, and as the symptoms worsen, weight loss. A very common problem in lung cancer patients is rapid and almost irreversible weight loss.

Deborah Howell (Host): Wow. Okay. Now what are the causes and the risk factors besides smoking for lung cancer? Or is that really the only one?

Robert Nagourney, MD: Well, interestingly lung cancer is a changing disease. In the past when cigarette smoking was more common, one type of lung cancer known as squamous cell was the predominant type. Today we find a new biology where adenocarcinoma, glandular cancer, is becoming more common. And also interestingly there are a substantial number, up to 15 or 20 percent of patients with lung cancer who themselves have no known history of exposure. They're not smokers, very often they're young, and very often they're women. And these are cancers driven by genetic changes that we're just coming to understand.

Deborah Howell (Host): So let me ask you a question. If my mother smoked heavily and had lung cancer, and I never smoked a cigarette in my life, am I prone to it?

Robert Nagourney, MD: Well, there is an exposure to secondhand smoke, and that is most likely, again, a toxin that could cause it. Clearly it's preferable to have secondhand smoke to smoking a full-on cigarette habit. But yes, that is a risk.

Deborah Howell (Host): I was actually speaking to the genetic pattern, not actually the exposure to smoke.

Robert Nagourney, MD: Well, yes, there are also predispositions at a genetic level. In that regard those are relatively weak. As I mentioned, there is a small number of people who have a cancer driven by a mutation, but we think those are somatic mutations, mostly arising in the individual, not from their parents.

Deborah Howell (Host): Okay, got it. What's the average survival rate of someone diagnosed with lung cancer?

Robert Nagourney, MD: Well, obviously lung cancer survival is highly dependent on how late-stage it is at diagnosis. If it's early stage, if it's a small nodule and it's removed surgically, patients can have a 70, 80 plus percent chance of survival. That's why we're so interested in early detection. However, as this disease progresses and about half of patients present with inoperable disease, at that point if it is already spread, the survival is measured usually at about one year.

Deborah Howell (Host): One year. And you can keep the patient comfortable for that year?

Robert Nagourney, MD: Oh absolutely. I mean comfort management is becoming increasingly good. But my goal as a therapist is not to comfort patients so much as to cure them.

Deborah Howell (Host): Okay. Well we are living in a good age for that. Which brings me of course to my next question. What are the latest advancements in the treatment of lung cancer?

Robert Nagourney, MD: Well I think recognizing increasingly that lung cancer is not a disease, but many diseases, and that each patient and each disease may require a different form of therapy. At the first level we know now that squamous cell that I mentioned earlier and adenocarcinomas may have somewhat different biology. So that's the first level. Secondly we know that about 15 to 20 percent of lung cancers carry specific targetable mutations. And if there is any really exciting breakthrough, it's recognizing these mutations and secondarily developing drugs that are highly specific for those mutations. And these would be drugs like Crizotinib, known as Xalkori, or the drug Erlotinib, known as Tarceva. And these are highly effective but only in those patients who have the exact targets. The final point that we think is very interesting, and we've just published a paper in October, is that each patient, even with conventional chemotherapies, can be better matched if you analyze the behavior and biology of their individual tumor.

Deborah Howell (Host): Okay. And does lifestyle also factor into the individual cancer treatments?

Robert Nagourney, MD: Well I think that we recognize increasingly that cancer may in fact be a function of lifestyle. Our dietary habits, our exercise programs, even our sleep habits may influence our general well-being. There's an increasing recognition that for example there's a connection between diseases like heart disease and cancer, diabetes and cancer, obesity and cancer. And so yes, I think that lifestyle plays into this quite a lot, and preventing cancers of almost all types can be better achieved with a healthy lifestyle, healthy diet, regular exercise, and good nutrition.

Deborah Howell (Host): And what about the role of stress?

Robert Nagourney, MD: I think that there's less complete understanding of the role of stress. One of the most famous experts, the original descriptions of this was named Hans Selye from the University of Montreal, and he described dis-stress, which was where your body was out of sync because you were stressed in any number of emotional and personal ways. There may well be a possibility that stress can influence the levels of corticosteroids in the bloodstream, it may again influence your ability to perform exercise activities. So yes, I think there is a general immunosuppressive quality to stress and that may contribute to cancer causation.

Deborah Howell (Host): Right. It certainly can't help the situation. How does functional profiling work?

Robert Nagourney, MD: Well we've realized for many years that patients are distinct and unique. Each patient's cancer is as unique as their fingerprints. The problem is that we have a tendency to put everyone on the same treatment or combination. What we began to be interested in is, could we match patients, could we basically fingerprint everyone and look for the profile, the pattern, that gave us the insights for drug combinations? So what we did was take pieces of cancer patients at the time of surgery, study them in the laboratory, and then measure which drug resulted in the greatest effect. We then used those drugs in the particular study I mentioned, and we doubled the response and nearly doubled the survival in this population.

Deborah Howell (Host): So when you're talking about doubling the survival rates, what kind of figures are we looking at?

Robert Nagourney, MD: In excess of 20 months on average. And here as I mentioned the best literature in the world today is 13.5 months. So we're pushing toward a two-fold improvement, and that's not by using new drugs or new combinations, it's really entirely by reshuffling the same deck of cards. All we did was play the same drugs and combinations, we just matched them to the patients individually.

Deborah Howell (Host): Well that would make sense, because a child of four with leukemia would certainly require a different set of parameters than a 50-year-old female.

Robert Nagourney, MD: Not only that, but two children of four with leukemia would each require a different treatment.

Deborah Howell (Host): Exactly. Well it's wonderful that you've been able to do this fingerprinting and profiling. What else would you like our audience to know today about functional profiling, and their chances of a cure in case they are diagnosed with lung cancer?

Robert Nagourney, MD: Well I think first of all, lung cancer patients have to realize that this is not hopeless. And then when they are diagnosed, instead of worrying about the bad outcomes that they anticipate, they should seek out the expertise of people at good centers conducting smart treatments. Secondly I think that people should recognize that techniques such as these genetic profiling or functional profiling can provide very useful information on the selection of treatments. And finally patients should realize that they have a part in their own good outcomes. If they maintain a smart lifestyle, remain active, eat well, maintain good micronutrition, and also have a good spiritual and personal take on their disease, they have a much better chance of surviving this rather dreadful problem.

Deborah Howell (Host): We are really looking more at the whole person these days, aren't we?

Robert Nagourney, MD: Absolutely.

Deborah Howell (Host): It's not just a function of symptoms and it's not just a function of drugs, it's really a whole regimen. Beginning with eating, lifestyle, stress reduction, the wonderful new medications that are out, and really sticking to the plan, right?

Robert Nagourney, MD: I would say that the patients have a much larger role in their own good outcomes than they have ever realized. And you were mentioning earlier stress, if a patient is emotionally and spiritually prepared to respond to their disease, I guarantee you they'll do better.

Deborah Howell (Host): Well it's been very heartening to speak with you. We want to thank you so much for all your work and your development of new ideas, new technologies, looking at the whole person. It's certainly a better age to be a cancer patient, especially a lung cancer patient in the year 2013, than it has been in the past for sure.

Robert Nagourney, MD: I couldn't agree more.

Deborah Howell (Host): We've been speaking with Dr. Robert Nagourney about advances in lung cancer treatment. I hope you've learned something you can share with friends and family members. Do you have a website, Dr. Nagourney?

Robert Nagourney, MD: We do. We have www.rationaltherapeutics.com.

Deborah Howell (Host): That's www.rationaltherapeutics.com. Thank you so very, very much. Again, Dr. Robert Nagourney. He is board certified in internal medicine, medical oncology, and hematology, and practices at Long Beach Memorial. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Have a great week.