Immunotherapy in NSCLC: Looking Toward the Future
Dr. Jyoti Patel and patient Laura O’Brien share their parting perspectives on stage III non-small cell lung cancer and the future of treatment.
PUBLISHED April 30, 2019
Jyoti D. Patel, MD: Laura, you went from coughing up some blood to what we thought was early-stage lung cancer and then ultimately to stage III lung cancer. You went on a clinical trial with chemotherapy and immunotherapy and were hoping for the best. What happened?
Laura O’Brien: Well, I had surgery in January, and a week later I got a call from your office, I was on speaker phone, and everyone was yelling, “The biopsies were negative! You’re cancer-free!” It was just so exciting.
Jyoti D. Patel, MD: It was pretty tremendous for us as well. What started off as a pretty sizable tumor on CT [computed tomography] scans, when we took it out, there was no evidence of cancer at all. So the chemotherapy and immunotherapy had wiped away all viable cancer cells, and then whatever was out was out. You had had a nice surgery and were home and walking around by the time we called, and we were thrilled. We were extraordinarily optimistic about your outcome, and it was so lovely for us to get to share that and to be part of your journey. This is what’s happening. So now we are moving into a realm in which I think expectations are higher than ever. Patients demand more, and we’re demanding more for our clinical trials. I think initially we used to see tumors shrink in maybe 10% of patients and thought we were doing a really good job.
Now we’re designing trials and understanding biology and bringing new drugs to patients, where the vast majority of them benefit. So with some targeted agents, almost 90% of people have a tumor shrink. Combinations of chemotherapy and immunotherapy or immunotherapy and immunotherapy have led to tremendous outcomes that I would have never dreamed of five or 10 years ago. And you are living proof of that. To have a tumor like that completely melt away after nine weeks of therapy is something that is motivating and exciting for all of us.
Laura O’Brien: When I started this journey, I was actually at a different hospital with different doctors, and then I knew I needed to see an oncologist. And I started with calling friends. I am a nurse, so I started checking with different people. Your name came up many times. And so I did my research. I looked at your background and your lung specialties, and we did get an appointment to come in to see you. You approached me with the clinical trial, and then I actually had an appointment with someone else the next day. I thought it was important to get a couple of different opinions. I looked at all the options. I looked at your treatment plan. I looked at their treatment plan and decided that your treatment plan was the best for me.
I have to say that the most important thing was when you said to me, “Five years from now, I want you to be able to do your walks. I want you to be able to do your bike rides.” And that was the deciding factor. I said this is the doctor for me. She has my best interest at heart.
Jyoti D. Patel, MD: Even though cancer can be a devastating diagnosis, there are so many ways forward with what we know about biology, what drugs we have, and what we’ve learned about clinical trials. And cancer is more treatable than ever and curable in many cases. It requires more effort. It requires patients who are willing participants, who are advocates for themselves and who demand that we do better. And we’re getting there one step at a time. And we want to celebrate many more people like Laura.
Laura O’Brien: If I can offer any advice, I would say don’t let cancer define you. You pick a treatment plan, you start the treatment plan, you don’t look back, you just keep living your life, you do what you need to do and you stay positive. Because if you’re thinking about it all the time, it’s just going to bring you down, and you just need to live your life. You need to get through it and move on from there.
Transcript Edited for Clarity