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Navigating Lung Cancer Treatment Decisions

Navigating Lung Cancer Treatment Decisions from Patient Empowerment Network on Vimeo.

What steps could help you and your doctor decide on the best treatment path for your individual disease? This animated video walks through key considerations, including molecular testing results, lifestyle factors and patient preference.

See More From the The Pro-Active Lung Cancer Patient Toolkit

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Diagnosed with Lung Cancer? An Expert Outlines Key Steps


Transcript:

Hi, I’m Kendra. I’m a nurse practitioner and I specialize in lung cancer.

When diagnosed with lung cancer, it’s important to take steps to get a deeper understanding of your disease, and the available treatment options, so that you can feel confident in your care decisions.

Before we walk through the actions that can help you decide on a treatment path, I want to remind you that this video is intended to help educate lung cancer patients and their loved ones and shouldn’t be a replacement for advice from your doctor.

OK, let’s get started.

The first step is to understand your diagnosis—including the type of lung cancer and stage of disease—so that you can find out what treatments are available to you. Your physician will use tests, including biopsies and imaging, such as X-rays and CT scans, to ensure you have an accurate diagnosis.

The next step is to understand the approaches available for YOUR individual disease.
Depending on your stage and type of lung cancer, treatments can include:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted therapy or
  • Immunotherapy

Or, you may receive a combination of one or more of these treatments.

Other testing that can impact your treatment options is molecular testing, which is used to identify specific mutations that are unique to your lung cancer. This may help in deciding if targeted therapies are an appropriate option for you.

Before you start any treatment, it’s essential to ask your doctor if you have had relevant molecular testing.

Another option that your physician may discuss with you is clinical trials, which may provide access to treatments that are not yet approved. At different points on your path with lung cancer, it’s important to talk with your doctor about whether there is a clinical trial that could be right for you.

Once you understand the treatments that are available to you, it’s time to talk to your doctor about the risks and benefits of each option and walk through the goals of your treatment.

One of the most important factors that your healthcare team will consider is YOUR treatment goals. Remember, you are a partner in your care and have an active voice in finding the best treatment for you. Physicians also typically consider a patient’s age, overall health, and existing conditions before they suggest a course.

So, what questions should you address when you are discussing your treatment goals with your doctor? Consider asking:

  • Is the goal of the treatment to cure your disease or to obtain long-term control your disease?
  • How effective will the treatment be and how will it impact your quality of life and lifestyle?
  • What are the treatment side effects–both the short-term effects as well as long-term effects that may occur after you have completed treatment?
  • Is there a member of the team, such as a social worker, that can help you understand the potential treatment costs? And is there access to financial resources that can help you if needed?
  • Are there supportive care options that can help with symptoms and pain management at any stage of your cancer?

It also may be a good idea to consider a second, or even third opinion consultation with a specialist. And, if you don’t feel supported or you don’t feel heard by your healthcare team, then it is always best to get another opinion.

Finally, once you have gathered all the information, it may be helpful to talk it out with people you trust, such as a partner, friend or family member, to help you make a decision that you feel confident about.

Now, how can you put this information to work for you?

  • Make sure you understand your type and stage of your lung cancer and the goals of your treatment options.
  • Talk to your physician about what you’ve learned.
  • Consider a consultation with a lung cancer specialist.
  • Ask about molecular testing and what testing results mean for you.
  • Discuss whether clinical trials are an option for your cancer.
  • Visit credible online resources to stay up to date on lung cancer information.
  • Visit powerfulpatients.org/lungcancer to learn more about lung cancer.

Key Next Steps After a Lung Cancer Diagnosis: Expert Advice

Key Next Steps After a Lung Cancer Diagnosis: Expert Advice from Patient Empowerment Network on Vimeo

Following a lung cancer diagnosis, the actions that a patient takes may impact their long-term care and treatment options. Dr. Erin Schenk, a lung cancer specialist, lists key steps a patient should consider post-diagnosis.

Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here.

See More From the The Pro-Active Lung Cancer Patient Toolkit

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Diagnosed with Lung Cancer? Why You Should Seek a Second Opinion

Why You Should Consider a Clinical Trial for Lung Cancer Treatment

Diagnosed with Lung Cancer? An Expert Outlines Key Steps


Transcript:

Dr. Erin Schenk:

As a medical oncologist who takes care of lung cancer patients, I would recommend that if you or a loved one are diagnosed with lung cancer, going to your meeting with the cancer doctor report the surgeon or the radiation doctor with a couple of main questions to ask in order to better understand your diagnosis and the treatment options.

So, the first one is what stage and stage is a descriptor that we use that talks about how far the lung cancer has spread if it’s spread at all. And sometimes, this involves additional testing to give you the best, most accurate answer. Oftentimes, patients are diagnosed with scans, but what’s also – excuse me, scans of the chest, but what’s also really important is better understanding whether or not lymph nodes in the middle of the chest are also involved.

This can require either a PET scan or occasionally procedures where tissue, the lymph nodes biopsied, and tissue samples are taken to see if the lung cancer has spread to those lymph nodes. PET scans are also able to better tell us whether or not lung cancer has spread outside of the lungs. And additionally, and MRI of the head can often be a really critical piece of information to better understand whether or not the lung cancer has spread to the brain. Unfortunately, lung cancer is one of those cancers that can spread to the brain tissue.

So, the first piece of information and more tests might be needed, is stage.

The second piece of information that’s very important is what type of lung cancer, and sometimes, this occurs hand-in-hand with better understanding stage. Usually, this involves a biopsy, so a sample of the tissue needs to be taken and then looked at underneath a microscope by a pathologist who are doctors who help us identify which type of lung cancer it is that a patient has. And then the final thing to ask your care team or your doctor is do I need additional molecular testing?

Molecular testing is a critical piece of information in order for doctors like me to help take care of lung cancer patients. Molecular testing lets us know what role immunotherapy might play in your diagnosis. It also lets us know whether or not targeted therapy which are oral pills we sometimes call TKIs are appropriate for your disease and your stage. These pieces of information, so stage, what type of lung cancer, and if molecular testing is necessary, these are, I think, the three critical pieces that you need going forward to help your cancer doctor and team better formulate a plan that is right for you.

Finally, I’d like to add in that if you are in a situation where you would like a second opinion, or you would like to get more thorough answers, I would encourage you to look for an academic center or a large medical center that has specialists who focus in on lung cancer. We are often very happy to see patients and talk with them about their treatment plan if any other tests or evaluations are needed to help you feel confident in the plan that your doctors closer to home have put together. That’s it.

Why You Should Consider a Clinical Trial for Lung Cancer Treatment

Why You Should Consider a Clinical Trial for Lung Cancer Treatment from Patient Empowerment Network on Vimeo.

Dr. Erin Schenk, a lung cancer expert and researcher, explains why patients with lung cancer should consider a clinical trial and the role trials plays in clinical care.

Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here.

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Transcript:

Dr. Erin Schenk:

We have a very active clinical trial practice in the lung cancer world for one reason alone, and that’s that while our current therapies are good, we can still do better. Lung cancer accounts for significant cancer-related deaths in the United States and the world. And we wanna work to try and improve how well patients do and also improve how many patients we are able to cure. Clinical trials can be at any step of your workup or treatment.

So, even patients with earlier-stage disease meaning lung cancer where we can resect it with surgery, there are a number of clinical trials going on right now to try to better improve the outcomes we see with our normal standards of care. So, whether you are having a lung cancer removed by surgery whether you’re receiving chemotherapy and radiation and immunotherapy whether your lung cancer has happened to spread outside of the lungs, there are clinical trials available at every step in the game.

And I would really encourage you to ask your cancer care team or your doctor about whether or not clinical trials might be available in your area. Because often, they can help identify new targets or other ways of trying to attack the vulnerabilities of your lung cancer.

If you are considering a clinical trial, there are a number of important questions to find out from the clinical trial team as well as your cancer care team. Some of the things are really practical, logistical questions and one of those is, “How often do I need to come to clinic? How many more schedule visits do I need?”

Usually, with clinical trials, upfront so before you get on the clinical trial or once you start receiving the clinical trial medicine or therapy, often there are more frequent visits in that initial time period. But after things are – after you’ve had several treatments with the trial medicine, often it becomes more standard of care meaning visiting once every three weeks for blood work and a visit with your team and then infusion.

So, it’s often a little more work up front, and then it gets back to the usual expectations of how often you have to be in our offices. So, I think those logistical concerns are very real because especially for larger institutions, sometimes, coming to our campuses can be a bit of a challenge. So, that would be one. I would recommend discussing logistics. Discussing with your team as to why they think this would be a trial for you is important.

Occasionally, we are able to screen for certain markers or certain things that are expressed on the cancer cells and then match you with clinical trials that try to target those specific molecules or proteins or flags that are on the surface of the cancer cell. So, oftentimes, we try to match patients up to a specific clinical trial, so better understanding why that one was recommended. And then I would ask your team to also discuss what are the side effects that have been noticed.

Often with these clinical trial medicines, we don’t have a lot of experience with how well patients do on these therapies. But sometimes, we can give you an idea in terms of what we expect and what we will watch closely for. So, I think logistics are important, why your doctor or your cancer team thinks this is a good trial for you, and then finally, what sort of side effects have been noticed as best we can tell with this new trial medicine.

Lung Cancer Treatment Advances: What are Antibody Drug Conjugates?

Lung Cancer Treatment Advances: What are Antibody Drug Conjugates? from Patient Empowerment Network on Vimeo.

 Dr. Erin Schenk, a lung cancer expert, discusses emerging research around antibody drug conjugates (ADC) and how this therapy works to treat patients with lung cancer.

Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here.

See More From the The Pro-Active Lung Cancer Patient Toolkit

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Lung Cancer Treatment: What Is Immunotherapy?

Why You Should Consider a Clinical Trial for Lung Cancer Treatment

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Transcript:

Dr. Erin Schenk:

Some interesting research that’s coming to the forefront in the lung cancer field are using new medicines called antibody-drug conjugates. And so, these medicines, I think of as another type of targeted therapy. So, what happens is that cancer cells express certain proteins or certain flags on their surface that aren’t often found on other normal cells.

And what these ADC drugs are able to do is that they’re able to seek the cells that express certain flags, and then deliver a chemotherapy payload directly to those cancer cells. One trial from the recent ASCO annual meeting from this year, 2020, was looking at an ADC that targeted HER2 which can sometimes be over-expressed by lung cancer cells.

And they had good initial reports in terms of patients being able to have disease control for some time and minimal side effects.

So, I think in general the idea of ADCs or looking for surface markers on the cancer cells to try to in a more targeted fashion deliver the chemotherapy payload, I think this is a really exciting area of investigation as well as a new potential therapy for our patients with lung cancer.

Lung Cancer Treatment: What Is Immunotherapy?

Lung Cancer Treatment: What Is Immunotherapy? from Patient Empowerment Network on Vimeo.

Dr. Erin Schenk, a lung cancer specialist, provides an in-depth explanation of what immunotherapy is, and its role in treating lung cancer.

Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here.

See More From the The Pro-Active Lung Cancer Patient Toolkit

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Diagnosed with Lung Cancer? An Expert Outlines Key Steps

What You Need to Know About Lung Cancer Research


Transcript:

Dr. Erin Schenk:

Immunotherapies are powerful new medicines that we available to us as medical oncologists and especially within patients with lung cancer. Immunotherapies are medicines that help to activate your body’s own defenses to go seek out and kill the cancer cells.

So, immunotherapies prevent stop signs on the cancer cells.

What happens is that as the cancer cells grow and as they become more resistant to your body’s natural defenses, it puts up certain stop signs. And these stop signs prevent your body’s immune system from attacking them. Immunotherapies, basically, it cuts off that stop sign so that your immune cells can go and attack the cancer cells.

Immunotherapies play a role in the treatment of many lung cancer patients, nearly all. So, immunotherapy has recently found a role in curative-intent therapy meaning we give these treatments to you to try and cure you of your cancer completely. And that’s in patients who have advanced lung cancer that they can’t surgically resect, or it’s not safe or feasible to cut out, but it hasn’t spread to anywhere else in the body.

So, often, those patients receive chemotherapy and radiation together, and then they receive immunotherapy for a year. So, that’s one set of patients we treat with immunotherapy. And then most other patients with lung cancers especially metastatic lung cancer or cancer that’s spread elsewhere in the body, immunotherapy plays a role in treatment regardless of what type of lung cancer that you have with a couple exceptions which I’ll get to.

So, first, if patients have small cell lung cancer that has spread in other parts of the body, immunotherapy’s an important part of the initial treatment regimen combined with chemotherapy. That’s one of the first advances in decades for patients with small-cell lung cancer. The other situation where we use immunotherapy in metastatic disease is with non-small cell lung cancer. And here we have data and studies to support the use of immunotherapy either alone or in combination with chemotherapy medicines.

And the determinate, there’s a number of factors we use to help determine whether a patient can get immunotherapy alone or immunotherapy in combination with chemotherapy, that’s based on PD-L1 status. So, that’s the immunotherapy marker that we look for on cancer cells. If the PD-L1 status is high enough on the cancer cells, we can discuss with our patients using immunotherapy alone.

If that PD-L1 marker on the cancer cells is not high, then we can use immunotherapy plus chemotherapy in our patients. One area where we’re still not quite sure how to best use immunotherapy are in patients with driver mutations or some of these mutations that we look for with special molecular testing like EGFR, ALK fusions, ROS1 fusions.

What we’ve been learning over time is that immunotherapy alone does not appear to help patients do better for longer. We’ve also been learning through clinical trials that immunotherapy combined with TKIs which is the targeted therapy patients receive if they have one of these driver mutations, that does not appear to be effective or safe from some of these early clinical trials.

There’s some debate right now amongst my national/international colleagues as to whether or not giving immunotherapy plus chemotherapy is the right choice for these patients after TKIs or targeted therapies stop working. It’s really up to the discussions that you have with your doctor and whether or not they think immunotherapy and chemotherapy could be right in that situation.

What You Need to Know About Lung Cancer Research

What You Need to Know About Lung Cancer Research from Patient Empowerment Network on Vimeo.

As a lung cancer patient, why should you stay informed about research? Expert Dr. Heather Wakelee reviews what patients need to know.

Heather Wakelee, MD is Professor of Medicine in the Division of Oncology at Stanford University. More about this expert here.

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Diagnosed with Lung Cancer? Why You Should Seek A Second Opinion


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Transcript:

Dr. Wakelee:

So, there’s so much happening in lung cancer research now, it is hard to really narrow it down to one thing to be specifically excited about. Where we have made so much progress in particular is with target treatments, and also with immune therapy. So, when we think about the targeted treatments, it’s only been about 15 years since we first learned about drugs that would specifically target the EGFR gene mutations.

And when we found a tumor with an EGFR gene mutation, we then had a medication we could give that would work better than chemo. And now we have five EGFR drugs available in the US. And then we found out about this ALK gene mutation that happen in some tumors. Now we have five drugs that work there. And the with ROS1, that was found, and now we’ve got four drugs that work there that are approved.

And it seems that we keep learning about more and more mutations, so those are mutations called NTRK and BRAF. And with all of those, we now have drug treatments, so it’s been very, very rapid discovery of specific gene mutations and drugs that work for that. And I think we’re continuing to see new targets being identified and new drugs being found.

And also, when those drugs stop working, better understanding why and what we can do to help them work longer, or what we can give next. So, that’s a very active area of research that’s exciting. And then we have the immune therapy. So, the ones that are available so far are drugs that block either PD-1 or PD-L1, and that's one of the really important stop signals for the immune system.

And tumors can use that stop signal to block an immune reaction to a tumor. But if you block that stop signal then the immune system can attack the cancer. So, that's really important, these PD-1, PD-L1 drugs.

We also know about another stop signal called CTLA-4, and there’re drugs that block that as well. And now, where there’s a ton of research is in trying to work with other parts of the immune system, other either pro-immune or anti-immune signals, and changing those in a way where we can improve the ability of the immune system to find the cancer cells and attack the cancer cells.

So, there are many, many studies being done with drugs, and especially in combinations, trying to get that response against the cancer from the immune system to be even stronger. And that’s, I think, where we’re making the most exciting headway now.