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Tag: targeted therapy

  • WTOP’s Neal Augenstein: 3 years after Stage 4 lung cancer diagnosis, what’s next – WTOP News

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    During the first three years of Augenstein’s lung cancer journey, he’s been happy to be able to share things he has been learning along the way.

    WTOP’s Neal Augenstein was diagnosed with Stage 4 lung cancer in 2022. (WTOP/Neal Augenstein)

    In my first 25 years at WTOP, my reports about lung cancer were primarily stories about famous people who died from the deadliest and second-most common cancer in the U.S. — until I was diagnosed with Stage 4 lung cancer exactly three years ago.

    Since then, most of my lung cancer stories have been about living.

    Within six months of being diagnosed with Stage 4 non-small cell lung cancer just before Thanksgiving 2022, after great results with one-pill-a-day targeted therapy that shrank cancerous tumors and lymph nodes in both lungs, I became eligible for a robotic-assisted lung lobectomy.

    Since then, I’ve had no evidence of disease, and have remained cancer-free since May 2023, while continuing to take my daily pill.

    Giving thanks? Indeed.

    During the first three years of my journey, I’ve been happy to be able to share things I’ve been learning along the way.

    First, is the importance of newly diagnosed cancer patients getting biomarker testing, and waiting for the results before beginning treatment.

    Biomarker testing involves testing biopsied lung tissue — often taken during a bronchoscopy — to try to learn the exact cell mutation that caused a patient’s cancer.

    “The importance of testing is if they have that mutation, then the treatment is very different, and the patient outcomes are also much better,” thoracic medical oncologist Ram Subramanian with Inova Schar Cancer Institute in Fairfax County, Virginia, told me.

    In my case, I was diagnosed with EGFR-positive lung cancer, which has several targeted treatments available, and generally limits the side effects of treatment compared to chemotherapy.

    Despite having no evidence of cancer now, I (and my doctors) wouldn’t say that I’m “cured,” since I was originally diagnosed after cancer had spread from the original site in my left lung.

    In 2025, life with lung cancer can be similar to life with other chronic diseases, including diabetes or heart disease.

    The key is aggressive surveillance, which in my case involves low-dose CT scans every four months, as well as brain MRIs and liquid biopsies twice a year. If something suspicious were to show up on one of these scans, it would likely be early-stage, which could be removed with surgery or targeted by radiation.

    And, while the  American Lung Association’s 2025 State of Lung Cancer report shows the five-year survival rate for lung cancer in the U.S. has risen to 29.7%, which represents a 26% improvement over the past five years, research continues to enable earlier detection, including the use of artificial intelligence.

    Lung cancer patients in the D.C. region are lucky — there are a large number of clinical trials in Virginia, Maryland and the District, offering new options and hope for patients and their families.

    Personally, while I’ve been lucky to not have any recurrences in my first three years living with cancer, I often discuss trials with my thoracic oncologist Amin Benyounes, who is the co-leader at the Inova Schar Cancer Institute’s Phase One Program.

    Benyounes said many patients considering enrollment in a clinical trial worry about the unknown: “Will this make me feel worse, will it make me feel sick, could it hurt more than it would help? Will my kids or my partner have to bear the burden of me feeling sick?”

    With clinical trials affording the possibilities for longer survival with fewer side effects, some patients ask, “What if I get my hopes up, and it doesn’t work?”

    According to Benyounes: “My answer to that is usually, ‘We have to take things one step at a time.’”

    That’s the same guidance he gave me when I began my cancer journey, three years ago.

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    Neal Augenstein

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  • NSCLC: Advances in Treatment

    NSCLC: Advances in Treatment

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    Doctors once thought non-small-cell lung cancer (NSCLC) was one disease. Most people got the same treatment — chemotherapy (chemo) — especially if their cancer had spread to other parts of the body. 

    Now, doctors know there are many different types of NSCLC, with “more coming down the pike,” says Nathan Pennell, MD, a medical oncologist specializing in thoracic cancer at the Cleveland Clinic’s Taussig Cancer Institute.

    That means treatment plans are no longer once-size-fits-all. Instead, treatments like targeted therapies and immunotherapy are tailored to each person’s tumor.

    Targeted Therapies

    Some cancer cells have gene changes (also called mutations) that help them grow and spread. The goal of several targeted therapies is to block those changes. The FDA has approved medicines to treat eleven different gene mutations that can drive NSCLC:

    • EGFR
    • ALK
    • BRAF
    • ROS1
    • RET
    • MET
    • KRAS
    • PIK3CA
    • HER2
    • NTRK
    • MEK1

    One drug targets the growth of tumors on blood vessels:

    Epidermal growth factor receptor — or EGFR — is the most common. It’s a protein on the surface of cells that helps them grow and divide. If you have too much EGFR, your cells grow faster than normal.  Medicines called EGFR inhibitors stop this growth.    

    Karen Reckamp, MD, co-directs the lung cancer and thoracic oncology program at City of Hope in Duarte, CA. She says targeted therapy has completely changed the way doctors manage lung cancer. Now, before you start treatment for advanced NSCLC, you’re likely to have genetic testing to see if you have a mutation that might help guide your treatment.

    Reckamp says this new way of doing things has changed the game for many people with advanced NSCLC.

    “We don’t talk about a cure,” Reckamp says. “But the tumor shrinks, people feel better, go back to work, and have a better quality of life.”

    Targeted therapies also have drawbacks. Some only work for the small number of people who have gene mutations that respond to a certain targeted therapy. About 15% of people with lung cancer have EGFR-positive lung cancer. The numbers are much smaller for other gene changes.

    The medicines also have side effects, like:

    • Skin rash
    • Diarrhea
    • Liver damage
    • Bone marrow problems

    Reckamp says these usually aren’t as severe as side effects from chemotherapy.

    “For most people, the side effects are pretty tolerable, and they do pretty well.”

    Another problem is that targeted medicines often stop working, eventually.

    “Cancer cells find ways to survive and overcome the toxic treatments we’re giving them,” Reckamp says. “When that happens, you have to try a different treatment.” 

    Still, she says targeted therapies have greatly improved the odds for people with NSCLC.

    “With chemotherapy alone, [extending life] by 1 year was as good as we could get. Now, with these therapies in addition to chemo, it’s not uncommon for patients to live 2, or even 5 years.”

    Immunotherapy

    Your immune system normally destroys cancer cells. But tumor cells are sneaky and can find ways to evade your body’s best defenses. If you have NSCLC, some cancer cells may churn out a protein called PD-L1. It attaches to another protein, PD-1, on important immune T cells. This is called an immune checkpoint, and it tells your T cells to leave the tumor alone.  

    One way to get around this is with medicines called checkpoint inhibitors. They prevent PD-L1 and PD-1 from getting together. This unleashes your immune system, so it’ll be at full power against cancer cells. But healthy cells get caught in the crossfire.

    “Immunotherapy can cause inflammation anywhere in your body from head to toe,” Reckamp says. “When your immune system never turns off, you can get something resembling an autoimmune disease like rheumatoid arthritis. Or you can have problems with your thyroid, liver, bladder, kidneys, and heart.

    “And this can happen anytime — even after you’ve stopped treatment. But most symptoms can be well-controlled with high-dose steroids.”

    Your doctor won’t suggest immunotherapy unless your tumor tests positive for high levels of PD-L1. The test isn’t always correct, though, and some tumors that test positive for PD-L1 may not respond to immunotherapy.  

    Still, Reckamp says immunotherapy is a better choice than chemo for most people who have it, despite the severe side effects and hefty price tag. It may even keep working after you stop taking it.

    In the Pipeline

    Reckamp says to look for improvements in targeted medicines and smarter drugs that can outwit and outlast cancer cells.

    “There are lots of clinical trials focused on overcoming resistance to targeted medicines and immunotherapy, and combining these with chemotherapy to improve not just the length of a [person’s] life, but also the quality,” she says.

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  • NSCLC: Advances in Treatment

    NSCLC: Advances in Treatment

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    NSCLC: Advances in Treatment

































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  • NSCLC: When You Need More Than One Treatment

    NSCLC: When You Need More Than One Treatment

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    NSCLC: When You Need More Than One Treatment

































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  • NSCLC: When You Need More Than One Treatment

    NSCLC: When You Need More Than One Treatment

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    Standard chemotherapy (chemo) was once the only treatment for advanced non-small-cell lung cancer (NSCLC). Now, you’re likely to get chemo plus a targeted medicine or immunotherapy, says Karen Reckamp, MD, co-director of the lung cancer and thoracic oncology program at City of Hope in Duarte, CA.

    She says most people need more than one therapy, and often, they get all three at some time during their treatment. Combined treatments may work better because they attack cancer in different ways. And while they aren’t likely to cure advanced NSCLC, they may help you live longer with fewer symptoms.

    Targeted Therapies

    These block gene changes that cause tumors to grow and spread. The meds are more precise in targeting tumors than chemo, so side effects may not be as tough to deal with.

    The problem is they often work for a while and then stop.  This may be because the gene changes again, so it’s no longer a good target. Or, cancer might find a way around the therapy. Either way, you’ll probably need to add another medicine — usually chemo or a different targeted drug.

    Immunotherapy

    This treatment works in a different way. It triggers your immune system to attack your cancer. If your tumor has a high level of the protein PD-L1, immunotherapy medicines called checkpoint inhibitors may be your best treatment. These often work better when combined with chemo.

    You May Still Need Chemo

    If you don’t have the PD-L1 protein or a gene target, immunotherapy plus chemo is likely to be your main treatment. Reckamp says that fact disappoints some people.

    “But we’re not at the point where we can do without [chemo],” she says. “In an era where we have all these new therapies, chemo is still helpful and will be part of most people’s treatment.”

    That’s because chemotherapy can mop up cancer cells that other treatments leave behind.

    “Metastatic cancer has spread through the lymph and blood to other places in the body,” Reckamp says. “That’s billions of cells. There’s always some cancer left, no matter what the treatment.”

    Dealing With Side Effects

    Cancer medicines can have serious side effects. What happens when you get two at the same time, or one right after the other? It can be tough, Reckamp says, especially since therapies can cause so many different problems.

    For example, platinum-based chemo — the kind used for advanced NSCLC — damages all your fast-growing cells, even the healthy ones. Common side effects are:

    • Nausea
    • Diarrhea
    • Hair loss
    • Anemia
    • Bleeding

    Chemo also can cause liver and kidney damage. If your side effects are severe, you may need a lower dose, or to stop treatment completely. Reckamp says many people can predict how they’re going to feel on certain days and plan around it. And since chemo is given in cycles, you have a chance to rest during the breaks.

    You may not get a break from certain targeted medicine, though.  Many targeted medicines are taken every day. That makes you more likely to have constant, but manageable symptoms, like rashes and diarrhea.

    “You might have one really bad day of diarrhea with chemo and mild diarrhea every day with a targeted therapy,” Reckamp says.

    Targeted medicines usually won’t make you as tired as chemo. Other side effects are usually easier on your body, too, but they still need to be dealt with.

    “All these drugs are attacking cancer, so there is a level of not feeling like yourself,” Reckamp says. “Most people get used to that feeling. When they stop treatment, they remember what they’re supposed to feel like.”

    What about side effects from immunotherapy, which can be pretty unpredictable?

    “That’s anyone’s guess,” Reckamp says. “It can cause inflammation anywhere in your body at any time, even after you stop treatment. You can get inflammation in the brain, colon, thyroid gland, liver, bladder, kidneys, or heart.

    “We can predict when you’ll feel bad with chemotherapy, but with immunotherapy, we can’t.”

    She says people who get both immunotherapy and chemo need to be on high alert. The number of possible side effects is high, and some can come without warning.

    “If you’re not feeling like yourself, call your doctor, and they can help guide you what to do next,” she advises. “Also, [very serious] problems like colitis and pneumonitis [lung inflammation] can happen quickly and suddenly. We need to hear about that right away.”

    Scott Gettinger, MD, an expert in immunotherapy and targeted therapy at Yale Cancer Center in New Haven, CT, also warns about pneumonitis. It’s inflammation of lung tissue that can cause cough and shortness of breath. For people with NSCLC, it can be deadly.

    “When you suspect pneumonitis, you need to start steroids right away,” he says.

    High-dose steroids can bring down life-threatening inflammation. Lower doses may help treat less serious symptoms.

    Despite the intense side effects, Reckamp says most people do pretty well with combined treatments.

    “You can work, travel, and live a fairly normal life, but you need to adjust for days when you don’t feel well,” she explains. “Hospitals and treatment centers have social workers and many other resources to help you get back into life.”

    But, Reckamp says, you’ll also need help you can’t get from a hospital.

    “You also need strong social support from your family,” she says.  “And it can be helpful to join a group of like-minded people or talk to a therapist or counselor.

    “Patients are living longer, so it’s important to help them figure out how to frame what they want for their lives and how to do what they want to do.”

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  • Inoperable Lung Cancer: Making Treatment Work for You

    Inoperable Lung Cancer: Making Treatment Work for You

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    By Larry Gershon, as told to Stephanie Watson 

    I was diagnosed with lung cancer by accident. In 2013, I went to urgent care with cold and asthma symptoms. When the doctor took an X-ray to make sure I didn’t have pneumonia, it showed a spot on my lung. After more scans, a surgical biopsy, and a brain MRI, I was diagnosed with stage IV lung cancer.

    I was in total disbelief. Then my oncologist said something that really uplifted me. She told me that even though my cancer wasn’t curable, people can live long and active lives while dealing with chronic illnesses. That would be our plan.

    There are new targeted therapies being approved every year to treat late-stage lung cancer. While most of these treatments have side effects, they are usually controllable and many patients can enjoy good results and lead pretty normal lives.

    Get Tested

    Hearing that you have inoperable lung cancer is tough. But hearing that nothing can be done to treat you is almost always untrue.

    It’s vitally important for every patient who is diagnosed with inoperable lung cancer to get comprehensive genomic testing. These tests tell your oncologist the best treatment option for you to have success.

    My genomic test found an EGFR mutation that causes my cancer to grow and progress. Once chemotherapy stopped working, I switched to a drug that targeted the EGFR mutation. I’ve been on the same targeted therapy for 5 years.

    Educate Yourself

    People who are educated about their disease and actively involved in their treatment do better because they are able to understand what’s going on. I think education is a huge part of dealing with a disease like lung cancer. Not knowing what to expect can lead to a lot more anxiety and stress.

    Google is not your best source for information.Learn about lung cancer from your doctor, a support group, or an organization like the Go2 Lung Cancer Foundation. There are also patient-founded lung cancer advocacy groups that support patients with specific genomic mutations. For example, there’s a group called the EGFR Resisters for the EGFR mutation I have.

    Other mutation types have their own support groups. These groups are in contact with the pharmaceutical companies and the doctors who are doing research to develop new treatments for each specific mutation.

    Care for Yourself

    Over the years, I’ve learned that people with late-stage lung cancer who get palliative care early have better results and tend to live longer.

    I volunteer with the GO2 Foundation’s Phone Buddy Program, where I help other lung cancer patients understand the treatment experience. One of the biggest misconceptions I hear is that palliative care only deals with end-of-life issues.

    It’s important for people with stage IV lung cancer to understand that palliative care can help you manage treatment side effects. I’ve used it to relieve side effects like nausea, diarrhea, and rash.

    Palliative care helps me focus and be smarter about what I eat and how I take care of myself, so I feel better overall. It can help patients and caregivers deal with anxiety and provide great resources when you need help. Palliative care focuses on the well-being of the patient and those who support them while your oncologist focuses on how to treat your cancer.

    Join a Support Group

    I also highly recommend finding a patient-focused support group. You’ll meet people who have walked in your shoes with whom you have a common experience, and people who can offer insight on how to deal with new experiences.

    A support group is a great source of comfort. You don’t get medical advice there because that’s not the purpose, but you can learn from someone else’s experience with things such as how to deal with treatment side effects or dealing with anxiety.

    I live in Palo Alto, CA. A friend made me aware of the GO2 Foundation for Lung Cancer (formerly the Bonnie J. Addario Lung Cancer Foundation). They host a lung cancer support group called “The Living Room” on the third Tuesday of every month. They invite thought leaders (doctors, researchers) in the lung cancer community to educate patients and answer their questions about lung cancer. That experience has been life-changing for me. The knowledge I’ve gained and the camaraderie I’ve found in this group is one of the most comforting experiences I’ve had since being diagnosed.

    Know When to Call

    Having cancer makes you hyper aware of what’s going on in your body. When you notice strange symptoms, you immediately wonder whether your cancer is getting worse. Is it progressing? Are things getting bad?

    Sometimes symptoms don’t have an explanation. But you should definitely make your oncologist aware of any new symptom that lasts for a week or more. Symptoms that persist may indicate that something is changing.

    Enroll in a Clinical Trial

    I’ve never participated in a clinical trial because I’m fortunate to have targeted therapies that have been effective in treating my type of lung cancer mutation. But I will not hesitate to participate in a clinical trial if I need a new, not yet approved treatment that can potentially offer hope to help control my lung cancer.

    Clinical trials have given us very effective treatments that are helping to keep many of us alive. There are clinical trials looking at all sorts of treatments. The treatments in a clinical trial can help improve overall survival and quality of life for people with all stages of lung cancer.

    Be Involved

    Bottom line, be involved in your treatment. Be active. Be interested in what’s going on. Ask your doctor questions and expect clear and specific answers.

    I think the worst possible situation for anyone with a stage IV cancer diagnosis is to be in the dark, to be unsure of what’s going on. It causes you to live with a horrible amount of anxiety and uncertainty.

    In my 9 years of living with lung cancer, I’ve learned a lot. The Go2 Foundation for Lung Cancer has educated me and made me an advocate for myself and others. Without them, I think my outcome would have been very different.

    Remember that no one is going to care about you more than you do. You are always your own best advocate.

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  • Advancements in Treating Psoriatic Arthritis

    Advancements in Treating Psoriatic Arthritis

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    By Jasvinder Singh, MD, as told to Sonya Collins

    What attracts me to research into psoriatic arthritis and other rheumatic diseases is that the discoveries we make can improve function and quality of life for people. It can give them the opportunity to once again enjoy life fully, spend time with their loved ones, and do the other things that bring them pleasure.

    I’m a professor of medicine and epidemiology at the University of Alabama at Birmingham, a physician at the Birmingham Veterans Affairs Medical Center, and I co-authored the guidelines for the treatment of psoriatic arthritis.

    A Revolution in Treatment Options

    Psoriatic arthritis is almost undergoing a revolution in terms of the treatments that are available.

    Much of the current research is focused on targeted therapies. That’s where the field is going. In the last 5 to 10 years, we’ve gone from traditional disease-modifying drugs to very specific treatments that target specific drivers of psoriatic arthritis.

    We have medications that have been around for a long time that can inhibit many cells that are active in psoriatic arthritis. We also have these newer targeted drugs that stop just one of these molecules, rather than all of them.

    The advantage of the older medications is that we have experience with them and a lot of long-term data about their safety.  The advantage of the new therapies, on the other hand, is that they’re more effective over time.

    It’s possible, down the road, that we’ll find that the side effects of targeted drugs are more predictable than those of the older medications. Their side effects may also be more tolerable to people.

    Most of the targeted drugs are given by injection just under the skin. Some of the most common side effects of medications, not just for psoriatic arthritis but in general, are  headaches and gastrointestinal issues like nausea. Since targeted drugs don’t go through the digestive system, the side effects may be milder.

    The more targeted approach may upset the balance of the body a little less than those other drugs do. We don’t know that for sure, though.

    Several targeted drugs are already approved and available for patients to use. This has really expanded the horizon for doctors and their patients to choose treatments that may control the disease better.

    Predicting a Response to Treatment

    Another important discovery that’s emerged in the last 10 years is that certain factors affect whether the drugs work or fail. Many sophisticated studies have shown that both smoking and obesity reduce the effectiveness of these drugs and how long their effects last.

    So there are things patients can do on their own, in combination with their medications, to better manage their disease.

    But it’s still hard to predict who’ll respond to which medication.

    Psoriatic arthritis is not a single type of disease. For the longest time, we’ve described it as five different types. Beyond that, there may be different drivers of the disease at play in any given patient. We don’t have specific tests to see what those are and which drug would work best. For now, we choose medications based on the potential benefits and risks and what the patient prefers.

    More importantly, across the life span of a patient, those drivers of the disease might change. It’s possible that a couple of them are active and that we can suppress them for a while with the available drugs. Then, the patient ages, develops other illnesses, and something else begins to drive the disease.

    So it’s hard to predict who’ll respond to which medication. That response can also change over time. But the more we use these newer drugs, the more we’ll learn about them.

    A Well-Stocked Toolbox

    If someone’s response to a medication does change, we switch them to another drug if we can. That’s why we want to keep lots of medication choices in our toolbox. This is a lifelong condition, and we want to have options available for when we need them. And I think we’re in a very good place for that right now. 

    Having said that, I’m happy to see strong and ongoing interest from drug companies in developing new products and additional targeted therapies, not just for psoriatic arthritis but for many autoimmune diseases.

    This is only possible with clinical trials. I always encourage patients to consider participating in them. That’s how we learn and discover new therapies. There’s the potential — if the trial drug is safe and effective — that it benefits patients in the trial themselves.

    We can’t promise that. But the benefit to other patients in the future, if the drug gets developed and approved, is immense. Because then the drug will be available to everybody.

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