What Patients Are Candidates for Immunotherapy in Lung Cancer Care?

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What Patients Are Candidates for Immunotherapy in Lung Cancer Care? from Patient Empowerment Network on Vimeo.

What is the role for immunotherapy in lung cancer care? Dr. Lecia Sequist explains how immunotherapy works against lung cancer and other medical conditions that may increase risk for immunotherapy as treatment for certain patients.

Dr. Sequist is program director of Cancer Early Detection & Diagnostics at Massachusetts General Hospital and also The Landry Family Professor of Medicine at Harvard Medical School.

[ACT]IVATION TIP:

“…talk to your doctor about whether immune therapy is a possibility for treating your cancer. And if not, just ask why not. There are lots of good reasons why it may not be recommended, but just make sure that it’s been thought about and about whether it should be part of your treatment plan or not.”

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Can Vaccines Play a Role in Preventing or Helping to Treat Lung Cancer

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How Should Newly Diagnosed Lung Cancer Patients Deal with Disease Stigma

Transcript:

Lisa Hatfield:

Dr. Sequist, is there a role for immunotherapy in lung cancer especially for newly diagnosed patients, or is that done more after a recurrence of lung cancer?

Dr. Lecia Sequist:

Yeah. There’s a big role for immunotherapy in lung cancer. Immunotherapy is a broad term. A lot of different drugs could fall into the category of being immune types of drugs. But in general, what this whole category of treatments is trying to do is to teach your body’s own immune system how to recognize the cancer and then be able to attack it. A lot of times when cancer develops, one of the ways that it’s been able to even go from one cell to a tumor that is visible or causing problems is that it’s been able to evade the immune system or sort of hide from your body’s immune system and pretend like it’s not there. And these newer immune treatments, they work in different ways. But essentially what they have in common is that they can rip off the camouflage, they can kind of expose the cancer to the immune system so that the immune system sees the cancer and starts attacking it like it should.

So there are lots of different ways that we can try to stimulate the immune system. And these drugs have gone in a short period of time from being something that was experimental and only given after everything else had failed, to now being given as soon as patients are diagnosed with lung cancer or even after a surgery. If a small tumor is taken out, sometimes we give immune therapy after a surgery or we give immunotherapy before a surgery in anticipation of it being taken out, trying to make the surgery easier or the results of the surgery even better. So immunotherapy has really changed a whole landscape of how lung cancer is treated, but immune therapy is not for everybody. So I know sometimes you might be reading on the Internet about a patient who had a really wonderful outcome with immunotherapy and you think, of course you think, well I want that drug, I want that outcome.

But there are some types of lung cancer that it doesn’t work well for. And there are some patients who might have a medical condition where the immune therapy could actually be dangerous for them. So there are a number of exceptions and not everybody should receive immune therapy. It depends on the type of cancer you have, the markers on the cancer, but also your medical background. And if you’ve had some medical conditions where the immune system is really active. Examples might be rheumatoid arthritis or Crohn’s disease, psoriasis. These are some of the common ones. But there’s a lot of different diseases that you might have had before you even had cancer where the immune treatment might be very risky for you or dangerous. So my activation tip is to talk to your doctor about whether immune therapy is a possibility for treating your cancer. And if not, just ask why not. There are lots of good reasons why it may not be recommended, but just make sure that it’s been thought about and about whether it should be part of your treatment plan or not. 

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Can Vaccines Play a Role in Preventing or Helping to Treat Lung Cancer?

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Can Vaccines Play a Role in Preventing or Helping to Treat Lung Cancer? from Patient Empowerment Network on Vimeo.

What’s the latest in lung cancer research and treatment updates? Expert Dr. Lecia Sequist shares information about emerging research currently under study, new treatments that have shown success, and her perspective about second opinions for patient care.

Dr. Sequist is program director of Cancer Early Detection & Diagnostics at Massachusetts General Hospital and also The Landry Family Professor of Medicine at Harvard Medical School.

[ACT]IVATION TIP:

“…ask your doctor if they think a second opinion could be helpful.”

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Tumor Genetics vs. Family Genetics in Lung Cancer: What is the Difference

Transcript:

Lisa Hatfield.

Dr. Sequist, fortunately, the lung cancer arsenal keeps expanding. What promising treatments do you see on the horizon or that are newly available to lung cancer patients?

Dr. Lecia Sequist:

Yeah. The field is changing so fast, it almost makes your head spin. And I think it’s wonderful that there are so many options. It’s actually been a challenge for the doctors to keep on top of the latest treatments, because they’ve been coming out so fast, especially over the last five years. 

And some of the things that I’m personally excited about in lung cancer is that there may soon be an opportunity to think about vaccines that could help prevent or could help treat lung cancers. That’s something that scientists are working on that aren’t available, but it does look like it’s realistic, that it could happen. Some of the technologies that helped develop, for example, the COVID vaccine in such a short period of time might be available to personalize treatment against an individual’s tumor. So my vaccine, if I got cancer, could be different than your vaccine if you got cancer, because they’re kind of personalized.

There’s also a new type of treatment called antibody drug conjugates, which are a smarter way of delivering chemotherapy. We’ve always just given chemotherapy to the whole body, usually through a vein, through an intravenous in the arm, and it drips in and it circulates around with the bloodstream. And the good thing about that is that it can go everywhere. So if there’s a cancer cell that’s hiding somewhere too small to be seen on the scan, the chemotherapy can get there. But it does, there’s a lot of collateral damage from toxicities from delivering chemo where there is no cancer. And with these antibody drug conjugates, the idea is that there’s an antibody in the front that’s honing into some kind of target on the cancer cell. And it still goes in through the IV, but when it reaches a cancer cell and attaches, then the backend sort of drops a bomb, which is a chemotherapy on that area.

So instead of the chemo being given to the whole body, every time the front end of this thing hits cancer cells, it engages and that triggers the backend, which is the chemotherapy kind of bomb to be dropped. So there are a lot of these types of drugs where it’s more like targeted delivery of chemo. Some of them have already been approved for cancers like breast cancer, but we don’t have an approved antibody drug conjugate in lung cancer yet. But there are a couple that are moving towards potential FDA approval. So I think given how complicated the new treatments are, my activation tip for patients would be to ask your doctor if they think a second opinion could be helpful. And I think a lot of patients feel that that might be rude or their doctor might not react in a positive way to them saying, do you think I should get a second opinion?

But as a physician, I can tell you that it’s not taken that way by most doctors. And in fact, a lot of oncologists will even suggest to their patients, you know, “Hey, this is a complicated area. I would love to get input from my colleague. I’m going to  send you to a city nearby for a second opinion.” We all rely on our colleagues a lot, and not everybody can know everything about every cancer, especially with how quickly things are changing. So second opinions are not a sign that you don’t trust your doctor or you don’t like your doctor. It’s just a sign that you really want more input. The more minds, the more brains that are thinking about your cancer, the better. And don’t be afraid to ask your doctor if they think a second opinion could be helpful for your case. 

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Can Artificial Intelligence and Machine Learning Help Advance Screening for Lung Cancer?

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Can Artificial Intelligence and Machine Learning Help Advance Screening for Lung Cancer? from Patient Empowerment Network on Vimeo.

How will lung cancer personalized medicine be improved with advanced technologies? Expert Dr. Lecia Sequist explains how artificial intelligence and machine learning help advance screening for lung cancer and shares advice for patients.

Dr. Sequist is program director of Cancer Early Detection & Diagnostics at Massachusetts General Hospital and also The Landry Family Professor of Medicine at Harvard Medical School.

[ACT]IVATION TIP:

“… if you are 50 and you have smoked in the past, I would urge you to talk to your doctor about whether you can access lung cancer screening. But if you’re younger or you haven’t smoked in the past, you can’t access lung cancer screening right now. And we’re hoping to change that with AI that can really help figure out who is at risk of this disease.”

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What Are the Noted Disparities in Lung Cancer Screening and Access

Transcript:

Lisa Hatfield:

Dr. Sequist, technology is advancing at such a fast pace, and we’re hearing words like artificial intelligence and machine learning. And I just read an article about a team that you’ve been working with that is developing or has developed an AI model that can detect future lung cancer risk. I believe it’s based on CT scans. Can you speak to that a little bit more and also talk a little bit more about where you see this AI technology taking cancer research and predicting cancer and also any challenges that we might face with AI and machine learning in healthcare?

Dr. Lecia Sequist:

Yeah. AI seems to be everywhere. You turn on the news or you look at your phone, and it’s talking about AI. And some of it seems scary, and Hollywood doesn’t help because there’s lots of movies about computers or robots kind of taking over the human race. And I think we have to separate Hollywood from real life. Artificial intelligence or machine learning, it’s a very general term. It can mean a lot of different things depending on what the context is. But it’s basically just a tool for understanding patterns. And we all understand patterns in our own life or our own house. I personally know that my dog is going to want to, as soon as we wake up in the morning, is going to want to go outside and then is going to want to have some food, and there are different patterns that you know in your daily life that you recognize, and you can anticipate what’s going to happen next.

AI is a tool that helps us anticipate what’s going to happen next for patterns that are way more complex than, yeah, your dog’s going to want to go outside and eat some food. So computers can sometimes pick up patterns that the human brain can’t really pick up, because they’re just too complicated. And that’s what we’ve found in our research. One of the vaccine things about lung cancer and trying to figure out how we can prevent lung cancer or find it at the earliest stage when it’s most curable is that it’s very hard to know who’s at risk. We know that lung cancer is one of the most common cancers out there, but knowing who is truly at risk and separating one person from the next is not so simple.

In the past, it’s mainly been, you know, determined by whether or not you ever smoke cigarettes. And it’s true that cigarette smoking is one risk factor for lung cancer, but it’s not the only one. And we don’t fully understand what all the risk factors might be, but we know that there are people who have smoked a lot in their life and never get lung cancer. And on the flip side, we know that there’s people who have never smoked or who maybe quit 30, 40 years ago and will still get lung cancer. And how do we know who’s at risk? That’s what we tried to solve with our research that I worked on with my colleagues at Mass General Hospital where I work and also at MIT, Massachusetts Institute of Technology, which is just down the road from us. And so we brought together our medical knowledge and our computer knowledge and tried to come up with a way to predict for any given individual person, are they at risk for lung cancer.

By looking at their lungs and not looking at the lungs the way a human radiologist sort of says, okay, there’s the right lung, there’s the left lung, and they’re looking for things that already exist like a tumor or a mass. The computer looks at a different type of pattern that human eyes and brains can’t really recognize and has learned the pattern, because we trained the computer with thousands and tens of thousands of scans where we knew this person went on to develop cancer and this one didn’t. And the computer learned the pattern of risk. And so using an X-ray or a CAT scan to predict future risk is something a little different. In medicine, we usually use an X-ray to say, okay, what’s happening now? Why does this patient have a fever? Why is this patient bleeding? And using an X-ray or a CAT scan in this case to predict the future is kind of a new thought for doctors. But we think that it could be a really valuable tool to help us understand who’s at risk for many different kinds of diseases. We happen to look at lung cancer, but I think you could use this idea for other diseases too.

Lisa Hatfield:

So will this AI model become mainstream anytime soon if a patient wants to access that? Or is it only being used for research purposes?

Dr. Lecia Sequist:

Well, we do before we start to offer anything mainstream or as part of routine care, we really need to understand how it can be used to help patients. So we are running some clinical trials right now to try and understand, is this a tool that could be used, for example, to give someone access to lung cancer screening? Because right now, if you want to have lung cancer screening, which is a very effective screening test to try and find cancer in people who feel completely well, trying to find cancer at the earliest stage before it has spread, can we give people access to lung cancer screening by using this AI test? Right now and if you want to get lung cancer screening, you have to be 50 or older, and you have to have smoked in the past. And if that fits your, if you are 50 and you have smoked in the past, I would urge you to talk to your doctor about whether you can access lung cancer screening. But if you’re younger or you haven’t smoked in the past, you can’t access lung cancer screening right now. And we’re hoping to change that with AI that can really help figure out who is at risk of this disease.

Lisa Hatfield:

Thank you. I’m excited to see where this goes in the future. 

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What Do Lung Cancer Patients Need to Know to Build a Treatment Plan?

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What Do Lung Cancer Patients Need to Know to Build a Treatment Plan? from Patient Empowerment Network on Vimeo.

What do lung cancer patients need to know about treatment options? Expert Dr. Lecia Sequist shares an overview of treatment classes for non-small cell lung cancer (NSCLC), advice for patients, and how each treatment class works against cancer.

Dr. Sequist is program director of Cancer Early Detection & Diagnostics at Massachusetts General Hospital and also The Landry Family Professor of Medicine at Harvard Medical School.

[ACT]IVATION TIP:

“…ask your doctor if immune therapy, targeted therapy, or chemotherapy are appropriate for your cancer. And if not, why not? There’s probably a good reason if they’re not recommending one of those things. But just make sure that you understand why you’re getting the treatment recommendation that you are.”

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Expert Advice for Lung Cancer Patients Considering a Clinical Trial

Transcript:

Lisa Hatfield:

Okay. Dr. Sequist, what are the different treatment options for lung cancer?

Dr. Lecia Sequist: 

That’s a really important question. And there are so many treatment options. But I think a way that I often explain it to my patients is sort of thinking in broad strokes and categories. So one way to think of it is there’s three main types of doctors, types of specialists that treat lung cancer. And they each have their own type of treatment that they offer. So there are medical oncologists like myself, who give drugs or different medical treatments. Some of them come in pills, some of them come in intravenous infusions, but they’re all medications. Then there are radiation oncologists who give radiation, which is strong, but invisible X-ray beams that are focused at the cancer to try and kill the cancer cells that way. And then there are surgeons who, that’s some of the most, that’s the one that people usually can understand the easiest.

They’re going to cut out a cancer surgically. And so together, the surgeon, the radiation oncologist and the medical oncologist will work together to come up with the best treatment plan for each patient. Now within my field, which is medical oncology, again, we have lots of different types of medicines that we can give for lung cancer, but most of them fall into three main buckets or types. So one of them is traditional chemotherapy. Chemotherapy drugs, there’s a whole bunch in this bucket. There’s a lot of different chemotherapy drugs. But what they all have in common is that they’re trying to kill dividing cells. They’re counting on the fact that maybe the cancer cells in the body are dividing more often than the healthy cells. And so if it goes in there and kills all the dividing cells, you’re going to kill more cancer than healthy cells.

The second type of treatment that medical oncologists give lung cancer patients is targeted therapy. These are drugs that go after some kind of target or flag or marker on the cancer cell. So a lot of times the oncology team will want to test the cancer to see what markers exist, and then if they have a treatment that goes after those markers, that’s called targeted therapy where you’re giving someone a treatment because of the markers that are seen in their cancer. A lot of those markers are found in genetic testing, but some are found through other types of testing. And then the third bucket of cancer drug treatments is called immunotherapy. And these are treatments that are trying to convince the body’s own immune system to fight the cancer. We’re supposed to be fighting things that are foreign to our body, like infections or bacteria and cancers. But sometimes when a cancer is developed, it’s tricked the immune system into ignoring it.

And so what we try to do with immunotherapy is wake up the immune system, explain what the trick is and say, hey, this is the foreign thing that you’re supposed to go after and try and kill. And so depending on the type of cancer that someone has, where it is in their body, what markers are on the tumor, then your doctors can come up with what they think is the most aggressive or likely to work combination of radiation or chemo or drug treatments that might, that might include traditional chemotherapy or targeted therapy or immunotherapy.

So my activation tip for this question would be to ask your doctor if immune therapy, targeted therapy, or chemotherapy are appropriate for your cancer. And if not, why not? There’s probably a good reason if they’re not recommending one of those things. But just make sure that you understand why you’re getting the treatment recommendation that you are. 

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Confusion to Clarity: Expert Explains the Importance of NSCLC Mutations

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Confusion to Clarity: Expert Explains the Importance of NSCLC Mutations from Patient Empowerment Network on Vimeo.

What are some key lung cancer concepts that patients can learn about? Dr. Lecia Sequist explains lung cancer versus metastatic lung cancer and additional terms that can be helpful for patients to educate themselves about for empowered care.

Dr. Sequist is program director of Cancer Early Detection & Diagnostics at Massachusetts General Hospital and also The Landry Family Professor of Medicine at Harvard Medical School.

[ACT]IVATION TIP:

“…you’re not alone. The terms are confusing. A lot of people get lost in the terminology, the medical terminology. Don’t be afraid to ask questions or go to a website that is recommended, that’s been vetted by doctors to really have good quality information to help you understand what these terms mean.”

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What Steps Can BIPOC Lung Cancer Patients Take to Guard Against Care Disparities

Transcript:

Lisa Hatfield: 

Dr. Sequist, we know that cancer isn’t just one disease. There are different types of cancer and even within one type of cancer, there are many different mutations that can occur within those cancer cells. Can you speak to some of those mutations with non-small cell lung cancer?

Dr. Lecia Sequist: 

Yeah. Cancer is really complicated, and it gets confusing, for both doctors and patients. We usually call a cancer by the organ that it started in.  So if the cancer starts in the lung, it’s usually called lung cancer. And it gets confusing because if the cancer spreads to another part of the body, it’s still considered lung cancer. So if someone started with a cancer in their lung, but it’s spread to their bones, the doctors would usually call it metastatic lung cancer that went to the bones as opposed to, I think a lot of people think of that as, now I have bone cancer. And so it can be very confusing. In addition to the broad type of cancer, like lung cancer, there are subtypes and then there are genetic subtypes. So there’s a lot of terms that get thrown out. And sometimes learning that you have cancer and learning about it, it’s almost like learning a foreign language. There’s so many terms that you have to first learn what the terms mean.

So I think my activation tip for this question would be, you’re not alone. The terms are confusing. A lot of people get lost in the terminology, the medical terminology. Don’t be afraid to ask questions or go to a website that is recommended, that’s been vetted by doctors to really have good quality information to help you understand what these terms mean. There’s also a lot of misinformation on the websites, that’s why you have to go to a site that maybe your doctor or your patient network recommends to make sure you’re getting accurate information. But the terms can be confusing. But it’s important to understand what you’ve been diagnosed with, so you can understand what your options are. 

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Do Lung Cancer Screening Guidelines Differ for Certain Populations?

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Do Lung Cancer Screening Guidelines Differ for Certain Populations? from Patient Empowerment Network on Vimeo.

Who should ensure they receive lung cancer screening? Expert Dr. Lecia Sequist explains lung cancer screening, the importance of screening, and patient age range and health history who should ensure they receive screening.

Dr. Sequist is program director of Cancer Early Detection & Diagnostics at Massachusetts General Hospital and also The Landry Family Professor of Medicine at Harvard Medical School.

[ACT]IVATION TIP:

“…if you are 50 years or older and you have smoked cigarettes in the past or someone that you know or love that’s that criteria, please talk to your doctor about whether you can access lung cancer screening. It’s very easy. It could save your life.”

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How Do You Break Down Lung Cancer Diagnosis to New Patients?

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Can Vaccines Play a Role in Preventing or Helping to Treat Lung Cancer

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How Should Newly Diagnosed Lung Cancer Patients Deal with Disease Stigma

Transcript:

Lisa Hatfield:

Dr. Sequist, is there any population that you would recommend regular screenings for lung cancer?

Dr. Lecia Sequist: 

This is a great question. Screening for lung cancer is really important. Screening basically means testing someone who doesn’t have cancer or doesn’t know that they have cancer and doesn’t have any symptoms of cancer. So someone who’s just walking around feeling healthy, living their normal life. But screening them for cancer is important in order to try and catch it early. Because we know that the outcomes for cancer, the likelihood of being cured, for example, is much better if it’s found at the earliest stages before symptoms start. Lung cancer screening is one of the most effective types of cancer screening that’s out there. It can be more effective than screening for breast cancer or colon cancer, but a lot of people don’t know that there even is a screening test for lung cancer.

The screening test for lung cancer is simple. It’s easy. It’s called a low-dose CAT scan. It takes less than five minutes to perform. It’s completely non-invasive, so you don’t have any tubes or even needles or IVs put into your body. You just lay on a CAT scan table, take a deep breath and hold it, and it just takes about 30 to 40 seconds for you to go through the machine. So it couldn’t be easier. And it’s available for people who are 50 years or older and have a history of smoking cigarettes. So if that applies to you or your loved ones, you should definitely ask your doctor about whether you can get access to lung cancer screening.

So my activation tip for this question would be if you are 50 years or older and you have smoked cigarettes in the past or someone that you know or love that’s that criteria, please talk to your doctor about whether you can access lung cancer screening. It’s very easy. It could save your life. 

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How Do You Break Down Lung Cancer Diagnosis to New Patients?

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How Do You Break Down Lung Cancer Diagnosis to New Patients? from Patient Empowerment Network on Vimeo.

How might a lung cancer diagnosis be explained to new patients? Expert Dr. Lecia Sequist from Massachusetts General Hospital shares how she breaks down the the tests involved in non-small cell lung cancer (NSCLC) diagnosis and treatment, advice to patients, and best practices she’s learned in communicating information to patients.

Dr. Sequist is program director of Cancer Early Detection & Diagnostics at Massachusetts General Hospital and also The Landry Family Professor of Medicine at Harvard Medical School.

[ACT]IVATION TIP:

“We know that not all patients are offered genetic testing. And if you have a diagnosis of non-small cell lung cancer, or especially the most common subtype of that called adenocarcinoma, genetic testing is most likely an important part of figuring out your treatment. So be sure to ask your doctor if that’s been done and if it hasn’t, should it be done.”

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Do Lung Cancer Screening Guidelines Differ for Certain Populations

Do Lung Cancer Screening Guidelines Differ for Certain Populations

 Can Artificial Intelligence and Machine Learning Help Advance Screening for Lung Cancer

Can Artificial Intelligence and Machine Learning Help Advance Screening for Lung Cancer

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What Are the Noted Disparities in Lung Cancer Screening and Access

Transcript:

Lisa Hatfield:

Dr. Sequist, you have a new patient coming into your office just diagnosed with non-small cell lung cancer. How do you explain to that patient? I’m sure they’re wide-eyed and fearful and afraid. How do you explain to the layperson what that is and then the subsequent treatment that they might be experiencing in the coming months with a new diagnosis?

Dr. Lecia Sequist:

Yeah, this is a very confusing time for most patients because they’re trying to wrap their head around what’s going on. They’re usually being fed information at such a rate. It’s like drinking from a fire hose, and it’s hard to take it all in. On top of that, they may not be feeling well physically. So I think it is important to repeat things, to pause a lot, to ask if there are questions, and to give people an opportunity to get back in touch with you with questions later, because, of course, it’s happened to all of us. As soon as we walk out of the doctor’s office, that’s when the question pops into our brain. But non-small cell lung cancer, it’s a very common cancer. And it basically is a type of cancer that starts in the lung, but it can spread to other parts of the body.

And some of the most important pieces of information that your doctor will need to help figure out a treatment plan along with you is to get a biopsy to confirm that the diagnosis is what they think it is. And that is usually an invasive procedure where a small piece of the cancer is removed from the body so that you can look at it under the microscope, and they can confirm that it’s that type of lung cancer. And then probably a series of scans or radiology tests where they’re looking at different parts of the body, maybe with different lenses such as a CAT scan or a PET scan or an MRI. Those are just different types of radiology exams to see if the cancer might have spread to any of the different places.

And for lung cancer, we usually try to look head to toe, essentially look at the whole body and get a complete picture of what’s going on. And the third important thing that doctors will need to come up with a treatment plan is to do something called genetic testing. This can be confusing for people because we’re not looking at their family. We’re not looking for genes that could have come from their parents or have been passed on to their children. We’re really looking at the genes of the cancer. And together looking at the biopsy, the genes that are activated within the cancer, if any, and where the cancer might be in the body, that helps the doctors put together a treatment plan of how to attack the cancer.

Lisa Hatfield:

Great. Thank you. Do you have any tips specifically for patients when they’re first diagnosed?

Dr. Lecia Sequist:

Yeah. My activation tip for someone with newly diagnosed lung cancer would be to make sure that they’re asking their doctor if genetic testing should be done on their cancer. We know that not all patients are offered genetic testing. And if you have a diagnosis of non-small cell lung cancer, or especially the most common subtype of that called adenocarcinoma, genetic testing is most likely an important part of figuring out your treatment. So be sure to ask your doctor if that’s been done and if it hasn’t, should it be done. 

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