Combatting Lung Cancer: a researcher, a doctor, a patient
Early in my career as a practicing Pulmonary and Critical Care specialist I was fortunate to be a Principal Investigator on an AstraZeneca study, which led to a long relationship investigating new pharmaceuticals in the Respiratory field. In my 33 years as a practicing doctor I have diagnosed over 800 lung cancers, and dedicated my time to providing patients with the best possible care.
With such an intimate knowledge of the signs and symptoms of lung cancer, experiencing a sudden shortness of breath meant that I instinctively knew something was wrong. In September 2014, after only 48 hours of symptoms and following the advice of a colleague, I found myself in the emergency room being diagnosed with Stage IV EGFR mutation-positive non-small cell lung cancer (NSCLC). You could say I have now experienced lung cancer journeys from almost every perspective.
As a lung doctor, I’ve seen first-hand the rapid advancements made in the cancer field, and remember vividly when a diagnosis of advanced lung cancer (more often than not) was a certain death sentence. But, with the development of novel targeted treatments, I also know that this is no longer always the case.
New targeted therapies have meant that by identifying certain types of lung cancer, we can directly block the mechanism that drives tumour growth. When I was diagnosed with EGFR mutation-positive lung cancer I was almost relieved, with the knowledge that I would be eligible to start taking a number of targeted treatments which block this specific pathway.
In the first six weeks of treatment my tumour mass reduced by roughly two-thirds, but eventually the frequency of resistance markers in my blood began to rise, indicating the treatment was no longer working. Small tumours were appearing in areas of my lungs the drug could not reach and I had to begin radiation therapy, and subsequently chemotherapy. These treatments, however, have a high level of toxicity and as a result I experienced a rapid decline in quality of life – I weighed only 130lbs, I couldn't walk from room to room. I was wheelchair bound, home bound. I felt like I was dying.
Having exhausted all approved treatment options, my wife and son relentlessly searched for other means of treatment, which led me to an extended access programme at a specialist oncology centre. Our research showed that the drug being studied could target cancer cells that express a specific tumour cell mutation, but the investigational drug was still undergoing clinical development and there was no certainty that my tumours expressed the required mutation type.
To establish whether I was an appropriate candidate, it was necessary to obtain some of my tumour DNA. With tumours located in areas too dangerous for biopsy, my physician determined it would be too dangerous to undergo such an invasive operation, but I was identified as an “excellent” candidate to try a new method of testing, circulating tumour DNA testing. Undertaking just a simple blood test, the relevant mutation was found in my bloodstream and I began treatment that very same day.
The importance of caregivers
It has been a wonderful thing to receive from people who care so much about me, and to let them have the opportunity to give care, as I have done my whole life. At my worst, instead of interrupting my care and rest, I decided they could leave a note in a box outside my hospital room. Each day I would receive 50 to 100 notes and would read them in my bed. I was moved by the concern, generosity and love of my family, friends, colleagues and patients. It was truly profound and helped me through a very dark period.
Whether you are a professional, a patient or a care-giver, the best advice I could give you is to take every opportunity to research and learn. Thanks to the efforts of my wife and son, I have been given a second life. My treatment journey is not over, but I can go to ball-games with my son, go out to dinner with friends, go for long walks with my dog and walk on the beach.
By taking the time to talk with doctors and experts, and to understand and explore your options as a patient, you give yourself the best chances of finding the most effective treatment for you. My oncologist said that with today’s treatment options things look promising. Even though it is inevitable I will eventually develop resistance to each drug, as my cancer evolves around the pathways that we block, I remain positive. Who knows what great medicines will become available in the time that I have left?