In the war on cancer, some foes are mightier than others, and lung cancer tops the list. To advance the quest for better treatments and help patients benefit from the latest discoveries, NYU Langone Health recently launched the Lung Cancer Center at NYU Langone’s Perlmutter Cancer Center. Led by Robert J. Cerfolio, MD, MBA, director of clinical thoracic surgery, the new center brings together a growing roster of internationally recognized researchers and clinicians, who are working to unlock lung cancer’s secrets and translate those findings into cutting-edge care. Here, they share some insights.
1. No Cancer is Deadlier, but the Tide May Be Turning
Although the numbers are falling as smoking becomes less popular, lung cancer still claims the lives of 158,000 Americans annually—more than breast, colon, and prostate cancers combined. Moreover, the 5-year survival rate is less than 20 percent. Yet new types of treatments are extending life significantly for some patients, and researchers are making strides in understanding the genetic and molecular mechanisms behind the disease.
“We’ve reached the end of the beginning,” says Benjamin G. Neel, MD, PhD, director of Perlmutter Cancer Center. “By investing in top talent and dramatically expanding our research capacities, NYU Langone is taking a stand against this major killer.”
2. Clinical Trials Can Change the Odds
What makes lung cancer so lethal is that it seldom causes symptoms in its earliest stages and tends to spread quickly—primarily to the brain, bones, or liver. Only 16 percent of cases are diagnosed at stage 1, when they can often be treated surgically.
For advanced lung cancers, chemotherapy can be helpful, but newer medications that target specific genetic changes within the tumor or boost the immune system’s ability to detect and destroy tumor cells can lead to longer and better life. Researchers are still trying to identify which kinds of patients are most likely to benefit.
Meanwhile, many clinical trials are devoted to even newer therapies—and new combinations—that may extend the benefit of immunotherapy, in particular, to more patients. “By enrolling in clinical trials for investigational therapies, patients have access to treatments beyond those in our existing arsenal,” explains Leena Gandhi, MD, PhD, director of thoracic medical oncology, who’s currently leading more than 20 trials and collaborating on many others. “For some, that can make a big difference in quality and quantity of life.”
Dr. Gandhi is also leading efforts with Kwok-Kin Wong, MD, PhD, director of the Division of Hematology and Medical Oncology, to build a comprehensive database of patient characteristics and specimens to study potential biomarkers of response to different therapies.
3. New High-Tech Procedures Are Gentler, with Fewer Complications
About 70 percent of lung cancers are diagnosed among people 65 or older. Invasive procedures, such as open-chest surgeries or needle biopsies, can be especially hard on older individuals. But interventional pulmonologists now use advanced technology to less invasively perform biopsies that once would have required piercing the chest wall. “These techniques are far less traumatic,” says Gaetane C. Michaud, MD, chief of interventional pulmonology. “Patients can usually go home the same day.”
When surgery is required to remove a tumor, the most common approach is video-assisted thoracic surgery, performed through tiny incisions and guided by a miniature camera. Dr. Cerfolio takes it to another level, relying instead on robotic surgery, which enhances the surgeon’s dexterity and precision. To date, he has performed over 1,750 robotic procedures, more than any other thoracic surgeon in the world. “We can do complex procedures with less pain, faster recovery, and less risk of complications,” he says.
4. Better Therapies Are Quickly Emerging
The pace of cancer research is now advancing at a rapid clip, in part thanks to a remarkable new gene-editing technology that allows scientists to recreate and manipulate cancer genes with unprecedented speed and precision. In the lab, scientists are untangling the factors that accelerate or halt tumor growth and learning to identify molecular signals that reveal which tumors might respond best to which treatments. In the clinic, they’re testing new experimental therapies, including vaccines that stimulate immune cells and so-called epigenetic drugs that target the proteins that turn genes on or off. “With some forms of leukemia and prostate cancer, patients now live for decades with few symptoms,” says Dr. Wong. “It’s going to take time, but we’re on our way to transforming lung cancer into a chronic but controllable disease.”
5. Teamwork Counts
Lung cancer patients often require several specialists, and at NYU Langone’s Lung Cancer Center, the entire team is housed on a single floor, eliminating the stress of traveling to different locations. “If a patient needs a pulmonary drainage procedure, we can perform it onsite,” says Daniel H. Sterman, MD, the Thomas and Suzanne Murphy Professor of Pulmonary and Critical Care Medicine and director of the Division of Pulmonary, Critical Care, and Sleep Medicine. A team of multidisciplinary experts also convenes at a weekly “tumor board,” where physicians, surgeons, researchers, and nurses discuss challenging cases and the latest science. “We take a coordinated approach to each patient’s care,” explains Abraham Chachoua, MD, the Jay and Isabel Fine Professor of Oncology and associate director of cancer services. “Every person we treat has a think tank on his side.”