He Used the C Word

This weekend I attended a regional lung cancer patient summit sponsored by the Lungevity Foundation in Columbus, Ohio. I got to meet other people with lung cancer, as well as care- givers, researchers, and advocates. Many of the lung cancer patients had metastatic disease (like me) and were multi-year survivors, so it was reassuring to meet other folks on targeted therapies and immunotherapies who are doing well.

We got to hear an inspiring keynote talk from Dr. David Carbone, who is director of The James Cancer Hospital Thoracic Oncology Center at The Ohio State University, and who used to work in here in Nashville at Vanderbilt. Dr. Carbone had good news for us, but first, he gave us a little historical background, most of which I already knew. Back in the bad old days, in the 1990s, when he first began treating lung cancer patients, there wasn't much to offer by way of treatment to those with metastatic disease. Patients with late-stage lung cancer usually died within a few months of diagnosis. But, things have really changed for the better, and with new treatments, many of us with metastatic disease are living years (not necessarily lots and lots of years, but at least we're using a plural form) instead of months. Folks in attendance were living proof of that! Dr. Carbone also said that he'd seen patients with advanced disease have complete responses to treatment, especially immunotherapy, and they are seeing durable responses beyond the five-year survival mark, even after the treatment has stopped. So....Dr. Carbone said that it might even be possible to talk about some of these patients as being cured of metastatic disease. Uh huh. He used the "C" word. Not for a lot of patients. Just a few. But cured. Of what had previously been an incurable metastatic disease. So that was good to hear.

As a rule, oncologists are trained to say to patients with metastatic lung cancer "you have an incurable cancer, but it is treatable." They no longer use the word "terminal." We are told that "each person's cancer is different", and the hope is our disease can be managed as a chronic illness, that we'll move from treatment to treatment  for as long as we can, until we run out of options. And for the most part, that is still true. And for the most part, we still risk running out of options, especially those of us who are on "breakthrough" and "cutting edge" therapies. That's the thing about cutting edge; it means you're on the edge.

The genetics of lung cancer are more complicated than they are for some other cancers; there are different types of lung cancer, and over 300 possible genetic drivers for most lung cancers. Plus with targeted therapies, new mutations develop resistance to treatment, so it's kind of like a crazy game of wack-a-mole trying to keep the disease pinned down.

But Dr. Carbone's optimism was contagious. I hope a cure for lung cancer will be too.