Breaking Down Lung Cancer: Prevention, Diagnosis, and Treatment Strategies

Breaking Down Lung Cancer: Prevention, Diagnosis, and Treatment Strategies

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welcome everyone thank you for tuning in to today's edition of breaking down lung cancer we're going to be discussing prevention diagnosis and treatment strategies I am Fiona Evans I am the director of patient advocacy here at massive bio and I'm joined today by Dr Louise Reyes welcome and thank you for joining us thank you very much for this young it's a pleasure to share with you today and uh looking forward for answering your question excellent could you give us a little um introduction a background about you and what you do yeah my name is Luis uh rice I am the medical director at Memorial Council Institute is part of the memorial surgery system the Public Health Care System here in South Gloria is the third largest in the country we have six hospitals in Broward County and I am also professor at Florida Atlantic University I'm for International University I do mainly lung cancer as American college for the last 23 years and we do also a lot of research here in the areas of lung cancer liquid biopsies and Healthcare and equity great well thank you um you're very busy so we appreciate your time today so we're going to jump right in um what are the primary risk factors for developing lung cancer and are there any lesser-known risk factors that people should be aware of yeah that's a very important question because you know we uh we we have to spend our lives trying to cure lung cancer by spending millions and billions of dollars but your question is very important at the end of the day it's 80 percent of our patients have never smoke maybe they will not be patients here you know that's why uh real uh we can address right away uh most of these lung cancer problems we still go back to the old statement that they stop smoking you know it's quit smoking is the best probably the best way to fight lung cancer that would be the education you know that's still the largest restart book and uh most of the the lung cancer prevalent the smoking prevalence sorry uh has been going down certain emails then in females they were only worried about the Young Generation that uh especially young ladies are still smoking and now we are really worried but I know of our lung cancer organizations I think are supporting dating because uh we used to start to smoke at 18 when we come by cigarettes uh these kids are smoking uh vacancies they are developed so we don't have an idea what is going to happen with them especially they have five extra years of vaping you know before they become adults right that's why we don't know about vaping before you ask me uh but we don't think it's safe until uh because remember for for lung cancer to develop you need to be smoking for many years without to answer the question regarding vaping in 20 or 30 years but I don't want to find 23 years later that there is a million people that was sleeping and it's too late for them to say them exactly yeah yeah another risk factor is uh uh we have around 30 000 Americans that are non-smokers and it's very frustrating for them to develop lung cancer because they said I you know I didn't see anything wrong you know there's still a lot of stigma for people that smokes and uh in these 30 000 people we think that maybe exposure to rain on gas uh you know original gasoline you see the soil um you know if you if you have spent time in a basement in Norwich United States maybe you are more exposed it's very hard to prove and now as much as I know um the builders played safe checking uh radon gas when they build houses so it's not supposed to happen anymore I hope um asbestos is another risk factor but you know it's for the last 30 or 40 years uh we are not supposed to be exposed to investors any longer because the construction codes are very strict right so occupational hazards you know um four years ago or or firefighters and rooftop workers welders uh CBR workers were exposed to address though and now it's not supposed to happen anymore so I hope that uh with this one the asbestos inside goes down and we can even you know get rid of mesothelioma there is another cancer both my advice and then we have a group of lung cancers that are unknown and uh very very interesting because for example genetics there is no genetic lung cancer that we have been able to prove we have suspicious about a jingle uh efr 79790 because we have found that that is a thing that appears in pages on treatment but we have some young individuals that carry the hinge and they don't even have lung cancer but that's for the people uh that is watching uh until today we haven't been able to prove that the lung cancer is hereditary so don't worry about your kids your loved ones uh there is no like a genetic risk for genetic tests that should improve that uh okay well that's that's one good thing right yeah but finally the most worrisome thing is that um okay so if tobacco exposure can cause because of the fumes can cause lung cancer have a contamination pollution you know so this year was a very important year because the people from UK Dr Charlie Santo who are the most bright lung cancer in the world and finally show the exposure of a certain amount of pollution is linked within developing of lung cancer and that is very worrisome for us because some cities uh that amount of pollution is probably already present daily 40 50 of the secrets of the world so that is giving some of the non-smokers can get lung cancer from pollution this is something that we can need to be working very hard to issue recommendations from our own government right right yeah that's very important is there anything that individuals can do to reduce the risk of developing lung cancer especially if they have a history of smoking or exposure to environmental toxins yeah um as soon as possible you're quitting smoking doesn't uh give you safety unfortunately because you need to quit smoking and be uh tobacco-free for 20 25 years to decrease your chances you know it's not like an energy or the next day you're fine that's right as soon as soon as possible that's the best advice to wait and then I already mentioned all of these other risk factors and uh it's better not to be exposed to any of them and uh so for people that already has a small remember that we have the lung cancer screening now available worldwide most of the government of the world already agree with that the implementation is poor you know United States we should post the screen 15 million okay 15 million people that used to smoke uh we barely screen so we are very very sure don't don't wait for your primary care to send you for a CAT scan for long screening once a year if you are reading a former smoker it's better that the patients start to empower themselves and say Hey you know I need a cancer done I use a small I want to check myself once a year because I don't want to find lung cancer stage four uh that unfortunately even today a large number of lung cancer then also stage four so and we cannot cure them that's why it's important that we didn't know them stage one uh thanks to this screening and the most important one is you know if you're a 50 year old horrible and you have a small candidates for 20 years you need to get once a year at this time the United States is covered by Medicare and insurance oh that's great news yeah so early detection is key you want to get your screenings in as you know especially if you are a smoker and I'm gonna move on to my next question here could you explain the difference between types of lung cancer and how they vary in terms of symptoms progression and treatment options a lot of lung cancer in the United States 235 000 new patients a year that's a lot of people unfortunately and the patients get frustrated because the classification of lung cancer based on tissue what we call histology it's very simple you know like you you either have a small cell lung cancer or you have no responses on cancer two types I mean I think the treatment for a small cell is different that's the cancer that is your your you have a and is unfortunately very little and usually it's uh behind a new development you know it's not well for some reason has been escaping us from a lot of developments to the point that for the no small cells that are close to 90 of the population we even have in our alliance fields for Smalls we don't have a billion you know so that's like very frustrating for the patients to learn that they they have lung cancer and the one that they got it with a small cell the most common one that is 87 percent of the population um because it's less smoking than the small cell that small cell actually is shrinking and the longest monster is growing in prevalence uh it can only be dividing and only three or four groups and that is why uh there is not a lot of science there uh today we do now molecular classification we don't classify the lung cancers by tissue we classify by um genetic analysis and we have learned that now there is many types of lung cancer what we're used to think there is two big groups and foursome groups that I mentioned with more than 40 or 50 groups and the treatment is going to be different from each of them mainly depending on the genetic aeration that we find for example the most popular in the world is a genetic adoration in a gene called egfr um fortunately you know 12 of Americans have this genetic aberration where they have lung cancer unfortunate and and being the good news is that we have a bill a moral region that is a Frontline therapy um unfortunately don't don't cure a lot of people but it's much better because now we can keep patients to read for years with this or a lady and instead to start with a palliative chemotherapy excellent that's that's good so for patients that have been diagnosed with lung cancer it's important for them to get that uh biomarker genetic testing yeah those extremely important question because in United States that we already have identified things 10 different oral agents approved for lung cancer that's a lot of orally there's 10 bills available like India Brewing uh only 50 percent of the Americans get tested yeah and less than that receive this thing or a lady so it's not like we don't have the science so now that we have a science it's more frustrating for me that right the patients don't have access in the best country of the world they want the more resources than any other country so that's why there's a lot that we need to do and that's why I love these programs because as I said empowering the patient the patients need to help I love when the patient comes to my office and I said okay you know this is my name you you already got the news of the lung cancer we're going to start and talk about your treatment and the first scene that equation of the family said yes or to rise but are you going to do my molecular testing I do my genomic testing I said for sure you know that's the most important thing that's why because amazing you know if you heard about the war in the spirit now Precision amazing that's amazing we're going to do a genetic testing and based on the gene that your lung cancer guard is and it's probably the one that generate the lung cancer we are going to give you hopefully an oral agent and if we don't give you another Legend we have immunotherapy we have chemotherapy we have other means to treat them but makes a big difference to give you this personalized treatment you are doing much longer that if I give you empirical chemotherapy like we used to do 20 years ago that everybody lived the same I'm very short very short survival or other agents we have patients alive eight nine ten years that was done curved in lung cancer before yes that's that's excellent so everybody should get molecular or biomarker genetic testing when they're if they're diagnosed with lung cancer and many other cancers um good good so everybody should be getting that yeah because we that's very important differentiation I think in United States I dream with a day that is a patient's right for any cancer patient to have molecular testing and I think little by little we are educating our legislatures so one day somebody will give a law for this and and we so far we have the sympathies of both parties so there is opportunity to agree but is the reason why it's not the law is not given yet is because it's really mandatory for 100 of the lung cancers but not 100 of the column breasts and other cancers yes so that is why we cannot still push for everybody but for lung cancer yes I already tell you thank the genes for what we have many oral agents that can keep your life for years or maybe cure you so this opportunity cannot be missed because otherwise the patient is going to suffer they lack of proper therapy if we don't do that right yeah it's very very important thank you for pointing that out the other thing is also the United States we're very lucky that we have what is called liquid biopsies that the gene analysis the genetic analysis that you need is normally done in the tissue but sometimes you know the tissue is not enough because when the pathology is saying oh this is a lung cancer it's a small cell right he has all the tissue sometimes no there is not enough issue that's why doing a simple blood drawing the patient we have the technology not only in the United States but all over the world to isolate two more DNA DNA from the tool and do the genetic analysis in this DNA of the two so means in the United States we have a second opportunity to do the genetic analysis if we cannot do in the issue we should do in the liquidity and because the liquid is so fast you get a result in pain and idates instead of 30 days with a tissue many of us are doing the keeping everybody because we can have an answer soon so the patient doesn't have to wait three or four weeks to know what is the right therapy because the patient already wants therapy today when he meets you he already has been waiting months for the diagnosis so that is why it's important also to remember the public you have the opportunity to go liquid biopsy it's covered by many payers and die and they care and that is why don't miss that opportunity I mean you can have both the liquid and the tissue economic analysis because we don't have any company that we can say oh this is the person one you don't need anything else that increases your chances of success absolutely uh can you talk about the various stages of lung cancer and how the uh treatment approach differs based on what stage of cancer the patient has yeah in general we have what we call early stage long Concepts these are the ones that we can take a patient for surgery get rid of the tumor but because there is always some residual disease after surgery we give them now thanks to the genetic analysis we can give a pill we can give immunotherapy or we can give a chemotherapy or a combination of two or three this is very important because we're already doing surgery for the last 40 or 50 years and not everybody that goes to surgery against cured that is in all the cancer but that is so that's why the genomic analysis now he moved now to early stages um because we already have proved that after the surgery will give you chemo for a short time four times for cycle and then we if you have a genetic evaluation that we can Target the patient is for example he is far the most popular name we give you a bit for three four or five years that can protect you in 50 percent of the time to develop uh lung cancer again or to have a recurrence of your lung cancer that's why for all of these early stages long answer that we call them stage one two and three uh that is a very important to do the surgery first we still need surgeries and then give your chemo before your and the instance to the genetic analysis you can get a field or something or we call immunotherapy that is an infusion that we give you to a strenuous immune system to try to avoid the recurrence of the cancer because it will kill the cancer whatever is in your body and then unfortunately we have the advanced stages the only patients with Advantage stages are the ones that it cannot be operated and of course all the patients with metastatic disease that they are a lot in America you'll be surprised that more than 30 or 40 percent of the lung cancer patients are still diagnosed in advance because you don't feel anything and it is too late so all of these patients have advantages are going to go for the genetic analysis and they get the oral agent the immunotherapy or the chemotherapy from the beginning because there is no chance for them to have surgery you know and sometimes we use the other modality the radiation therapy to help in some cases that are early no for example you did your surgery there was some residual tumor in the age of the the surgery can use radiation there and in advance stages we also use radiation to control pain or to control the turmeric the tumor is resistant he doesn't want to die with our oral engine so with the chemo we use radiation to help us to control that's why in general we for easy for the power you can classifying early stage or Advanced stage got it are there any recent breakthroughs in understanding the genetic aspects of lungs lung cancer that have influenced treatment decisions I know you mentioned there's lots of genes that have been identified but anything else that you want to mention maybe this time um in lung cancer we are very blessed until 2010 practically we only use chemotherapy and the medial survivals half of the patients used to survive one year only and the other half is to die earlier or later less than five percent used to be cured after 2010 we started to discover the oral against the bills but also we start to develop a immunotherapy immunotherapy is not easy to understand because it's not a vaccine it's not a bad accident and everybody is an escrow now it's not a vaccine unfortunately vaccines don't work for lung cancer but um we can say this like the reason why you develop lung cancer like any other cancer is because your immune system is not working very well again that cancer the immune system may be working very well if you get a respiratory infection today you're going to die when system is going to protect you but for some reason that cancer is growing for a month and your immune system things that the cancer is friendly so it's not attacking the cancer yeah it's very interesting in lung cancer uh the lung cancer mimics friendly tissues and it's totally different for example from melanoma in the case of melanoma your immune system attacks with fears very seriously melanoma and you can see when you pull the melanoma in the surgeries is full of T cells from from the patients that are trying to destroy the melanoma and successfully no that's why melanoma wins the award in lung cancer no in lung cancer it seems like our D cells defenses think that the lung cancer is friendly and they don't attack them there is a break there is a break in the immune system and we saw that we have discovered the break we have discovered what is a receptor and it's a very popular called pdl1 and that receptor is the one responsible of the brain because the cancer when he arrives it stimulates the receptor that breaks the immune system that puts the brake in the system so what we do now is we have many we can say proteins that we use antibodies and these antibodies work in that receptor period one and release immune system and release an immune system your own immune system notices that oh there is a guy here that is no friendly that we didn't take it back and this is amazing because we prove this in metastatic patients because sounds very theoretical you know really like a fantasy how do you really know how you're sure that your immune system is killing another kid right no unfortunately metastatic patients with soap about giving these antibodies these proteins the immune system gets stimulated and now the patient that was not attacking the tumor their own immune system is destroying the two more disappearance with immunotherapy we can heal now 20 of the metastatic patients so that's amazing so that is amazing the chemo used to go through five percent despite the fact that they were metastatic face I guess we need to learn how to make these multiplication you know we still have not learned how to make it 100 successful it's only 20 successful to Pure people but has increased the survival of the lung cancer patients to two or three years compared with one year of immune of chemotherapy so that's what we do if you if your genetic profile don't make you qualify for one reason or a legend we give you the immunotherapy and we are working very hard to try to improve the immunotherapy we try to learn why it works in some patients and other patients don't work maybe there are some like the films different types of immunotherapies instead we use only one in the future hopefully we can have five different types as we have ten Fields so that's why it's a very exciting area for us but the oral therapy what we call Target therapy the fields and the immunotherapy are the two most amazing developments in the last 10 years in the area of lung cancer and as you probably know in many other areas of other cancers that benefit from these two technologies yeah absolutely that's amazing truly amazing uh so what are the typical diagnostic procedures used to confirm lung cancer and how have these evolved over time yeah the typical procedure is you know we use a CAT scan that shows in your loan that is a mass then we go for the Pet Scan that more than draw a picture that pets can tell you that much that Vision that we've seen you along that we're not supposed to be there is benign Maybe by was let's consider the mission is malignant then we do a biopsy you know biopsies are very popular we do bronchoslocus all we do outside needle needle biopsis to the low to the cheeseboard reaching along so by these two uh we do the diagnosis no so that's being standard occur for many many years and these are very low risks you know there are not really too many complications with this technology it's nowadays got it okay so you know I know we have talked about research and what that's done um you know over time here um but are there any more exciting um areas of research or innovation that uh are geared towards lung cancer treatment and prevention that we can look forward to coming you know in the coming years hey yes um because for example remember our two we have two main two main two main ingredients the builds and the immunotherapy but uh our immunotherapy I told you it only cures 20 of the patients because we need to make it better we need to discover uh what's a trick with the immune system because what happened is um after this amazing response of the immune system that was that was uh with a break for some reason a tumor that is a very smart guy after 15 months it becomes resistant again so the two more shuts down the immune system that was working very well against him and then they mean the immunotherapy doesn't work so we now we're working in very exciting Technologies to try to either enhance this response so hopefully the tumor will not become resistant at 15 months so those with immunotherapy now we give some shots like boosters something immunotherapy to try to help to increase the response and the most exciting thing that happened in lung cancer and probably most of the cancers in the last year or two years is that we have a new generation of immunotherapies now we have immunotherapies that they go to the receptor where the receptor of the cancer is um but instead of only blocking because that's what we used to do before you know and even in breast cancer that's what they do you know the the breast cancer has a gene called her too and everybody in the world knows that there is a drug called perception that goes to the receptor by supporting that blocks the receptor and cures tons of people or even if you're using cure you keep you alive right but in lung cancer please as you as we told you since that is not enough to only block the receptor with the protein so these new generation of drugs block the receptor but they carry a smart wound they carry a smart bomb of quinoa so it's very funny we develop these oral aliens and immunotherapy so we can get rid of him we don't want to use but now we have found that chemo is extremely successful when we blew out the tumor but we don't damage the face this is the best way to do it now is degeneration called antibody drug congruence adcs these are antivirus proteins that are going to bridge the reception first for the tumor and then they release that is small the smart bone that each antibody carries one volt and or two bones or three bones and but the only the chemo bombs it only released when they reach the receptor so so there is no risk for your hair or for your skin or for your stomach side effects because it's very accurate Precision makes agents are amazing because we work not only for lung cancer they work for many other Concepts actually I think there is already one approved for for breast cancer and so we call we we already have one approved for lung cancer and that is why this is a new generation of the Rocks so hopefully the patients don't do well with our immunotherapy and this is this gives another line of defense for rotation and as I said because it's a type of drug is not only one pharmaceutical company each pharmaceutical company has this mini chemo so we have a lot of these different drugs that can be used a lot of different receptors so that's why it's a lot of a lot of excitement not only for lung cancer but also for other cancers with this antivirus you know conjugates this is the most exciting thing I also want to tell the public that most of the solid tumors including lung cancer bone marrow transplants or any transplant doesn't work for us you know these two words don't because this is the most popular question you know we killed our people we leukemia right home marrow transplants and the new types of transplants all characters uh this is very exciting but yeah doesn't work for lung cancer that's why uh is not in that way that we are going to I've been trying to cure for lung cancer but we're very fortunate that we fortunately that we have other ways as I was explaining them excellent and so you know these are all examples of research and we find these um new treatments and advanced treatments through clinical trials so what would be your advice to a patient who is diagnosed with cancer you know regarding clinical trials is that something that you would tell them to talk about to ask about what what advice do you give patients about that okay this is a very difficult conversation because the lung cancer is ranked number three on lethality you know unfortunately I think we still have that after pancreas cancer and melanoma this is the third one that kills more people you know as I told you with chemotherapy we were only able to save five percent of the advanced ones and maybe another 15 percent of the people that are at early stage so the electricity or lung cancer was like 85 percent so Oregon now thanks to all of this technologies that we have described in our legalities is going down but we still have all 50 percent right for sure because a lot of the morality that I mentioned the URL in keeping the people alive uh but we're not curing people yeah so that is why uh it's a difficult conversation but I think it's important to be honest with the patient you know they want because they need to know that they need to prepare himself herself or to his family because there is a chance that he may not be a cure and uh and also the other important thing for us is to keep a very good quality of life so it is going to be three years four years we really want that meaningful years we want them to go to all vacation we want them to spend them with the loved ones and uh and trying to minimize time in the hospital or things like that that's why the therapies I described and Target therapy with oral agents and the immunotherapy are not very toxic for more than 90 percent of the patients uh therapy you think it builds at home the immunotherapy you have to come every three or four weeks but that is small inconvenience because the rest of the time is yours and you can say more than 90 of the time the toxicity is minimum to the point that unfortunately there is some young people with long guns and they cannot retire yet they need to work so they are they are working full time but they're still having immunotherapy and therapy because most of the science things are very tolerable language and they can still have a good quality of life but we tell all of these things to the patients when they want because unfortunately there is nobody after us you know we as a oncologist we learned that the primary care feels very uncomfortable talking about is the pulmonology is very uncomfortable the surgeon gives the bad news that your cancer is inoperable but he's not going to be with you the next three years so he doesn't have the responsibility to talk about organization with you that's why there's nobody coming after us so that's why we really that and we really like give a lot of Hope because really sometimes everybody you know why are you giving me hope if you want to live three years because I I tell you because we researched so many new drugs that maybe three years since the bridge that I need because in three years I'll find something to keep your life from here so for something that may cure you that's the only is true when you see the patients in day one when they are new you don't really know exactly who is going to get cured or no but you don't really know that's why uh you really have hope to for example uh so for for all of these reasons I have say I think it's very important that the patient knows from day one for everything that we have this sponsor in this interview uh that's what I think we really need to empower the patients so they are very aware about their dreaming options and uh and they can decide you know some people may be very willing to be treated aggressively some people may prefer to be more conservative and we always need to respect you know the same as this stigma you know we uh we love our patients if you smoke we don't smoke you know uh nobody judges you and I think this type of adjustments have damaged a lot you know the the calls and and has not been in the best interest of the patient but I think engaging the patients now thanks to this interviews and information that you guys provide is the best thing that we to do to help them other than doing them absolutely and that's key the patient should be well informed you know reaching out to their doctors talking with you during their visits and they can learn so much from you as we have today so I thank you so much for your time and um we appreciate you know everything that you're doing for patients so thank you so much no again I want to give thanks to massive value because you know this is very important we really want to advertise um we need your help and I'm talking about the audience uh we want to please promote lung cancer screening you know we are so lucky in United States that is even involved by insurance and a lot of Cancer Centers like mine if you don't have insurance uh for 90 dollars we do that once a year oh that's interesting yeah you can do once a year we need also to advertise the the fact that we don't smoke anymore and once that you have lung cancer uh release molecular testing push hard for molecular testing I already told you makes a big difference yeah you need to require your doctor to go molecular testing before to treat you I have a lot of Hope as we discuss in research we have now the targeted therapist we have the immunotherapy and thanks to that uh patients are living longer there is a type for example of lung cancer called ALK this type of ALK people even investment the patients an average of eight years so because maybe in the next six months or one year the FDA will approve the next law that can give you ideas so thank you very much for the interview I'm more than happy to share with you in the future thank you so much we appreciate you and for everyone listening of course you can reach out to us massive bio our website massabio.com we will help you with our with clinical trials and we can help with connecting you to molecular testing because it is so very important so thanks again take care thank you bye-bye

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