Targeted Therapies in Lung Cancer (#TTLC20) 20th Anniversary Meeting — IASLC Podcast

Ever wonder what happens at the annual IASLC Targeted Therapies in Lung Cancer (#TTLC20) meeting in Santa Monica, California? To mark the meeting’s 20th Anniversay this week, I chatted with two of the co-chairs, Drs. Paul Bunn and Suresh Ramalingam, on the IASLC “Lung Cancer Considered” podcast. Listen or download here:

Help guide efforts to modernize ClinicalTrials.gov — submit comments by 14-March-2020

ALL HANDS ON DECK! Engaged patients, patient advocates, research advocates:  this means YOU.

Clinicaltrials.gov (the federal website that lists all available clinical trials) is being modernized, and they want to hear from YOU. Please submit your comments and suggestions about the clinical trials submission process, site functionality, data standards, ease of searching, etc by 14-Mar-2020 at https://nlmenterprise.co1.qualtrics.com/jfe/form/SV_e2rLEUAx99myump

A public meeting will be held April 30 to discuss the submissions.

What is an IRB and why should patients care?

Image credit:  This Photo by Unknown Author is licensed under CC BY-ND

If you travel, please be sure you’re immune to measles

This Photo by Unknown Author is licensed under CC BY-SA-NC

 

Fellow travelers (especially those with cancer or other health issues):

Given the worldwide spread of measles, please be sure you have immunity to measles.  You might need an MMR (Measles Mumps Rubella) booster vaccine.
The global measles outbreaks have demonstrated the measles virus can be spread by travelers. You, as a traveler, can be exposed to the disease. However, if you do not have immunity, you can also expose others to the disease.  A single traveler carrying the measles virus can expose a local population even before the traveler has symptoms of the disease. It doesn’t have to be international travel — any travel to another location risks spreading the disease to a new population.
The CDC claims “If you and your travel companions have received two doses of a measles-containing vaccine (and can document both of them), you have sufficient protection against the disease. You do not need any additional measles vaccines or lab work. You are also protected against measles if you have laboratory evidence of immunity, laboratory confirmation of measles disease, or if you were born before 1957.”
In the case of Baby Boomers or those dealing with chronic or serious health conditions, I would go further.
I was born before 1956, so the assumption would be that I’m immune to measles.  However, since I have compromised lungs due to lung cancer treatment and Washington State had a measles outbreak last year, I asked my PCP about my immunity. She recommeded I have a titer to test whether I still have immunity to measles, mumps and rubella. The tests only required a blood draw, followed by a separate analysis of immunity for each disease.
My titers showed I still had immunity to measles and rubella, diseases which I had as a kid. However, I’ve never had mumps. Even though I had the MMR vaccine when I was 17,  the titer showed I had lost my immunity to mumps. Because of my level of immunity and my previous MMR, my doctor prescribed a single MMR booster shot. The cost of all three titers and the MMR booster were completely covered by my insurance (a BCBS company).
My son is in his 30’s, and had the MMR vaccine as an infant. He never had any of these diseases, although he did get chicken pox. His titers showed he was immune to two diseases, but had lost immunity to the third. His doctor recommended a single MMR booster. His insurance (Kaiser) covered the titers and MMR booster for him as well.
Please, if you plan to travel, make sure you have immunity to measles. More information is available here:

Note:
The value of vaccines is established by scientific evidence. Please don’t debate this fact in the comments.

Better lung cancer treatment lowers overall cancer death rate–yet stigma persists

STAT News published an article today titled “U.S. cancer death rate drops by largest annual margin ever, report says.” An excerpt says:

The overall cancer death rate has been falling about 1.5% a year since 1991. It fell 2.2% from 2016 to 2017, according to the new American Cancer Society report. That’s the largest drop ever seen in national cancer statistics going back to 1930, said Rebecca Siegel, the lead author.  ‘It’s absolutely driven by lung cancer,’ which accounts for about a quarter of all cancer deaths, she said. Take lung cancer out of the mix, and the 2017 rate drop is 1.4%, she added.

Experts mainly credit advances in treatment. Topping the list are refinements in surgery, better diagnostic scanning, and more precise use of radiation.

They also celebrate the impact of newer drugs. Genetic testing can now identify specific cancer cell mutations, which allow more targeted therapy using newer pharmaceuticals that are a step beyond traditional chemotherapy.

This news reinforces National Cancer Institute (NCI) data published in 2019 that the lung cancer 5-year survival rate rose to 19.4% for all types of lung cancer.  When I was diagnosed with lung cancer in 2011, the 5-year survival rate for lung cancer was only 16%, and the majority of lung cancer patients survived less than one year. As the STAT article says, it has a LOT do with newer lung cancer diagnosis and treatment options. A major contributor is genomic testing of tumors, and the targeted therapies that can inhibit cancer cells driven by altered genes.  Patients on some targeted therapies have a median survival of over five years! About 30% of non-small cell lung cancer patients are currently eligible to take some form of targeted therapy, and that number may soon rise to 50%.

The benefits of targeted therapies have just begun to affect the NCI’s five-year survival stats. The first successful lung cancer targeted therapy clinical trial (crizotinib for ALK-positive non-small cell lung cancer) began in 2007, and the drug was approved in 2011. The NCI’s 2019 stats are based on data collected between 2009 and 2015. The survival rate will continue to go up due to approval of more targeted therapies, as well as the advent of immunotherapy (first approved in 2014), more precise radiation treatments, better surgical techniques, and early detection with lung cancer screening. When lung cancer is caught in early stages, 80% of patients are CURABLE.

However, despite obtaining their information from same source (the Associated Press), some media outlets have emphasized different angles of this story. An National Public Radio (NPR) article states, “What’s behind the decline [in cancer deaths]? In part, smoking rates have fallen steadily, which means the biggest risk factor for lung cancer has fallen appreciably. New cancer treatments are also playing a role, Siegel says.” (That’s ALL NPR’s article says about the contribution of better lung cancer treatment to the reduction of cancer deaths).

I wish the media would stop emphasizing smoking cessation as the cure for lung cancer death, instead of the significant advancements lung cancer treatment. Anyone with lungs can get lung cancer. An increasing number of lung cancer cases (currently around 20%) occur in never smokers. While overall lung cancer deaths have been dropping slightly, the death rate in young women who have never smoked is actually RISING. The World Health Organization has acknolwedged that air pollution is a risk factor for lung cancer, as is exposure to radon gas and other environmental exposures.

Crediting smoking cessation as the primary reason for reduction in lung cancer deaths perpetuates stigma, which contributes to worse lung cancer outcomes through physician nihilism, patient anxiety depression, and reduced funding for lung cancer research. Once a person has been diagnosed with a serious disease, they should receive the same compassion and treatment regardless of their personal characteristics. Blaming the patient and telling them to stop smoking never cured anyone.  But it may prevent the patient from experiencing the best possible outcome for their disease. Why won’t the media emphasize very real contribution–and the hope–offered by better lung cancer treatments ?

So, when you see news about the reduction in cancer deaths (and lung cancer in particular), please look past the errant “due primarily to smoking reduction” emphasis.  Focus instead on the hope offered by cancer research and the increasing number of new lung cancer therapies.  We don’t have a lung cancer cure for everyone, but researchers are working on it. Those touched by lung cancer need that hope.

We’re getting better at killing lung cancer.  Stigma is SO much harder to kill.

 

Do you have the 2nd biggest cause of #lungcancer in your home?

Radon Zones by State (image credit: US EPA)

Many people might not aware the second leading cause of lung cancer could be in their home.  Radon is a naturally-occurring, invisible gas that’s odorless and tasteless.  It’s created deep underground when uranium decays, and rises to the surface where it can enter homes, often through the basement.

Some areas of the USA have higher exposure to radon than others because of the type of underlying bedrock. The US EPA offers an interactive map with information on which areas of the USA tend to have the highest incidence of radon gas in homes (you can see a snapshot at the top of this page). The map is only a guide, however.  You can live in an area that shows a low risk of radon and still have high radon levels in your home.

Testing your home is the best way to tell if radon gas is present. Testing for radon is cheap and easy. Consumer Reports has reviewed radon testing kits so you can find the best testing option for you. If you’re buying a home, ask if it has been tested for radon.

If you find radon is in your home, it’s relatively easy to install inexpensive measures to reduce the concentration of radon in the air and make your home safer. The US EPA Radon website has many resources for doing this.

Take steps to avoid lung cancer, which kills over 400 people daily in the USA. Test your home for radon. If you find some, fix it.

The challenge of providing financial assistance for expensive cancer drugs

Drug companies must be especially cautious when interacting with patients and nonprofits. Such interactions must navigate a policy minefield designed to protect patients as well as ensure fair market conpetition.

One example of such policy is regulation that prohibit drug companies from enticing patients to take one drug instead of another. This is important from a medical ethics perspective. However, such policies complicate the process of assisting patients with affording expensive newer drugs like cancer targeted therapies and immunotherapy.

Most patients could not afford to take the expensive ($17K+ per month) FDA-approved drug — like crizotinib, the one that keeps me going as a ROS1 cancer patient — without insurance and copay assistance. This is especially problematic for Medicare patients, who must pay out of pocket to get through the prescription drug coverage “donut hole” every year. I’ll be there soon.

To be fair, and to comply with regulations, patient assistance programs should help all patients access any approved targeted therapy. But who should pay for that? If one drug maker supports such a program, must all makers of competing drugs do so? If only one or two drugmakers participate in the program, does that make it unethical? Does such a program support higher drug prices, or fuel innovation by allowing patients rapid access to new, more effective drugs?

I don’t have the brainpower to answer those questions. I just know that cancer targeted therapy has made a huge difference in my life for nearly seven years, and I want every patient to have the same opportunity to access an appropriate new therapy that matches their biomarker.

The article below explores some of the pitfalls awaiting those who try to help patients pay for expensive new drugs. Sorry it’s behind a paywalll.

Two patient charities settle allegations of helping drug makers pay Medicare kickbacks (STAT News)