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abril 2024

Caroline with her boys

Caroline, a nurse practitioner who lives in Louisiana, was more familiar with lung cancer than she cared to be. “About 15 years ago, my maternal aunt was diagnosed with stage 4 lung cancer – in her 40s – and died a year later. And she was a never smoker, very healthy,” she explained.

“We all thought, ‘okay, that’s random.’ Fast forward to 2021, my maternal grandmother was also diagnosed with stage 4 lung cancer. Another never smoker. Thankfully, my grandmother lives in Houston and got into MD Anderson. They mentioned the EGFR mutation, so she got tested and was positive. That led to my mom getting tested – she tested positive for the gene. Then I tested positive.”

Her mother, who lives in New Jersey, was treated at Memorial Sloan Kettering for stage 1 lung cancer.  “I actually was pregnant at the time she had her surgery. After I had my baby, I had my first CT scan, which showed all the nodules.”

Fortunately, Caroline had already decided that if she needed treatment, she wanted to go to her mom’s thoracic surgeon. “I had surgery in octubre 2022, and I actually had a lot of complications. I had a chest tube for two months, and I had to go back to the operating room twice,” she said. “Even though I loved my team at MSK, I live in New Orleans. I’m going to need surveillance for the rest of my life, and it’s too far away.”

Caroline found a thoracic surgeon at MD Anderson, and is very happy with her new medical team. She undergoes screening every 6 months to monitor her remaining nodules.

A network of support

To cope with the uncertainty, “I surround myself with a strong network of family and friends,” she said. “I focus on the present by finding joy in small daily activities and cherishing any positive moments.” She is especially grateful for her husband, her two young boys, and her family and friends.

“My husband has always been by my side and able to advocate for me when I physically or mentally was unable to myself. I am also fortunate to have a large group of girlfriends from my hometown that are still my best friends. We get together often and talk daily through a group chat. I am impressed and blessed with how supportive they have been – visiting me while I was in the hospital, helping with my kids, and always there for advice or if I needed to vent.”

As a urologic oncology NP, Caroline is keenly interested in research developments. Dr. Geoff Oxnard, a thoracic medical oncologist in Boston, has developed techniques in cancer genomics and has a special interest in the EGFR T790m germline mutation. When Caroline found out she had the mutation, she decided to fly to Boston and meet with him.

“He’s the one who really inspired me to get involved. He told me that as a doctor, he can only do so much to raise awareness… it’s going to take a patient to share their story and get the word out.”

For our abril #TogetherSeparately livestream talk, Julia Rotow, MD, and Isabel Preeshagul, DO, MBS, discussed resources available to patients and caregivers, assembling and managing a care team, and questions to ask at appointments. Dr. Rotow is Clinical Director, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, and Assistant Professor of Medicine, Harvard Medical School.

Watch the recording below.

The good news

The FDA recently granted approval to tepotinib for the treatment of advanced non-small cell lung cancer (NSCLC) with MET exon 14 skipping alterations.

Why it’s important

MET alterations occur in 3-4% of patients with NSCLC, and those alterations are responsible for driving the development of the cancer. Patients who have MET exon 14 skipping alterations are typically older individuals at 70 years or greater. The Vision trial was a Phase 2 study that evaluated tepotinib in different groups of patients. In those with exon 14 skipping alterations who were not previously treated, 57% had at least a 50% shrinkage of their cancer, and the control of the disease lasted for a median of 46 months. For patients who had previously received treatment, the response rate was 45%, and in many the cancer control lasted for more than 12 months (JAMA Oncology, Volume 9, pages 1260-66, 2023). The drug was also beneficial for patients with brain metastases. The treatment was well tolerated with leg swelling as the most common side effect.

What it means for patients

Tepotinib represents an effective oral treatment for patients with advanced MET exon 14 mutated NSCLC. This is particularly important since these patients tend to be older individuals. Prior to this advancement, chemotherapy had been the standard treatment. This also emphasizes the value of doing biomarker testing to evaluate newly diagnosed lung cancer patients for abnormalities such as MET exon 14 skipping mutations so that the appropriate treatment can be prescribed. It is interesting to note that the Vision trial also allowed the use of liquid biopsy (blood sample) to detect the MET alteration.

What to watch for

Research continues to be done involving tepotinib as well as other novel MET inhibitors. It is important to note that these agents are being tested in other MET abnormalities in addition to the MET exon 14 skipping alterations. There is always room for improvement for these patients to extend their survival.


Read the FDA announcement

Read about LCRF grantees who currently are working on MET-related projects:

  • Amanda Bradley, PhD, Fred Hutchinson Cancer Center
  • Xiuning Le, MD, PhD, University of Texas M.D. Anderson Cancer Center
  • Emiliano Cocco, PhD, University of Miami – Dr. Cocco’s team is collaborating with Dr. Alexander Drilon’s clinical trial at Memorial Sloan Kettering Cancer Center. Dr. Drilon is a member of LCRF’s Scientific Advisory Board.

Meet the newest member of LCRF’s science team, and hear a quick update on the foundation’s research program as well as news from the lung cancer space. Watch the video below.

Featured:
Aubrey Rhodes, LCRF Executive Director
Dhru Deb, PhD, Senior Director, Research & Administration
Antoinette (Toni) Wozniak, MD, Chief Scientific Officer

By Jeff Stibelman
marzo 2024

I was first diagnosed with cancer of the cervical spine on enero 1, 2017, after experiencing very severe nerve pain down my whole right side. Thankfully, due to the sensitivity of what was to be my operation, my doctor sent me to one of the best surgeons in the country at USC Keck MD Center, LA, California. At that time I was told in the beginning it was a schwannoma, a non-cancerous lesion, but it was on my main nerve, hence the excruciating pain, affecting my whole right side. I had to wait for weeks with a lot of pain, since they thought it was benign. I finally had quite an extensive surgery, it lasted for many hours. After a week stay in ICU I found out it was atypical, and it was indeed, cancer!

Because of the sensitivity of the surgery and fear of paralysis, they only removed 3/4 of the tumor, leaving me with some slight paralysis and of course the remaining cancer. Next was radiosurgery radiation to try to get the remainder. I was then included by my surgeon as part of a study and in his classes at USC as my case was very unusual. He wanted to keep me there as a patient because of it being so rare I stayed for 3 months until insurance disallowed me from staying any longer.

Jeff with his oncologist

Before I left, my doctor at USC, who wanted to keep me, taught me what to say, how to say it and what to ask for and most importantly to advocate for myself. He taught me so much, he is an amazing human. So after radiation I went back to my original care facility, I was seen by a neurologist oncologist every three months for MRIs, labs and scans that included a full body scan. Everything seemed to be going pretty well and stable until fast forwarding to marzo of 2021 when I decided being immuno-compromised I would get the COVID vaccine. Before doing so my PCP who I’ve been seeing and knew for a very long time suggested I come in and he do a complete physical on me since I hadn’t had one for a couple years. All looked great, he listened to my heart and lungs and they sounded all clear by stethoscope. However, I was complaining of a slight cough, so my doctor decided at that time to do a chest x-ray, as I hadn’t had one for quite some time.

Now mind you, at this point a lot of doctors would have just said everything looks good. You probably have a slight cold starting, so go home and get some rest and drink a lot of fluids. But because I’ve known him for so long, he decided to take the extra step and give me the x-ray. He said go down and do the X-ray and come right back up again so he can read it instead of waiting for it to come up in the portal. As I walked back in the room, it was evident by the look on his face, which I’ve seen before, and I knew in my heart what it meant when this normally very stoic doctor looked visibly concerned. He turned the screen and showed me what was a very large mass in my lower right lobe. He ordered a PET scan, CT scan, and MRIs. Then he referred me to see a pulmonologist who did an Ebus (scoping and sampling of the mass for testing) which showed that I had stage 4 non-small cell lung cancer, with mets to a lymph node, brain and some bones. The new scans also referred back to my 2017 chest CT saying that the mass has grown significantly. You’re probably thinking “what, wait, did I miss something?”

Yeah, you heard me right – it was never mentioned in the radiologist report back in 2017 when it was Stage 1a and operable – and when statistically I had a better chance of a cure, or at a minimum, a much longer life. I was misdiagnosed. So off to my oncologist I went who gave me 6 months to a year to live (yes, I asked) and she ordered radiation and chemotherapy to start ASAP. At this point, knowing I’ve heard those three little words before (“you have cancer”), I had two ways to go – so to quote one of my all-time favorite movies, the Shawshank Redemption, either “I can get busy living or get busy dying” so I chose life!

By the grace of G-d she also did biomarker testing, and right before I was to start both chemo and radiation I found out that I had the EGFR mutation Exon 19 Deletion and was able to do a TKIs targeted therapy. So in abril 2021 I started Tagrisso (which didn’t exist until only 6 years ago, awareness and research did that). Unfortunately, I still have the lung mass, but it has shrunken, and my five brain lesions and lymph nodes are NED so far. As far as my bone metastasis, I do what is called Zometa infusions to strengthen them from fracture. So the good news is I’m stable which we all know is a big win.

Video: Jeff talks about biomarkers

And if not for that simple chest X-ray – and dare I say, COVID – I might not have been here telling you my story. So, I continue, what I started from the time of my very first diagnosis in 2017 till today, to be an advocate to raise more awareness for testing and research, to find a cure and stop the stigma of this terrible disease called Lung Cancer. It can be silent and is the number one cancer killer. “If you have lungs, you can get lung cancer.”

At the Fight For Air Climb

I also urge new and previously diagnosed cancer patients, caregivers or anyone affected, to be proactive, to advocate for yourselves. Being quiet does not work. Push for more answers, push for more testing, get second opinions if you’re not getting the result. This is what I learned from my misdiagnoses and advocating. I also believe telling your story is very important; again, staying quiet doesn’t work. No, it’s not always easy, but others need to hear it and we need to tell it, for more awareness, to find cures for this number one killer. I am always available for all my sisters, brothers, caregivers or anyone who is touched by lung cancer.

Until then, stay strong but always positive.

Foundation honors Mark G. Kris, MD

NEW YORK, NY (abril 2, 2024) – The Lung Cancer Research Foundation (LCRF) is pleased to announce Dr. Mark G. Kris as its honoree for the 3rd annual Evening of Innovation Gala, which will be held on septiembre 24, 2024 at the Metropolitan Club in Manhattan. Members of LCRF’s Board of Directors and Gala Committee are committed to showcasing LCRF’s impact through recognition of an individual whose support of the organization and the field of lung cancer research is unparalleled, and someone who exemplifies the spirit of LCRF to improve the lives of persons with lung cancers through research.

As a thoracic oncologist at Memorial Sloan Kettering, Dr. Kris’s clinical and research accomplishments over the last four decades have transformed lung cancer care both nationally and internationally. He has played a prominent role in the discovery and use of chemotherapy and later targeted therapies matched to the genetic changes found in each person’s cancers. He was part of a small group of investigators that developed the medicines today given routinely to every patient to prevent nausea and vomiting. The lives touched by this effort are truly innumerable. Dr. Kris is a tireless patient advocate and a visionary. He strives to create “what comes next” to better treat and cure lung cancers. In addition to his other roles, he mentors young physicians who are today becoming the new leaders in the field.

Dr. Kris was a founder of The Lung Cancer Mutation Consortium (LCMC) in 2009. Fifteen years later, his leadership drives LCMC’s fourth iteration, the LEADER trial set to enroll 1000 persons with lung cancer before surgery at 20 institutions across the United States. This project supported by LCRF will open a new chapter in targeted therapy. Combining targeted therapies with surgery offers the best hope today to use precision medicine to lead to cures.

Dr. Kris’s impact at the Lung Cancer Research Foundation spans decades, beginning with an advisory role in Joan’s Legacy. He has been a vital member of the Scientific Advisory Board for over 10 years and played an essential role in building LCRF’s research program. His guidance to the founding members of LCRF has shaped its strategic trajectory. His leadership and direction empower LCRF to fund the brightest minds and make the biggest impact for patients. “The contributions to lung cancer treatment by Dr. Kris are innumerable,” remarked Aubrey Rhodes, Executive Director of LCRF. “He has relentlessly championed finding ways to improve his patients’ lives, both through research and  as a doctor. He has been an advisor and mentor to many and has contributed so much to the lung cancer community. It is only fitting that we honor him, and his impact, at the Evening of Innovation gala.”

Colleen Conner Ziegler, LCRF’s Board of Directors Chair commented: “He has not only provided his patients with excellent care throughout his career, but he has also pushed for research to do even better than we do today. He is a real champion for innovative research, and we’re pleased to honor him at this year’s gala event.”

“I’m humbled to be chosen for this honor,” said Dr. Kris. “The real champions are my patients, their loved ones, my nurse and physician colleagues who bring discoveries to our patients, and our  researchers in the laboratories. We look particularly to our scientists to discover the breakthroughs we need in the clinic.  I believe in the power of collaborative science, and that working together, facing head on these complex challenges, we will find a way to realize the dream to cure all person’s lung cancers. The first step to reach this goal is to believe that cure is possible for each patient. I ask you to dream with me. Thank you for the recognition of my work.”

The 2024 Evening of Innovation Gala will take place at 6 pm on Tuesday, septiembre 24, 2024, at the Metropolitan Club in New York City. We will hear from the people whose lives Dr. Kris has touched during the event and provide attendees with opportunities to make their own impact on lung cancer research. More details can be found at LCRF.org/gala.

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About the Lung Cancer Research Foundation (LCRF)
The Lung Cancer Research Foundation® (LCRF) is the leading nonprofit organization focused on funding innovative, high-reward research with the potential to extend survival and improve quality of life for people with lung cancer. LCRF’s mission is to improve lung cancer outcomes by funding research for the prevention, diagnosis, treatment, and cure of lung cancer. To date, LCRF has funded 419 research grants, totaling nearly $44 million, the highest amount provided by a nonprofit organization dedicated to funding lung cancer research. For more information about the LCRF grant program and funding opportunities, visit LCRF.org/research.

Contact:
Sheila Sullivan
Sr. Director, Marketing & Communications, LCRF
ssullivan@LCRF.org

marzo 30 is National Doctors’ Day, and once again we invited you to send thank you messages to the physicians who have made a difference in your life. Here are a few of the kudos you shared with your inspiring doctors!

Thank you to doctors everywhere who are using the results of lung cancer research to give their patients better, longer lives.

It’s never too late to support research in honor of your own doctor. Make your own tribute here.


To Mohamed Mohamed, MD,
Wesley Long Cancer Center
“Thank you, Dr. M, for taking this difficult journey with me, being sensitive to my needs, while still recommending the most effective treatments and encouraging me every step of the way. I am very grateful for your care.”


To Lecia Sequist, MD, Mass General Hospital and
Sarada Gurubhagavatula, MD, Summit Health
“I think of you often and want to thank you from the bottom of my heart for all that you did for Bill and me. After Bill was diagnosed with cancer, we were so fortunate to have found such kind, caring and dedicated doctors. From the moment we met you, we knew that we had come to the right place. As Bill would often say, you were not only amazing doctors but wonderful people. We both felt so much more at ease after we spoke to you, and we trusted all of the advice that you gave us. I know that if it had not been for you, we would not have had nearly as much time together. I can’t thank you enough for giving us the precious gift of time.”


To Brad Hiatt, DO, MercyOne Hospital
“I am so grateful to my oncologist, Dr. Brad Hiatt at MercyOne Hospital in Des Moine, IA! He’s the best..I was stage 4 lung cancer and I thought I was doomed! I began my fight in 2019 and my two tumors are in the dormant stage and I hope they stay that way! I will be 75 in junio and almost 5 years ago since my cancer was diagnosed..I have wonderful doctors! Thank you, Dr. Hiatt and team! You are all a blessing!”


To Joshua Sabari, MD, NYU Langone
“Dr. Sabari is extremely knowledgeable about developments in the field and is very giving of his time even though he is super busy. Most important,  as a patient, he eases my worries and I know my care is top-notch.”


To Christina Mangiaracina, DO,
Delancy Medical Group, Penn Medicine
“Thank you for your commitment to early detection & intervention. I wish all doctors shared your dedication to patients and your understanding of lung cancer.”


To Alexander Drilon, MD, Memorial Sloan Kettering
“Thinking of you and JAMIE, and all of your staff on this day of thanking DOCTORS. Can’t tell you how much you all meant to us during my mom‘s treatment. We were blessed to have you all as our care team. We still miss her every day.”


“Thanks for what you did for my wife, Nita.”


“You gave my mother over 7 years of life with stage 4 using cancer. We worked to keep the virus away and you worked to stay ahead of all mutations. She died last enero, NOT due to the cancer. Thank you for all your do!”


“There will never be enough words to express my gratitude for the care, compassion and dedication you have to your patients and improving lung cancer outcomes. I am blessed to have you and your staff as a part of my team and am grateful for your attentiveness, thoroughness and knowledge. Thank you for giving me hope! I feel like the lucky one to have you in my corner!”


To Catherine Shu, MD, Columbia University
“Super grateful for the care you provide me and others facing lung cancer. I am privileged to be your patient!”


To Jennifer Garst, MD, Duke University Medical Center 
“I am forever grateful for you. Your kindness, expertise and knowledge has gotten me through two lung cancers. I am so lucky that Dr. Garst and my surgeon, Dr. Tom D’Amico, are at DUMC. I am alive because of these physicians. Dr. Garst’s compassion and expertise has kept me grounded for the last 20 + years.”


To Ryan Brisson, MD, University of Florida
“Your dedication to the field of radiation oncology is such a blessing to our community! Thank you for your focus on reducing the toxicity of cancer treatment, allowing your patients to lead longer, fuller lives.”


To Matthew Gubens, MD, MS,
UCSF University of California San Francisco
“Thank you for all you’ve been doing and continue to do!”


To Heather Wakelee, MD,
Stanford Medicine Cancer Center
“Thank you for your excellent guidance and support.”

By Marley Coxe
marzo 2024

“Sure, I’m tired, I’m a mom – it comes with the job. We all have days we’re exhausted.”

“I just got over being pretty sick, so my lingering cough must be the illness leaving.”

“It’s the beginning of spring; allergies are in season.”

“This nausea must be my anxiety. My grandmother just passed away – I need to take the time to process and mourn.”

“I’m so out of breath – if I would get myself into better shape, these inclines wouldn’t be so hard to walk up.”

These were the excuses I told myself.

Marley with her boys

Looking back, my symptoms started around febrero last year. By abril, I was avoiding steps, and hills made me want to cry. My son Kane’s baseball team always sat on the side of the field with the hill ­­– I dreaded it. When I went on the 1st grade class field trip, I was determined to make it up that hill to see the giraffe, even if I had to focus everything on my breathing. I had to get myself in better shape.

Nausea took over my entire day. My doctor and I believed I was experiencing acid reflux. I was prescribed two medications and went onto a strict anti-inflammatory diet to heal my stomach. I had an endoscopy scheduled for the end of junio, which was the earliest they could get me on the schedule.

In the meantime, I started to feel it was more than acid reflux and fought with my doctor to listen. I was told: acid reflux is easy to treat, take your medication as prescribed, and change your diet. As usual, I felt embarrassed that I let myself get into this condition.

Getting a long-avoided test

I have a hemangioma on my liver and had put off getting an MRI since I knew it was just a strawberry mark. I didn’t feel like giving two hours of free time to lie in an MRI tube, so I had rescheduled that appointment so many times. I finally had the test, and I’m so glad I did.

The MRI took place after my acid reflux diagnosis and before my scheduled endoscopy. The MRI results showed my liver was fine. But the images showed enough of my left lung to indicate it had collapsed. Those results excited me. I wanted to scream, “I’m not crying wolf!”

The evening I received my MRI results, I was scheduled for a CT scan and lots of bloodwork. I didn’t think it was cancer. I truly believed I had an infection or maybe Covid.

Things moved pretty fast. The next afternoon – the second to last day before Kane would finish 1st grade – I was rocking my younger son, Reid, before nap time. I had an alert on my online chart that my CT results were in: “suspicion of lung cancer.” The rest of that day is a blur. I cried a lot. I cried to my family, my friends, my doctor, the nurses who called to set up my next appointments… I crumbled.

The biopsy to determine the exact type of cancer I had is where I met the pulmonologist, Dr. Ayers, a very knowledgeable and respectful doctor. Dr Ayers said he didn’t believe I had lung cancer – I was too young, too healthy. He told me he would biopsy the swollen lymph nodes in my chest and not sample the nodule in my lung.

My husband Colby, the kids, and I left for Wildwood, NJ. I knew I would be getting my biopsy results during our vacation. But again, I wasn’t worried. I truly believed that if it was cancer, it would be one that had the highest survival rates.

Day two of vacation, I was on the beach when my phone rang – it was Dr Ayers. He told me I had adenocarcinoma of the lung, how truly shocked he was, and how sorry he was to give me the diagnosis. I asked him what stage he thought the cancer was, and he explained it was at least stage 3 – and it was going to be a tough battle. I don’t remember what else he said on that phone call.

My PET scan showed my cancer had metastasized to the lymph nodes in my chest, axillary, and near my kidneys. Fluid drained from my lungs also held cancer cells. I was diagnosed with ALK positive stage 4 non-small cell lung cancer.

Combating the fear

The fear and sadness I feel is combated by the love and support I’ve been shown since diagnosis. My husband, my family, and my friends have all shown me such care. Cancer has taught me the importance of being present. My future probably doesn’t include becoming old and gray, and I’m not sure I’ll get to hold my grandchildren one day. But I’m here now – and my goals are to see the milestones in my boys’ lives.

Medicine is forever evolving, and I have so much hope that this cancer can be made into a chronic disease one day. Every 3 months, I have scans of my cancerous spots. I’ve never wanted to be called unremarkable and boring more than when those results come through! Living with lung cancer involves lots of hope and a ton of prayer.

The good news
The FDA recently approved Osimertinib combined with chemotherapy for the initial treatment of advanced EGFR-mutated non-small cell lung cancer (NSCLC) based on the results of the FLAURA2 trial.

Why it’s important
Osimertinib, which is a newer generation oral inhibitor of EGFR, has improved the treatment of EGFR-mutated lung cancer but unfortunately it is not curative for most patients. FLAURA2 was a large, international trial that treated over five hundred patients with advanced EGFR-mutated NSCLC with Osimertinib alone or combined with chemotherapy. The patients treated with Osimertinib and chemotherapy had an 8-month significant improvement in control of their cancer (New England Journal of Medicine, Volume 389, pages 1935-48). The combination therapy also had more benefit in patients who had brain metastases at their first diagnosis. The treatment was also able to delay the spread of cancer to the brain in patients who did not initially have brain metastases (Journal of Clinical Oncology, Volume 42, pages 808-20).

What it means for patients
This represents the first trial to show a benefit for patients with EGFR-mutated NSCLC treated with the combination of Osimertinib and chemotherapy. Even though there was an improvement in control of the cancer the results of the trial are still early, and it is unclear whether this improvement will result in patients living longer. The combination treatment did have more side effects primarily related to the chemotherapy. This approach to treatment may not be for every patient. Treatment options and their potential risks and benefits should always be discussed with one’s physician.

What to watch for
As the results of the FLAURA2 trial mature, physicians should have a better idea as to which patients will benefit from this approach to treatment. This continues to be an active area for research and physicians/scientists are actively trying to improve outcomes through understanding the biology of lung cancer and developing novel approaches to treatment.

Read more about the FDA approval here

During our marzo #TogetherSeparately livestream, Stephen V. Liu, MD, Director of Thoracic Oncology and Head of Developmental Therapeutics, Georgetown University, gave an overview of the topics discussed during febrero’s IASLC Targeted Therapies Meeting. Isabel Preeshagul, DO, MBS, moderated the discussion. Watch the recording below.

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